Endovascular techniques were introduced in the 1970's for the treatment of vascular lesions of difficult access and with a high risk of mortality.  During the 80's and especially during the last ten years, endovascular procedures have become practically the treatment of preference for almost all arterial diseases, both obstructive and aneurysmal in the various arterial territories.  In the 1990's the introduction of the use of endo-prosthesis with a stent, revolutionized completely the treatment of vascular diseases, which until then, were treated with traditional surgery.

With the rapid, progressive increase in the number of procedures performed (approximately 100,000 only in the year 2000) the question of which specialist was most qualified to treat these cases became inevitable.  Four specialities appeared to be eligible: vascular surgery (VS), cardiology (C), radiology (R) and neuro-radiology (NR).  More recently, other specialists such as cardiac surgeons (CS) or vascular medicine physicians (VMP), have shown particular interest in this peculiar field of medical practice in rapid evolution, with the intention of dedicating to it at least part of their professional activity.

The vascular surgeon has good experience on the ward, in the operating theatre, in both elective and emergency surgery, is familiar with arterial plaques and lesions, has an excellent concept of three-dimensional anatomy and is aware of the importance of sterility.

The interventional cardiologist has equally good clinical experience on the ward but less surgical experience and less familiarity with plaques but, on the other hand has wider experience in coronary angioplasties than the vascular surgeon.  Both vascular surgeons and interventional cardiologists have scarce practical knowledge on the use of radiological apparatus and 'imaging'.

Interventional radiologists and interventional neuro-radiologists are those who have the most experience in navigating and manoeuvring guide-wires and catheters in the vascular territories, but compared to interventional cardiologists and especially vascular surgeons, it is they who have the least experience in elective surgery, in emergency situations and in patient follow-up. Their patient referral is usually scarce.

A situation has come about in which, in the interest of the patient, it would be preferable, in order to maintain the 'gold-standard', that at least two or more of the above-mentioned specialists be present and consulted in each centre where endovascular procedures are carried out.  This situation may not always be possible and could cause conflict among colleagues of an endovascular team, since it is quite clear that only one person can be considered ultimately responsible at a time for each procedure.

More recently, as a result of the tremendously rapid evolution of technical skills and professional acquisitions and development of new devices, the large majority of vascular procedures can be performed either endoluminally or through hybrid (endovascular and open) approaches.

It is frequently reported that a procedure is performed by an interventional cardiologist or radiologist with the support of a vascular surgeon, whose contribution is often required just for ancillary procedures, or is performed by a vascular surgeon who does not have a background of adequate training in manoeuvring catheters or in imaging skill formation and has difficult or insufficient access to imaging equipment.

We are witnessing a transitional situation.  The problems that we are now facing, did not exist in the past and will not exist in the future.

In the year 2000, we established at the University of Milano Bicocca the MET educational programme, with the conviction in mind that in the near future the excellence for the non-medical treatment of vascular diseases will be represented by the Interventional Vascular Specialist, who will acquire a background totally different from what is presently conceived in order to be defined as a specialist in vascular surgery, interventional cardiology and radiology.

MET is a philosophical approach to the need to create a hybrid specialist through professional training from highly qualified tutors.

Following these considerations a conclusion has been reached, which is that of constituting a new role of specialist who should acquire and reunite in one, notions of the various specialities involved.

During the MET the trainee should:

-  Learn how to diagnose and judge in patient selection.

-  Learn how to find the solution to vascular problems in the most efficient, durable and less invasive manner possible.

- Be in a position to handle procedures, foreseeing, avoiding or resolving any eventual complications that may arise.

Ninety per cent of the training period is directly with the patients and the trainee is exposed to assisting and directly performing a relevant number of cases:

-  At least 100 diagnostic angios.

-  Over 100 balloon and stenting procedures.

-  From 30 to 50 EVARs with the tutoring of trained doctors, nurses and technicians.

-  Over 50 open and hybrid procedures.

A Faculty of Milano-Bicocca University Lecturers (Internal Members) and experts in the field of diagnosis, indication and practice in catheter derived procedures, from other Italian and non-Italian Institutions (External Members), has been constituted.  These tutors participate in the didactic programme of the Master, with seminars, traditional lectures, master-classes and workshops, etc. which will cover the remaining 10% of the training period.

In addition, the trainee is requested to write a scientific paper (in English) on a specific case (case report) to which he/she was personally exposed during the training period, or a clinical study with reviews from literature or finally, original research or project.