Emeritus Faculty, Acad Council, Radiology - General Radiology
1. Cardiovascular pathophysiology
2. Angiography and interventional radiology
3. Pathogenesis of pulmonary hypertension
4. Biological effects of ionizing radiation on humans
5. Disabled leadership and its impact on decision making
6. Health policy
Despite the considerable literature on the overuse of new medical technologies, little attention has been paid to the biologic and monetary costs that may be incurred by underuse. Percutaneous transluminal angioplasty as a treatment for peripheral vascular disease is an example of an important technology that has been underused. Although angioplasty alone is less costly but also less efficacious than surgery, a strategy that combines the two procedures (angioplasty first, then surgery if angioplasty is unsuccessful or if occlusion recurs) is uniformly superior to surgery alone in patients who have lesions for which angioplasty can be considered. From a nationwide perspective, if 40 per cent of all patients with iliac or femoral disease (or both) requiring intervention were treated with the combined strategy, there would be an estimated savings (as compared with surgery alone) of 352 lives and $82 million, as well as an additional 5006 patent limbs. Despite these advantages, the use of angioplasty during the period under consideration (up to 1980) was limited, possibly because of the mechanism of patient triage and the inertial forces that operate when a therapeutic method that appears effective--even if more complex and hazardous than a newer approach--has been widely applied.
View details for Web of Science ID A1984RX92400006
View details for PubMedID 6228736
View details for PubMedID 6344594
Coronary arteriography is properly considered the in vivo "gold standard" by which all other clinical diagnostic criteria and noninvasive tests of coronary disease are gauged. In most respects, the radiographic-morphologic findings of the coronary arteriogram are readily translated into the pathologic substrate of disease. Careful correlative studies suggest, however, that in an important group of patients the arteriogram underpredicts the degree of disease, and in a far smaller group it overpredicts. Furthermore, there is no "one" correct interpretation of the coronary arteriogram; there are striking inter- and intraindividual variations in the assessment of the degree of stenosis when experts evaluate the examinations. Despite the discrepancies in angiographic-pathologic correlation and in multiple observer analysis, coronary arteriography in its present form represents an important predictive element in assessing the prognosis for the patient with coronary disease. The distribution and degree of the lesions per se are important prognostic factors, but these take on additional force in the presence of asynergy, cardiac enlargement, congestive heart failure, or depressed ejection fraction, all of which worsen the prognosis significantly.
View details for Web of Science ID A1982NU68300001
View details for PubMedID 7046401