CIRSE Fellowship report: Dr. Ana Isabel Simões Ferreira

By Dr. Ana Isabel Simões Ferreira

Thanks to CIRSE’s one-month fellowship programme, I was able to join Prof. Gerard O’ Sullivan and his team at Galway University Hospital, Ireland, in April 2024.

My main goal was to learn about deep venous disease, so I could later be confident in treating such patients at my hospital. But I learned so much more!

First of all, it is a great experience to be in a different setup. You immediately start thinking about what you could bring back and what you can optimize in your own practice workflow. You get acquainted with new materials, procedures, and techniques that were not even a part of your main goal, but that are still a fortunate acquisition. And last, but not least, you make friends and benefit from great teachers!

Dr. Ana Isabel Simões Ferreira

Dr. Simões Ferreira with Prof. Gerry O’Sullivan in the angiosuite. 

Some things I learned during my time in Galway:

Regarding anaesthesia, I learned that by joining HCO3 to lidocaine, the patient wouldn’t feel pain related to the subcutaneous injection of the local anaesthesia; also, for longer procedures, it is useful to do a mixture of lidocaine with bupivacaine right at the beginning to make the local anaesthetic last longer. I was able to watch procedures done under sedoanalgesia given by the interventional radiologist consultant and observe the setup of putting a patient in a prone position after general anaesthesia.

I watched and learned about the clinical assessment, Doppler ultrasound evaluation, and expectation management of patients with deep venous thrombosis and pelvic congestion syndrome. Two patients that particularly impacted me: first, a mother of three bearing terrible pelvic and lumbar pain, with occasional fog events, who had been avoiding painful intercourse since her last pregnancy and was finally able to get an explanation and treatment for her symptoms. The youngest of her children was two years old at the time of the appointment! Second, a 26-year-old young man, looking as healthy and athletic as possible, who had had a descending DVT, including IVC blockage, three years ago and was unable to run, or play any sports at all. His symptoms lasted two years until he got a venous stenting reconstruction, which allowed him to return to running marathons. It was a life-changing treatment for him. I was amazed to witness how endovascular treatments can make a huge impact in these patients’ lives.

Early in the morning, just before starting all the excitement of the LINC venous cases live broadcasting.

The first day I was caught off guard by Galway’s “warm weather” on my way to the canteen; I had no clue the canteen was outside the main hospital building and didn’t bring a coat!

Galway is picturesque, with some sheep enjoying a sunny day next to Galway Clinic!

Patient selection is key, however, and not all patients are eligible for stenting reconstruction, for instance. Patient non-compliance to medication is one of the main reasons for stent occlusion, assuming technical success with good inflow and outflow.

I got the chance to see and scrub in for a few endovascular procedures in the setting of acute on chronic and chronic iliofemoral deep venous thrombosis, inferior vena cava reconstruction, and cava and/or iliofemoral stent recanalization after thrombosis.  I operated and learned about unreplaceable IVUS, as well as different thrombectomy devices – angiojet, lightning and clotriever systems – and their best indications. I also learned which catheters and guidewires will help you along the way for specific situations.

There were also some cases of superficial venous disease treated by means of radiofrequency ablation of an incompetent great saphenous vein, phlebectomy, and foam sclerotherapy. I was able to watch a couple of cases of pelvic congestion syndrome treated using percutaneous treatment of vulvar varices, and a few cases of upper limb DVT treated by catheter-directed thrombolysis alone, and SVC syndrome treatment by angioplasty and stenting.

Furthermore, I got the chance to update my skills and learn tricks and tips on some procedures I don’t usually perform in my daily practice, such as uterine embolization, superior hypogastric nerve block, long standing IVC filters difficult removals, positioning of a double J ureteric stent, adrenal venous sampling, PICC lines, port-a-caths and permcaths.

I found the hospital setting at Galway University Hospital to be quite welcoming, and easy-going; obviously, the fact that there were almost no language barriers helped a lot. (But let’s just say, with all due respect, that the Irish accent can be a challenge for the first weeks!)

I became more aware of the set up needed to run a “venous clinic” and all the hard work involved in the process, before, during, and after endovascular treatment. Prof. Gerard O’ Sullivan is a great example to learn from and an outstanding teacher. I appreciated him and his team having me there very much

The cherry on top of the cake was being able to come back a few weeks later to help and take part in LINC’s venous cases live broadcasting!

My message to other IRs considering doing a fellowship, whether they are trainees, fellows or consultants is: Go for it! It is a challenging and refreshing experience where you can learn so much more than you initially set out to learn.

I am thankful to CIRSE to promote this great experience!