“One of the biggest challenges for interventional radiology in 2017 is that we are in desperate need of outcomes research that documents the value of interventional radiology in modern healthcare,” Matt Mauro, CEO of UNC Faculty Physicians and chairman, Department of Radiology, University of North Carolina at Chapel Hill Education, Chapel Hill, USA, tells Interventional News.
When did you first decide on a career in medicine and why did you choose interventional radiology?
I obtained an engineering degree from Cornell University (Electrical Engineering) with the intent of pursuing a career in that field. It was during a summer internship at an engineering company that I discovered that engineering was not my path, mainly because of the lack of a direct personal connection with people. It was suggested to me that medicine was the integration of science (biological sciences) and direct contact with people. I switched my career choice the summer before entering my senior year at Cornell University.
Who were your mentors and what wisdom did they impart to you?
My interest in imaging and intervention began as a medical student at Cornell University Medical College. I was intending to be a surgeon and had multiple discussions with the chair of surgery at New York Hospital about matching there. It was Joe Whalen, Mort Meyers, and Tom Sos (all Cornell Radiology faculty members) who believed in the power of imaging and the future of image-guided interventions. My early career was particularly influenced by Fred Keller, Barry Katzen, and Bob White—all giants in the field of interventional radiology. They demonstrated the importance of patient interaction and the tremendous impact on patient care that our newly developing specialty could have through their clinical skills.
Which innovations in interventional radiology have most influenced your career, and how?
My first arterial puncture was in 1977. We were making our own catheters from reels of polyethylene tubing—shaping tips, tapering etc. We were performing very detailed diagnostic arteriograms for many disorders since this was the primary method of diagnosis and staging—prior to the evolution of quality cross sectional imaging. Treatment was confined to vasopressin infusions for lower gastrointestinal bleeding and some bland embolotherapy. Innovation and inspiration by many have been responsible for the creation and growth of our specialty. Embolotherapy has been one of my primary interests within the field of interventional radiology, and the development of the vast array of embolic materials and their delivery mechanisms have been particularly important to my career. Other areas of innovation that have particularly impacted me include image guided venous access, venous reconstruction, and the management of aneurysmal disease.
From an interventional radiologist to the CEO of UNC Faculty physicians—how has your outlook changed?
During my career, I have transitioned through three jobs, each with different responsibilities and priorities with respect to interventional radiology. From the beginning of my faculty appointment (1982) to my appointment as chair (2007), I was responsible for the development and growth of this area of practice both at UNC as well as in the field in general. In that role, I introduced each new device, technology, and procedure to our medical centre. Upon becoming department chair, that role fell to my colleagues, and my new responsibility was to the department as a whole. However, I remained very active with two full days per week in the interventional suite, a half-day clinic, and full call. I was careful not to micromanage any of my divisions, including interventional radiology. In 2015, with my appointment to the newly created position of CEO of UNC Faculty Physicians, I have the overall responsibility for a US$500 million enterprise with direct reporting structure to the CEO of the entire UNC Health Care System. In this role, I could no longer maintain an active interventional practice, but I continue to rotate on our vascular imaging service, a component of the interventional radiology division. My primary focus and responsibility now is to the entire UNC medical practice, but I hold the firm opinion that a strong interventional radiology programme is essential and vital to our unified success. It is for example, necessary for lowering our length of stay and the prompt management of a variety of complications generated by other services.
From your perspective as CEO, what does interventional radiology do well and what does it need to improve to stay relevant?
A successful and well-run interventional radiology programme improves the clinical care and efficiency of care to the patients of the medical centre. However, it may go unnoticed because it is not considered a “service line” unto itself. It is actually an important part of multiple service lines (eg. cancer, Heart and Vascular, Abdominal Transplant, Neurosciences), and it should be represented as such. Recognised leaders of these service lines will typically not be interventional radiologists, and, therefore, interventional radiology’s contribution may not be readily apparent to senior leadership. It is important for interventional radiology to be well situated within the service line leadership structure so that its value can be clarified appropriately.
One interesting caveat is that at UNC, senior leadership clearly recognises interventional radiology. However, it is sometimes difficult for me to advocate strongly for interventional radiology for fear of appearing biased.
Specifically, how has the state of research in interventional radiology changed from the early days until now?
Interventional radiology has always struggled with level one data—prospective randomised trials. The trials that were developed have been predominantly industry-sponsored. Our colleagues are data driven, and these new studies are required to show efficacy and value. I would say one of the biggest challenges for interventional radiology in 2017 is that we are in desperate need of interventional radiology outcomes research that documents the value of interventional radiology in modern healthcare.
