CIRSE Fellowship report: Dr. Inês Conde Vasco

By Dr. Inês Conde Vasco

I am an interventional radiology resident at the end of my residency at the Curry Cabral Hospital in Lisbon, Portugal. Curry Cabral is a reference centre for hepatobiliary and pancreatic diseases and liver transplantation, so I have had the privilege of gaining most of my experience in that area. What I was looking for in this fellowship was to gain exposure to other areas of vascular and non-vascular interventions.

With this in mind, the IR department of the Hospital Universitário Severo Ochoa in Madrid, headed by Professor Abadal, was the department I chose to complement my training. The medical team is composed of three interventional radiologists (Professor Dr. Jose Maria Abadal, Dr. Esther Galvez, and Dr. Maria Jesus Alvarez), who are highly dedicated to the interventional field and possess a very refined clinical sense. They were always didactic with the residents, before, during, and after the procedures. Despite its peripheral location within the Madrid area, the hospital treats a considerable number of patients on a daily basis. In addition to performing the procedures, the tasks included preparing reports on the procedures, ordering follow-ups and consultations, and also discharging patients.

The main hospital building.

Left to right: Prof. Dr. Jose Maria Abadal, me, Dr. Maria Jesus Alvarez, Dr. Esther Galvez

Dr. Esther Galvez (right) preparing for a CT-guided liver ablation. Nurses are positioning the patient.

I was really excited to get the chance to learn about different types of procedures. And this fellowship was absolutely perfect for that! I had contact with and participated in procedures of varying complexity, from the simplest (such as ultrasound-guided percutaneous drainage) to the most complex (such as endovascular treatment of abdominal aortic aneurysms).

Additionally, I was able to gain experience in both vascular and non-vascular procedures, as well as in oncological and non-oncological cases. There was also the opportunity to participate in multidisciplinary meetings from different fields of medicine. They were always happy to share their tips and tricks during the procedures and encouraged me to get involved in all the activities. They really made me feel like I was part of the team!

One of the most memorable experiences was performing EVAR with the vascular surgery team. In one case, I was particularly surprised because one of the femoral accesses was surgically open and required an endarterectomy, which I was able to participate in. It was a very different experience than I had ever had before, and it allowed me to see how vascular surgeons approach some challenges. Another noteworthy technical aspect is the distinctive approach to performing hemodialysis fistula angioplasties guided only by ultrasound. For those who have no experience in the treatment of hemodialysis fistulas, like me, it proved to be a very interesting procedure and learning experience. Even if you’re an experienced pro, it’s still worth a peek!

Professor Abadal is very concerned about the safety of his patients, always encouraging us to fill out a checklist before each procedure. During case preparation, I was often challenged to look for material and select the devices wisely. The angiosuite always had an anesthesiologist present who provided support in all procedures, which I think is a great bonus in terms of safety and speed of treatments. In short, it was very inspiring to see the complete integration of IR into the hospital’s workflow and how decisions were made in close contact with the referring doctors.

Planning before EVAR.

Prof. Dr. Abadal talking to the patient following renal angioplasty with a stent.

Endoescuela en el Hospital Puerta de Hierro de Majadahonda, Madrid.

The consultation day was also a valuable learning experience. We monitored the patients, conducted clinical evaluations and performed ultrasounds when necessary, and explained the subsequent steps. I had the opportunity to observe thyroid punctures with an anatomopathologist present, which not only provided insight into the procedure itself but also enabled me to review basic concepts of pathological anatomy.

I was fortunate to receive an invitation to participate in the Endoescuela at Hospital Puerta de Hierro in Majadahonda, Madrid, as it coincided with my stay in Madrid. It allowed me to learn about different IR techniques/experiences with animal models and medical devices.

In addition to having the opportunity to consolidate the knowledge I already had from my experience, being exposed to the diversity of procedures in this department has had a great impact on my training, and will certainly have an impact on my future clinical practice. I’d absolutely choose H.U. Severo Ochoa again for my fellowship, and I’d even stay longer if I could! And, of course, the city of Madrid needs no introduction and is one of the best places to live.

I highly recommend this hospital to future fellows, not only for the professionalism and enthusiasm with which they take care of their patients but also for the kindness with which they welcome you. Professor Abadal and his team are excellent clinicians and interventional radiologists, and they are also very friendly, which makes you feel integrated and confident from the beginning. With such a wide range of pathologies and procedures, I believe it is a suitable rotation for any resident/fellow interested in interventional radiology, regardless of their level of experience.