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Professor of Radiology, Vascular-Interventional Radiology


Peter Bream, Jr., MD, FSIR, is a third-generation radiologist. After completing his fellowship at UNC, he joined the faculty at Vanderbilt University Medical Center. At Vanderbilt, he was the fellowship program director and was instrumental in developing one of the first Integrated Interventional Radiology residency programs. He also served as the IR Medical Director and the PICC team medical director. He was heavily involved as a liaison to the Department of Trauma, serving as a representative on the committee that achieved the American College of Surgeons (ACS) Level One trauma designation. While at Vanderbilt, he was promoted to Associate Professor in the Departments of Medicine (Nephrology) and Radiology. Upon arrival at UNC, he was promoted to Clinical Professor. He serves as the American Board of Radiology’s oral board examiner and question writer. He is the editor of the Interventional Radiology section of the American College of Radiology’s Case in Point.

In addition to a wide variety of non-vascular IR procedures, he specializes in complex venous access, especially involving patients on hemodialysis. His clinical expertise is wide-ranging but focuses on complex IVC filter retrieval, central venous reconstruction, enterocutaneous fistula repair, and pulmonary AVM embolization. He developed a new method for percutaneous placement of gastrostomy tubes that allows a larger tube to be placed initially with no additional risk to the patient.

Dr. Bream’s research has focused on descriptions of his new gastrostomy technique, novel ways to access the central veins, and reviews of dialysis catheters and utilization of the HeRO device. He is also active in social media and has co-authored papers on the use of social media in Interventional Radiology.

Dr. Bream is also a clinical physician at the UNC Center for Heart and Vascular Care.


Vascular Interventional Radiology


Special interest in developing new techniques, dialysis access maintenance, central venous access and occlusion, entrocutaneous fistula management, and enteral access, especially in challenging populations.

Philosophy of Care

I always keep the patient first and foremost in every clinical interaction. I like the ability that IR affords us to take a step back and look at the entire situation. I have a psychology degree and use that to understand the patient’s perspective. Throughout my career, I have seen tremendous technological advancements. There is so much we CAN do for a patient. However, one must often be able to step back and ask SHOULD we do this? A holistic approach to the patient can be successful only through a thorough understanding of the pathology, available guidelines, thorough history and physical, and input from colleagues. I pride myself in always questioning why we are doing things so we stay focused and can develop innovative ways to treat the entire patient.

Education & Training

  • Medical School: University of North Carolina, Chapel Hill
  • Internship: University of North Carolina, Chapel Hill
  • Residency: University of Alabama, Birmingham
  • Fellowship: University of North Carolina, Chapel Hill


To see a list of Dr. Bream’s publications, click here.

Peter Bream headshot