How has the interventional radiologist changed from the 1980s, when you were a fellow, to now?
Interventional radiology can continually reinvent itself in response to innovations across the medical discipline. In the early eighties, percutaneous biliary interventions were replacing open operative remedies for biliary and gallbladder disease. With the advent of interventional endoscopy, our role has been modified. The success of interventional radiology will be its constant ability to innovate and apply our principles to other areas. When one door closes, another opens. Our innovation will sustain our success, and our minimally invasive methodology will be desired in a world of population health.
Which early procedures are you keeping an eye on?
Management of morbid obesity via left gastric artery embolization—obesity is an American epidemic and bypass surgery has significant complications; continued development of prostatic artery embolization—a very common problem in older men—we have a place in this arena; and targeted cancer therapies.
Interventional radiology has always had close ties to the device industry. How is this relationship best navigated?
Interventional radiology is the marriage of complex imaging and devices—those items that can be placed within the body through small openings and guided by imaging. A healthy relationship with device manufacturers is very important. New and innovative devices advance our specialty, perhaps more than any other factor. The benefits include the development of clinically useful products that are of value to society. The pitfalls arise when personal profit enters into the relationship and clouds our ultimate mission. The relationship is best navigated by maintaining a professional level of understanding that the partnership is focused on advancing clinical care.
Please describe a memorable case…
I will offer two memorable cases.
It was the very early days of transjugular intrahepatic portosystemic shunts (TIPS), and I had given a few presentations to a group of somewhat sceptical transplant surgeons. In the middle of one evening, a Childs C cirrhotic patient presented with uncontrollable variceal haemorrhage with a >60% operative mortality. The chief of our transplant programme personally called me (I was not even on call that evening) and asked if I wanted to try a TIPS on this patient—a test case. I successfully performed our first TIPS procedure in the middle of the night; the patient stabilised and was discharged several days later. Although this violated the general approach that your first case of a new procedure should be performed on a patient with high chance of success, this case solidified the value of TIPS at UNC.
Percutaneous inferior vena cava (IVC) filter deployment had just been published. At that time, IVC filters were inserted by surgical cutdown by our vascular surgery service. I spoke to our chief of vascular surgery who again was sceptical about percutaneously placing a 24F sheath in the vein and deploying this device. He insisted on being present for our test case. As soon as I made the venous puncture, the vascular surgery chief was paged, and he stepped out for several minutes to return the call. When he returned, I was holding pressure on the access site—we had already dilated the access site and deployed the filter.
What are your interests outside of medicine?
I was a multisport athlete in college and continued playing organised soccer and basketball until I was 40.
From ages 40 to 60 I became heavily involved in competitive martial arts (tae kwon do, hapkido and kickboxing).
Nowadays, in addition to spending time in the gym on a routine basis, I enjoy the yard and auto maintenance that comes with car and home ownership; movies; and times with friends and family.
- CEO UNC Faculty Physicians, University of North Carolina at Chapel Hill Education, Chapel Hill, USA
- Chairman, Department of Radiology, University of North Carolina at Chapel Hill Education
- Ernest H Wood Distinguished professor of Radiology and professor of Surgery, Department of Radiology, University of North Carolina at Chapel Hill Education
|1982||Fellow in abdominal and vascular/interventional radiology, The Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, USA|
|1981||Fellow in diagnostic and vascular radiology, Department of Radiology, University of North Carolina School of Medicine Chapel Hill, North Carolina|
|1980||Chief resident in radiology, Department of Radiology, University of North Carolina School of Medicine Chapel Hill|
|1977||MD, Cornell University Medical College New York, New York, USA|
|2014||Society of Interventional Radiology (SIR) Gold Medal|
|2009–2013||Chairman, Radiologic Society of North America (RSNA) Scientific Programs Committee|
|2011–present||Voting/Alternate ABMS assembly representative|
|2010||American Board of Radiology (ABR), Lifetime Service Award|
|2010||Charles Tegtmeyer Lecturer, International Symposium on Endovascular Therapy annual meeting|
|2009||Dotter Lecturer; 25th annual SIR meeting|
Society roles (selected)
|1999–2000||Executive committee, American Heart Association|
|2008–2013||Section editor, The American Journal of Roentgenology, American Roentgen Ray Society|
|2012–2014||President, Southeastern Angiographic Society|
|2015–present||Board of Governors, ABR|
|2015–present||Board of Directors, RSNA|