The essential ‘need’ for vascular surgeons in pulmonary embolism treatment paradigm

Charles B. Ross

The specter of pulmonary embolism (PE) as a common and lethal disease process—with mortality of massive PE static at about 50% for decades while rapid advances were made in stroke and STEMI care—forms the backdrop to a VAM 2023 breakfast session taking place on Friday.

With the introduction of new and refined management strategies and interventional options for PE, says session moderator Charles B. Ross, MD, chief of vascular and endovascular services at Piedmont Heart Institute in Atlanta, outcomes are changing at an accelerated pace for the better.

With these advances in mind, vascular surgeons who are SVS members from pulmonary embolism response teams (PERTs) or busy PE programs from six large hospitals and systems will discuss advances in care and the role that vascular surgeons play in the current PE landscape in the breakfast session. The session—Management of Pulmonary Embolism: Fundamentals and Advances—is from 6:45–8a.m.

One key talk delves into the importance of a multidisciplinary team for treatment of patients with pulmonary embolism that includes vascular surgery, and how it offers the best opportunity for improved patient outcomes. The addition of artificial intelligence in PE diagnosis, as well as the necessary role of vascular surgeons in PERT care form some of the central themes set to be discussed by Dennis R. Gable, MD, a vascular surgeon at Texas Vascular Associates in Plano, Texas. His talk will lead off the program from 6:45–6:55a.m.

Fundamentally, Dr Gable tells VS@VAM, venous thromboembolism (VTE), including PE, has always been considered a “peripheral vascular” diagnosis and, “we, as peripheral vascular specialists, need to be involved in this treatment paradigm and pathophysiology.”

Gable is set to hone in on what he describes as the necessity of vascular surgery as a key component of PERTs—multispecialty entities which incorporate interventional cardiology, vascular surgery, cardiothoracic surgery, pulmonology, critical care, hematology and heart failure specialists, among others.

Gable will explain how the leadership and providers of interventional management of PE varies from hospital to hospital, with vascular surgeons deeply involved at some centers—but minimally involved at others. This heterogeneity concerns Gable. One of the points of discussion is this: “If you do not participate in PE care, it may in the long run cause us as a specialty more harm by diminishing our role in overall VTE management,” he explains. “It eliminates us from being involved with these patients and the ability to maintain a voice in their care.”

On the emerging role of artificial intelligence (AI) in vascular surgery, Gable will introduce the concept of how AI can shave considerable time off the process of determining management for individual patients. “If you get a scan that shows a central PE, rather than having the information go back to ER doctors or the referring physicians—and then them having to make a call, get everybody together and eventually get a PERT team consult—with AI, when a PE is seen on imaging, there is an automatic PERT alert including images and stratification data sent out to the PERT team on call,” he says.

“You can make a diagnosis, put a plan together, discuss with members of the PERT team in real time, expedite consensus decision-making and treatment logistics far more efficiently.”


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