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Viewpoint: adaptation of vascular surgery in the interventional era
  1. Edward Choke,
  2. Robert Sayers
  1. Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
  1. Correspondence to Dr Edward Choke; Department of Cardiovascular Sciences, University of Leicester, Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE2 7LX, UK; tcchoke{at}hotmail.com

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Introduction

In the UK, vascular surgery and interventional radiology are both involved in the management of patients with vascular disease. Both have the required skills and proficiencies, with their own distinctive advantages in treating vascular patients in specific situations.

Keeping pace with state-of-the-art practice is a basic prerequisite of any modern surgical specialty. The state of the art in vascular surgery is no longer open surgery; it is endovascular techniques. From the patients’ point of view, endovascular procedures have obvious advantages in achieving quicker recovery times with subsequent shorter hospital stays, improving clinical outcomes and reducing rates of infection. From healthcare institutions and commissioners’ point of view, the cost savings from shorter hospital stays and less morbidity are economically appealing. The high expense of imaging equipment, of building and staffing of dedicated hybrid theatres and of the endovascular devices themselves are potential obstacles. However, the combination of strong patient preference with top level evidence-based medicine from randomised controlled trials demonstrating comparable medium term efficacy will continue to drive the trend towards endovascular techniques.

The interventional radiologists’ skill sets are dedicated to minimally invasive techniques. Vascular surgeons have been quick to recognise these benefits, and therefore, many have adopted interventional techniques into their skill sets. This encroachment by vascular surgeons into a territory customarily occupied by interventional radiologists needs to be addressed judiciously and delicately. The overall aim is to achieve a delicate balance of relationships to deliver the best possible care to vascular patients. There are obvious values in trying to resolve any ensuing conflicts and find means to flourish in situations where physicians collaborate effectively with each other.

This article reviews the drivers for change in vascular surgery, the reasons for the development of the potential ‘territorial conflict’ in vascular medicine and proposes some possible solutions through restructuring of vascular …

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