A Brief History of the New SVS

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The modern SVS is a vibrant blend of two rich historical and co-evolving traditions – the original SVS and the American Association for Vascular Surgery (AAVS) which merged in 2003 under the leadership of Dr. Jack Cronenwett (SVS) and Dr. Thomas Riles (AAVS). It was a merger that sanctified a long cooperative relationship that had existed between the two organizations.

The original SVS was the brainchild of Dr. James Ross Veal, according to Dr. James S.T. Yao in his history of the SVS beginnings. The society was inaugurated at the Fairmont Hotel in San Francisco on July 3, 1946, at a meeting which chose its name, elected its officers, and 31 charter members. A year later, its first annual meeting was held on June 8, 1947, in Atlantic City, and in a sense this heralded the dawn of modern arterial reconstructive surgery, though it was not until Dr. Robert R. Linton’s ninth presidential address in 1955, that such an address dealt with arterial reconstruction.

Among the charter members was the “father of vascular surgery,” Dr. Rudolph Matas of Tulane University. In his acceptance of a ceremonial gavel in his honor, which he passed into the permanent custody of the SVS, he reminisced on how it was on May 5, 1888, “the first actual demonstration of the new principle that repair of an injured or damaged blood vessel could be obtained without the suppression of its blood-carrying function. It took place at the Charity Hospital [wood from one of its stairway posts was used to make the gavel].”



Courtesy National Library of Medicine

Dr. Rudolph Matas (1960-1957) was a founding member of SVS and the “father of vascular surgery.”

This operation, which Dr. Matas himself performed, relegated to the dustbin of history “the fundamental maxim of that great master of vascular surgery, Antonio Scarpa, in the late 18th century, namely that no wound or injury of an artery could be repaired without a total suppression of its blood-carrying function.”

The Matas gavel remains a treasured artifact and was used for many years as the symbol of presidential transition in the SVS.

The first SVS president, Dr. Alton Ochsner, gave his address, entitled “Venous Thromboembolism,” at the first annual meeting. From then on the SVS continued incremental growth, expanding and refining its goals and structure and improving the tenor of its annual meeting. The first SVS constitution was drawn up by the committee and then adopted in June 1949, although the documents regarding it are lost to time. The first extant version is from 1955, according to SVS chronicler and charter member Dr. Harris B. Shumacker, Jr.

The official original SVS seal, carrying the image of another vascular surgery pioneer, John Hunter, was designed and implemented on the membership certificate by SVS Secretary Henry Swan in 1955. In 1958, the journal, Surgery, became the official organ of SVS and would remain so for 25 years.

By 1964, SVS began expanding its scope. That year, the SVS requested representation on the Board of Governors of the American College of Surgeons, which occurred in 1965. Also in the 1960s, the SVS pledged its support to the National Society of Medical Research and expanded its ties to the American Heart Association, gaining representation on its Joint Committee on Stroke.

Early lobbying efforts in this period included society support for a bill to establish a National Medical Devices Standard Commission, inspired by the SVS’s keen interest in the safety and composition of surgical implants.

In June, 1973, the first proposal of a Committee for Vascular Surgery on the American Board of Surgery was made, and ultimately implemented several years later. This brought renewed and vigorous interest in the issue of vascular training, which has continued ever since, and by the early 1980s, the American Board of Surgery was offering a Special Certification in General Vascular Surgery in consultation with SVS and AAVS, which provided institutional guidelines for training.

In 1986, SVS created a Foundation for Research and Education, which would, in 1989, under the foundation presidency of Dr. Michael Ellis DeBakey (another SVS charter member), undergo a name change to the Lifeline Foundation, which included sponsorship or responsibility for a variety of research and training oriented awards, grants, and initiatives. This tradition is carried on by the SVS Foundation.



Courtesy Baylor College of Medicine

Dr. Michael Ellis DeBakey (1908-2008) was a founding member of SVS and a founding editor of the Journal of Vascular Surgery.

In summarizing the fifth decade of SVS (1987-1996), Dr. Yao cites the introduction of endovascular techniques as a drastic change in the landscape of vascular practice. The sixth decade (1997-2006) “witnessed a milestone of transformation” with the merger of SVS and AAVS. “We were finally united as an independent surgical specialty.”

Since the earliest years, AAVS and SVS had close ties, with both cooperating in 1984 to inaugurate the Journal of Vascular Surgery, which became the official organ of both groups and remains so for the combined SVS to this day. The founding editors were Dr. Michael DeBakey and Dr. Emerick Szilagyi.

In 1988, SVS established the Crawford Critical Issues Forum at the annual meeting, which was soon to incorporate members of the then North American Chapter of the International Society for Cardiovascular Surgery, the forerunner of AAVS.

