Tell us about the Heart and Vascular Institute at North Mississippi Medical Center.
North Mississippi Medical Center’s (NMMC) heart program dates back to 1980, when the hospital received a certificate of need (CON) to perform heart catheterization and open heart procedures. NMMC’s first heart bypass surgery was performed in January 1981, followed that February by the hospital’s first heart valve replacement surgery. Today, NMMC’s Heart and Vascular Institute is backed by the expertise of three cardiothoracic surgeons, 13 cardiologists, two electrophysiologists, three vascular surgeons, and a network of internal medicine and family physicians, as well as other specialists and providers.
Can you describe your patient population?
Mississippi has a high prevalence of cardiovascular disease. The majority of our patients usually have diffuse peripheral disease with multiple co-morbidities. Because of these co-morbidities, we tend to see claudicant and critical limb ischemia (CLI) patients earlier in the course of their disease.
Can you tell us about the physicians who perform peripheral interventions in your lab?
We have a mix of board-certified vascular surgeons and interventional cardiologists with additional board certification in endovascular interventions and vascular medicine performing the endovascular interventions. The vascular surgeons additionally use the hybrid OR, attached to the cath lab, to perform abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA) repair.
Tell us about the integration of vascular surgeons into the cath lab.
The vascular surgeons have been completely integrated into the cath lab schedule — often performing two to five procedures daily. One cath lab room is designated as the vascular suite, but all four labs and the hybrid lab are vascular intervention-capable.
How has the close proximity of cardiologists and vascular surgeons contributed to better patient care?
This allows for the mutual exchange of ideas and technical assistance during procedures that improves patient care. Difficult cases are often scheduled with the cardiologist and vascular surgeon as co-surgeons in order to leverage their unique skills and facilitate the best outcome.
How are physicians working with other specialties as a team for critical limb ischemia patients?
We have developed a multispecialty approach to peripheral diseases. In stable patients, vascular-trained cardiologists and internal medicine physicians attempt to optimize medical therapy. Endocrine specialists work to bring diabetes under control. Rehabilitation specialists work on tobacco cessation, diet, and exercise therapies. When these therapies fail — or the patients present with CLI — our vascular intervention team is consulted. Furthermore, we have an active wound care clinic to assist with the management of these patients.
What are some of the new technologies in use for peripheral procedures?
Some of the newer technologies we offer include:
- CO2 angiography;
- Atherectomy — including directional, orbital, and photoablative;
- Drug-coated balloon angioplasty;
- Pharmacomechanical thrombolysis/thrombectomy;
- Lithoplasty (Shockwave Medical);
- Growth factor injections to assist in wound healing.
Tell us about access options in use at NMMC.
We use ultrasound-guided access for all procedures. We offer pedal, brachial, and antegrade access for patients who cannot have traditional access.
Are physicians involved in any clinical research at this time?
Yes, our physicians enjoy being involved with multiple peripheral intervention trials.
Are physicians doing outreach to the community?
The vascular surgeons and cardiologists have visited clinics in the surrounding areas promoting screening and early referral to vascular specialists. They have also participated in health fairs and given presentations at local events to enlighten the public and primary care physicians/nurse practitioners about vascular disease.
What are the future expectations for the peripheral program?
We anticipate growth through the addition of additional physician specialists, both on the vascular surgery and interventional cardiology side. We are also expanding access through development of outreach clinics. We intend to stay current with the newest devices in the peripheral vascular market and provide our patients with the highest quality vascular care.
What expectations do vascular surgeons have for their own procedure mix?
The vascular surgeons expect that their case mix will remain 60-70 percent endovascular, with the remaining traditional open techniques. Of the endovascular procedures for peripheral arterial disease, we think atherectomy with drug-coated balloons will be the procedure of choice for many patients, with stenting as a secondary procedure. The vascular surgeons keep up with the latest and greatest ideas/procedures through their membership in the Society for Vascular Surgery and its associated literature.
What advice do you have for other labs looking to integrate vascular surgeons doing peripheral interventional procedures?
Just do it! Honestly, anything that you can do to foster a cooperative relationship between vascular surgery and interventional cardiology is imperative for success. A good working relationship and willingness to help one another between these specialties keeps the cath lab staff out of the middle of any turf wars. When done right, everybody (especially the patient) wins.
Carla Durham, RN, can be contacted at email@example.com.