Overcoming Interventional Radiology Turf Wars
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For years, peripheral arterial disease, a common circulation problem popularly referred to as "hardening of the arteries," has been a major focus of interventional radiology treatment. PAD is narrowing of the blood vessels in the leg, which limits the supply of oxygen and nutrients to the leg, causing pain and discomfort. It affects 10 million people in the United States and can lead to heart attack or stroke.
The interventional radiologist often can treat PAD using minimally invasive techniques, relying on miniaturized tools, x-rays, and catheters to perform angioplasty or insert stents. Occasionally, open surgery is necessary to remove blockages from arteries or to bypass clogged arteries in procedures performed by vascular surgeons.
Another area where turf wars have developed is in the area of determining whether the PAD techniques of cardiologists and vascular surgeons are equitable to those of interventional radiologists. Murphy, at Rhode Island Hospital, wanted to verify what he thought would be improved outcomes for interventional radiology compared to other specialists.
In a review of treatments for 14,000 Medicare patients 65 and older, endovascular lower-extremity revascularization procedures were shown to require fewer repeat procedures, less intensive care use, lower costs, and shorter hospital stays when done by interventional radiologists compared to vascular surgeons.
Overall, there were lower costs, too, according to the study Murphy published earlier this year in the Journal of Vascular and Interventional Radiology, in which the outcomes of PAD treatments were reviewed. The average one-year procedure cost by interventional radiologists was about $17,640, which is $1,372 less than the same procedure done by vascular surgeons. Such savings could translate to $20 million a year, according to Murphy.
Murphy says the study proved the importance of interventional radiology, particularly in PAD, and the likelihood that it should be incorporated into other programs. "When vascular surgeons do the procedures, they are not as invested as interventional radiologists, in my opinion, because if the procedure doesn't work, they have a fallback and can provide an open surgical procedure. Interventional radiologists have no other procedures and get it right the first time," he says.
A decade ago, interventional radiologists were doing a greater percentage of PAD cases than today, because many other specialists are now performing them, Murphy says. However, the volume of cases "is still large and still growing." He says he did not carry out the study to perpetuate turf wars, but to reinforce the need and importance of interventional radiology in procedures.
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