“Transparency is not a threat to any specialty; it is the foundation of patient-centred care. Our duty is not to defend professional territories, but to ensure that every patient hears the whole story—whether the solution involves a scalpel, a catheter, or something in between.”
These are the words of interventional radiologist Sara Lojo-Lendoiro (Hospital Arquitecto Marcide, Ferrol, Spain), who spoke with Interventional News following her recent publication in CardioVascular and Interventional Radiology (CVIR) titled ‘The option you never heard about: Why patients deserve the whole story’.
In the editorial, Lojo-Lendoiro and her colleagues Jose A Guirola Ortiz (Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain) and Sergio Sierre (Hospital de Pediatria J P Garrahan, Buenos Aires, Argentina) describe how, every day in hospitals worldwide, treatment choices are shaped not by the full range of available therapies, but by the perspective of the first specialist the patient encounters. In their view, patients often receive information “filtered” through a single professional lens, resulting in the omission of viable, and often minimally invasive, alternatives.
“In these situations, no one truly benefits,” Lojo-Lendoiro tells Interventional News. “When a less invasive option with comparable efficacy is withheld, patients face longer recoveries and higher complication rates; clinicians shoulder the burden of preventable morbidity and dissatisfaction; and institutions incur greater costs, prolonged hospitalisations, and reduced efficiency.”
She continues that, what sometimes appears to benefit from the omission of minimally invasive alternatives is the system itself. Traditional referral pathways and professional silos create “familiar, administratively simple routes that feel efficient”, she notes, as they avoid the need for coordination, shared decision making or structural change. Yet, in her view, this supposed efficiency is “short lived”, creating downstream consequences such as higher complication rates, repeat admissions and increased healthcare costs, which ultimately place a greater burden on both clinicians and institutions.
“The damage is not theoretical: it is measurable, preventable, and rooted in organisational inertia rather than clinical necessity,” Lojo-Lendoiro says.
Giving an example of a commonly omitted procedure, Lojo-Lendoiro describes uterine artery embolization (UAE) for symptomatic fibroids. She states that, although “strong evidence” shows UAE provides long-term symptom control comparable to surgery—“with fewer complications, no laparotomy and fertility preservation”— it is still frequently bypassed in favour of open myomectomy or hysterectomy.
“Our editorial highlights that surgical alternatives carry risks such as ureteric, bladder or bowel injury and longer recovery, all risks that are largely avoided with UAE. Yet, UAE is often omitted due to specialty silos, underrepresentation in guidelines and the lack of routine multidisciplinary review,” explains Lojo-Lendoiro
While the ethical imperative to inform patients of every viable treatment option is universal, Lojo- Lendoiro shares that the legal requirement to disclose all reasonable options is “unevenly enforced” across jurisdictions. In the USA, she describes Canterbury versus Spence, which established that physicians must disclose all reasonable alternatives, even those which they cannot personally provide and refer when appropriate.
“In the UK, Montgomery versus Lanarkshire reframed consent around what a reasonable patient would want to know”, Lojo-Lendoiro explains, “rather than what a reasonable doctor would choose to disclose.” In their editorial, the authors write that this ruling shifted the legal standard from one centred on the doctor, to one centred on the patient’s “information needs, values and preferences”. They continue that this demonstrated a “decisive step towards a shared decision-making model and officially ended the dominance of paternalism in British consent law”.
In Spain, Law 41/2002 guarantees comprehensive information but does not explicitly require referral outside one’s speciality, creating a “grey zone”, as Lojo-Lendoiro describes it.
“This creates a grey zone where omission is ethically problematic but not always legally actionable. Thus, while the ethical breach is clear, the legal consequences vary—leaving patients’ access dependent on local culture rather than universal standards.”
Lojo-Lendoiro states that she has repeatedly observed this ‘grey zone’ in the real world: patients arriving at the interventional radiology (IR) suite only after irreversible treatment decisions had already been made, without having been informed that a minimally invasive option existed. Alternatively, patients arrive seeking treatment to resolve complications from surgeries, she says, without having been given another option. Lojo-Lendoiro shares that the “most painful words remain: ‘No one ever told me this was possible’” when encountering patients in these scenarios.
“We realised that this was not a matter of individual negligence, but rather a systemic blindspot in ‘therapeutic borderlands’. Our goal was not to claim superiority of IR, but to advocate for full transparency and structural reform,” she tells Interventional News.
Having previously been overlooked as a viable treatment provider, Lojo- Lendoiro believes that this is not due to lack of evidence, but rather because the referral process has historically excluded IR. In the early development of IR, she describes that interventional radiologists were viewed as a “technical resource” rather than an autonomous therapeutic discipline—a gap that was “used to justify keeping patients within traditional pathways”.
Today, however, since the development of IR as a full clinical speciality, this reality has changed, she states, but calls for systemic reform to address a “failure of visibility”. Lojo- Lendoiro explains that their editorial was meant not as a confrontation, but to promote institutional presence and encourage multidisciplinary boards where IR is standard rather than optional.
“Our goal is not to ‘win’ cases, but to ensure that no decision is made without the patient having the full picture in front of them,” says Lojo-Lendoiro.
With the rise of artificial intelligence (AI), Lojo-Lendoiro states that patients today are arriving with an understanding of possible treatment options; however she believes that conventional surgical or medical pathways remain “disproportionately represented” via these channels in comparison to IR.
“If IR is absent from these digital spaces, it is effectively absent from the patient’s decision-making process. Being present at the bedside is no longer enough, we must also be present online. Strengthening the digital visibility of IR through accurate, patient-centred, and accessible content is therefore not a matter of marketing, but of equity, transparency, and informed choice,” she adds.
Although data continue to accumulate in support of minimally invasive therapies, this does not automatically translate into access, Lojo-Lendoiro says. In her view, “without structural change, robust evidence can paradoxically deepen boundaries as professional identities and procedural domains feel threatened”.
“Evidence alone will not dissolve boundaries,” she continues. “This is why this is not a scientific problem, but a governance problem. If referrals continue to depend on goodwill rather than protocols, we will remain in a vulnerable position. The future of IR will not be secured by asking for a seat at the table, but by redesigning the table itself”, she concludes.