In 2001, Dr. Robert Hobson served as the first president of the renamed AAVS. In his address at the 49th annual meeting of the organization, he highlighted some of its major accomplishments including their then recent efforts to launch a new website called VascularWeb and the establishment of the American Vascular Association (AVA), with the assistance of SVS. The AVA was a division devoted to public education in vascular disease, which after the merger with SVS would become one with the Lifeline Foundation.

Summarizing the unity of the two organizations, in his SVS Presidential address in 2003, Dr. Jack Cronenwett stated, “It is clear that the SVS and AAVS have functioned as a single entity representing vascular surgery for many years.”

He detailed the history of the two organizations and the logic of their merger from their consistent meetings together for more than three decades, from their fundraising effort, and from their shared committees, including the Joint Council established in 1975.

So significant was the Joint Council, according to Dr. Cronenwett, that “by the year 2000, the individual society council meetings lasted only one hour, but were followed by a seven-hour Joint Council meeting involving 45 persons, where all the important business of the societies was conducted.” Surprisingly, the council was never incorporated legally or had authority to take action, but made decisions only by consensus of both societies, Dr. Cronenwett said.

It was this Joint Council that charged the SVS and AAVS presidents in 2002 to “investigate the management and governance of the societies and to develop specific proposals to address these concerns.” It was a charge that led to the, almost inevitable, in retrospect, merger of the two societies a year later.

Dr. K. Craig Kent credited the merger with invigorating and transforming SVS, as he said in his 2007 presidential address: “Where was SVS five years ago? There were two societies, a division of leadership and competition between SVS and AAVS. SVS had no central administrative support … Where is SVS today? I would say strong and well. This began with the merger of SVS and AAVS in 2003 to create an all inclusive society. We now have an office in Chicago with central administrative leadership. We have a Vascular Surgery Board within the American Board of Surgery and a primary certificate.”

He went on to praise the new mature infrastructure of SVS and herald its major initiatives. Since its creation, the Chicago office has been run under the support of SVS Executive Director Rebecca M. Maron and has provided support and continuity to all SVS presidents since.

Major successes have occurred under the auspices of the SVS in promoting the interests vascular surgery in the Congress, according to Dr. K. Wayne Johnston in his 2008 presidential address.

“The first realization that we could have a direct impact in Washington came in 1997. At that time SVS faced major reductions in practice expense payments from Medicare. SVS convinced a number of key Senators and Congressmen that underrepresented specialties at the American Medical Association, such as vascular surgery, should have the opportunity to submit their supplemental practice expense data for review. SVS was the first speciality society to submit supplemental data from many members across the country, and our efforts saved millions of dollars in lost income,” stated Dr. Johnston.

A second major legislative victory, The Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act occurred in 2005, two years after the merger, with the new SVS serving as the lead organization in the National Aneurysm Alliance, with Immediate Past-President Dr. Robert Zwolak as the key operative in the coalition.

A third, although only partial victory, according to Dr. Johnston, came when SVS, with the aid of the Society for Vascular Ultrasound, mounted a successful effort to remove specific ultrasound services from major cuts in the Deficit Reduction Act of 2005.

SVS continues to work to promote the interests of vascular surgeons and their patients in a period of turbulent government medical reform.

A breakthrough in education occurred when the Accreditation Council for Graduate Medical Education approved the Primary Certificate in vascular surgery, which took effect July 1, 2008, and allows for more educational options and a more focused program for vascular trainees.

A good summary of the modern SVS can be found in the words of Dr. Anton Sidawy in his 2010 presidential address.

“Over the last few decades … the Society and the specialty had to overcome obstacles, reinvent themselves, and take on major endeavors, and in doing so, we became stronger and expanded our horizons to better serve patients with vascular disease. Throughout it all, the Society and the specialty remained true and faithful to our core values of integrity, professionalism, and commitment to our members and patients,” said Dr. Sidawy.

Sources:

Cronenwett, J. L. J. Vasc. Surg. 2004; 39:1-8.

Hobson, R. W., J. Vasc. Surg. 2002; 35:1-7.

Johnston, K. W., J. Vasc. Surg. 2008; 48:1613-9.

Kent, K. C., J. Vasc. Surg. 2008; 47: 231-6.

Shumacker, H. B. “The Society for Vascular Surgery. A History: 1945- 1983,” The Society for Vascular Surgery, 1984; 583 pp.

Sidawy, A. N., J. Vasc. Surg. 2011; 510-6.

Yao, J. S. T., J. Vasc. Surg. 2010;51: 776-9.

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