What is interventional radiology? What is vascular surgery? Most importantly, what is the difference between these two specialties?

Nature of the Work  

Interventional radiologists perform minimally invasive, image-guided procedures in an interventional suite. Interventional suites are different from a conventional operating room. IR suites contain imaging equipment and large monitors that allow interventionalists to execute procedures with real-time imaging capabilities. Vascular surgeons perform both open and minimally invasive procedures. Vascular surgeons operate in conventional operating rooms as well as hybrid suites that are also co-inhabited by interventional radiologists.

Interventional radiologists can treat myriad conditions in nearly every part of the body. They perform vascular and non-vascular interventions. They perform vascular procedures in the carotid arteries and peripheral arteries, including the renal, popliteal, and femoral arteries, or treat aortic aneurysms and dissections. The bulk of their work includes non-vascular procedures, such as cholecystostomy, nephrostomy, gastrostomy, insertion of ports or dialysis catheters, abscess drainage, transjugular intrahepatic portosystemic shunting (TIPS) for patients with portal hypertension and bleeding varices, vertebroplasty and kyphoplasty for pain related to spinal compression fractures, and cancer treatment procedures (radiofrequency ablation, microwave ablation, and cryoablation, chemoembolization, and radioembolization).

Vascular surgeons manage arteries and veins in every part of the body except the brain and the heart. Vascular surgeons’ work focuses on the restoration of blood flow to regions affected by trauma or diseased and damaged blood vessels. Examples of vascular surgery procedures include surgical bypass, amputation, aneurysm repairs, endovascular or open treatment for aortic dissection, dialysis access, and carotid endarterectomy for patients with diseased arteries in the neck.

Scope of Interventional Work

Both interventional radiologists and vascular surgeons perform endovascular procedures. Interventional radiologists are certified in both diagnostic and interventional radiology and IR training incorporates complex peripheral vascular interventions as well as AAA repair. The diagnostic radiology training allows them to possess the skills to read and interpret most imaging modalities. These skills benefit the interventionalist for procedure planning purposes as well as making intraoperative decisions. Vascular surgeons, on the other hand, have a different skill set and perform many open surgeries in addition to endovascular procedures. Due to their surgical training as their foundation and comfort with open cases, vascular surgeons may convert an endovascular case to an open case if necessary. Sometimes, vascular surgeons perform hybrid open and endovascular cases. Overall, those interested in mastering endovascular work can do so via training in vascular surgery, interventional radiology, or interventional cardiology.

Patient Interaction

Interventional radiologists treat both healthy and sick patients of all ages. Interventional radiologists are becoming more clinical in their practice, and most IR physicians now have clinic time with longitudinal follow-up for their patients. In the hospital, interventional radiologists have started to round on patients and conduct consult or follow-up visits. Vascular surgeons have traditionally had much more patient interaction and may see their patients for decades. The patient population is usually sicker and older, and patients with chronic vascular disease tend to undergo multiple vascular procedures and maintain long-term follow-up with vascular surgery.

Procedure and Hospital Course

Interventional radiology procedure duration and post-operative hospital stay tend to be shorter for the patient from a recovery standpoint. Patients are usually under conscious sedation during IR procedures. Patients are often discharged same-day and have a much shorter recovery course. Vascular surgery procedures tend to be longer and require general anesthesia with post-operative stays that can last for a few days.

Lifestyle

Any surgical/procedural specialty requires a demanding lifestyle. Interventional radiology lifestyle may or may not be better than that of vascular surgery depending on the institution and on the number of residents to split call. Vascular surgeons have a demanding career due to the long nature of the procedures and the incidence of life-threatening emergencies. IRs are increasingly involved with early emergent care of GI bleeding, traumatic bleeding, PE thrombectomy, acute stroke, and many others thus also require a demanding schedule.

Reputation

People seem to be more familiar with the role of a vascular surgeon than the role of an interventional radiologist. Vascular surgery has established its role in the hospital system for a long time, but interventional radiology is just beginning to establish itself as an independent department separate from diagnostic radiology. Very few people understand what interventional radiologists do, or at least the scope of practice, so many referring physicians and patients do not yet fully understand how interventional radiology can improve patient care.

Residency Pathways

IR now has a direct integrated IR pathway (6 years total training), ESIR (6-7 years total), or independent IR residency (5 years of DR residency + 2 years of IR residency, for 7 years total). Vascular surgery training options include an integrated residency pathway (5 years total training) or vascular surgery fellowship after general surgery residency (7 years total).

Written by: Jung Hyun Yun, Stony Brook University SOM, MS4