Cath Lab Digest

As we begin this new year, we also initiate a new “blog” from Vascular Disease Management. This blog should serve as a sounding board for many aspects of vascular disease, from medical management, intervention —both surgical or endovascular — to the new trends for therapy, with a keen eye towards an evidence-based measure for therapy — is the direction I want for this endeavor.

For the inaugural statement I wanted to direct my thoughts towards the ongoing discussions regarding vascular therapy. As we already know, the approach for most all vascular disease has shifted to an endovascular one with few exceptions. I believe this to be driven by the need to become less invasive for many, if not all, our patients and is a reasonable approach to this end. When Andreas Greuntzig performed the first angioplasty in 1977 and peripherally in 1978, one thought at the time — Was the need to “prove” this therapy beneficial in lieu of surgical or other “gold” standard approaches? This, however, has not happened in several anatomic locations despite the perceived and actual need for such. The enthusiasm for endovascular therapy and improved technical and catheter devices specifically made for the territory they treat have not driven a parallel robust industry in the scientific pursuits for much of what we do — renal and superficial femoral artery revascularization — as simple examples. Beyond several single-center experiences, many large-scale data in these territories have fallen short of the perceived benefits of the endovascular therapy.

My hope in the coming year, through governmental/payer pressure and investigator-sponsored investigation, is to begin to glean a better idea of what is best for our patients with vascular disease and their therapies, whether primarily medical or interventional. With this blog, I hope we can openly discuss the approaches we use to treat our patients with peripheral arterial disease and the best therapies for their benefit. This open discussion will, I hope, be civil and direct regarding the key questions we as investigators have. As the author, I do not support the idea that one person has all the answers, but should be the source of asking the appropriate questions, with the group providing the answers either by consensus or through scientific investigation.

Lawrence A. Garcia, MD

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Dr. Garcia received his B.A. and M.D. degrees from the University of Arizona. He was an Intern and Resident at Parkland Memorial Hospital, University of Texas at Southwestern in Dallas, Texas. He received his training in Cardiology at the University of Iowa Hospitals and Clinics in Iowa City, Iowa, and as an interventional cardiologist at the Beth Israel Deaconess Medical Center, Harvard Medical School. Further, he received his peripheral vascular training at St. Elizabeth’s Medical Center, Tuft’s University, Boston, Massachusetts. He then served as the Chief of Vascular Medicine and Peripheral Vascular Interventions for the Florida Heart Group in Orlando, Florida. Dr. Garcia returned to Harvard’s Beth Israel Hospital as a full-time interventional cardiologist and Director of the Peripheral Cardiovascular Program and Peripheral Interventions at the Beth Israel Deaconess Medical Center as well as the Director of the Interventional Fellowship Program. This program developed into one of the busiest in the city of Boston, performing over 600 peripheral procedures per year.

Dr. Garcia has now returned to St. Elizabeth’s Medical Center as Chief of the Section of Interventional Cardiology and as Associate Director of the Vascular Medicine Program. Dr. Garcia’s work has largely focused on arterial occlusion-reperfusion models and the efficacy of therapeutic modalities or interventions with regard to free radical generation or endovascular stenting outcomes. Dr. Garcia continues his research interests in a wide variety of studies including acute MI studies, unstable angina studies, interventional trials, peripheral interventional trials, angiogenesis trials, imaging modality studies, and numerous device trials for both the coronary and peripheral circulations. His work has been presented in numerous manuscripts, abstracts, textbooks and textbook chapters.