An elderly female patient at Holy Family Hospital suffered from intestinal angina, a narrowing of the arteries that deliver blood to the intestines, and the constriction had left her malnourished and weak. A catheter-based procedure to restore proper blood flow and correct the problem had failed twice, and major surgery didnt seem appropriate, given the womans age and condition.


The eventual solutionthe subject of an article in the Holy Family publication Health Scene earlier this yearinvolved melding the skills of vascular surgeons and interventional radiologists who work for Spokane-based Inland Vascular Institute.


At the suggestion of vascular surgeon Dr. Gregory Luna, a smaller incision was used to allow the radiologistswho specialize in less invasive proceduresto access the blocked area from the opposite side of the blockage and insert a stent.


The successful, and unusual, procedure was typical of the collaborative benefits hoped for in July 2000 when Spokane Vascular Associates, a group of four vascular surgeons, joined with Inland Imaging Associates PS, then comprised of 35 radiologists, to create Inland Vascular, a division of Inland Imaging.


The Inland Imaging professional-services group is one of several affiliated entities that together operate a number of outpatient imaging centers and provide a range of radiology services to patients across the Inland Northwest through affiliations with hospitals.


It wasnt a shotgun wedding, but its been a mixed marriage, quips one of the vascular surgeons, Dr. Stephen Murray.


He describes the union as perhaps one of the first in the nation to merge these warring factions and their once sharply divergent, but now increasingly intertwined disciplines.


There have been bumps in the road, but weve been able to negotiate them successfully, Murray says, adding that the institutes patient volume probably has doubled since its first year.


Were bursting at the seams. We dont have enough space, and we dont have the personnel to handle that rising patient demand properly, he says.


The institute occupies 4,800 square feet of space on the fourth floor of the Heart Institute of Spokane building, at 122 W. Seventh, just north of Sacred Heart Medical Center, and plans to expand shortly into 1,700 square feet of adjoining space there.


It also recently opened an office in the Holy Family Medical Building at 235 E. Rowan, next to Holy Family Hospital, that includes a vascular and thoracic clinic, a full-time vascular lab, and a procedure room dedicated to laser and minimally invasive treatment of varicose veins.


The institute has signed a letter of intent to lease 3,500 square feet of space in a proposed major addition planned on the north side of Holy Family, and presumably would move its current Holy Family operation into that space once its completed.


Those plans, though, havent been firmed up yet.


Holy Family disclosed tentative plans for the estimated 87,000-square-foot, $16 million expansion in October, and hopes to begin work on it next spring, assuming the project receives budgetary approval.


Inland Vascular diagnoses and treats a range of blood vessel-related problems and conditions, from varicose veins, uterine fibroids, and stroke, to end-stage renal disease, and cerebral and aortic aneurysms.


It currently has five vascular surgeons and six interventional radiologists, and it probably will add one or two more surgeons over the next year and a half, Murray says.


It also employs a total of four physicians assistants and nurse practitioners and a support staff of about 15 people, and expects to hire more soon.


All of the physicianssurgeons and radiologistsare fellowship-trained and board-certified, meaning they have received extensive additional training in chosen specialties and have met quality of care-related criteria set forth by specialty boards, but certification isnt required to practice those specialties.


Inland Vascular claims that it now has all of the actively practicing, fellowship-trained and board-certified circulatory specialists in the Inland Northwest.


Radiologists diagnose diseases by obtaining and interpreting medical images, and correlating those findings with other examinations and tests.


However, they also treat some diseases, such as through radiation or through minimally invasive, image-guided catheterizations.


The latter discipline, called interventional radiology, has emerged strongly in recent years and has been touted as an often preferable alternative to conventional open surgery because it entails less risk, pain, and recovery time.


That claimover which there remains strong disagreement in some casesand a perceived general encroachment by radiologists into surgeons traditional turf, has created professional tension, intensified by reimbursement issues and long-term practice viability concerns.


Inland Vascular has made the relationship work by requiring some sacrifice on both sides, Murray says. The interventional radiologists gave up exclusivity to do minimally invasive procedures, which all of the surgeons there now also have been specially trained to do, he says, and the surgeons gave up exclusivity to manage patients, which has been a closely guarded component of their historic domain.


Interventional radiology is much closer in culture to surgery than other radiology specialties, he says. Were more similar than we are dissimilar, I guess, in the management of these patients.


Its been difficult to quantify statistically to what extent that blending of medical disciplines and work cultures has improved patient care, Murray says.


Generally speaking, though, he says, What we know is weve been able to deliver less-invasive care on a more appropriate basis.


Furthermore, the combining of that vascular-related expertise at one practice has improved the availability of services here, largely eliminating the need for patients to travel to specialists in other cities, Murray asserts.


There is really nothing from a vascular standpoint we cant do. We rarely send patients elsewhere, he says.


Fellow vascular surgeon Luna says he, too, believes the merger has been beneficial.


Sharing that expertise has just made us better, he says. Its been a good deal on both sides.