The people, discoveries, innovations and events that brought the vascular surgery profession to where it is today formed the bedrock of the subject matter for this year’s John Homans Lecture—“Who put the vascular in vascular surgery?”—at the 2025 Vascular Annual Meeting (VAM) in New Orleans (June 4–7).
Jerry Goldstone, MD, an adjunct professor at Stanford University College of Medicine, pored over some of the most important developments in the field since the founding of the SVS in 1946, an occurrence which set the stage for the modern vascular surgical specialty.
“When the 31 founding members were gathered for their first meeting in 1947, how could they possibly have imagined what vascular surgery is like today,” Goldstone told Vascular Specialist. “They formed this organization because there was no organization devoted to vascular surgery. Most were general surgeons with a special interest in vascular, some were cardiac people with a special interest in vascular.”
What they helped shape yielded some tremendously important advances over the years, minting vascular surgery as a bona fide, standalone specialty in its own right, Goldstone told VAM 2025. After canvassing colleagues in the field, he landed on “about 10 of the
most important things that got us from 0 to a place, now, where there is one big society, 6,000 members, our own journals, recognition internationally, good science,”
he explained.
Among the topics he charted were the formation of the SVS and its merger with the American Association for Vascular Surgery (AAVS), previously the North American Chapter, International Society for Cardiovascular Surgery (NA-ISCVS); the development of grafts; the coming of the vascular lab and duplex ultrasound; carotid endarterectomy (CEA); two innovations in venous disease in the shape of the Greenfield filter for pulmonary embolism (PE) and laser ablation of the great saphenous vein; the founding of the Journal of Vascular Surgery (JVS); and the birth of the vascular surgery fellowship.
For one, the merger that created the modern SVS in 2003 brought together a society that was exclusive with one that bore a larger, more unlimited membership base “into one
big organization that has 6,000 members.”
That’s one of the major developments, Goldstone related. But much earlier, the development of grafts brought vascular surgery from a place of few repair options to one in which, from the early 1950s, a vein graft became available for the lower extremity, continuing on with further developments for larger vessels. The coming of the first textile graft emerged and “changed everything,” Goldstone continued. “So now, by the mid-50s, we’ve got grafts that can basically repair any artery anywhere—that’s a huge jump forward for the profession.”
The vascular lab and duplex ultrasound machine, meanwhile, “literally changed the nature of the diagnosis,” he said. They brought diagnosis directly into the hands of vascular surgeons, now with the tools in their offices. “You get real anatomic information, and at the time all of this was going on, angiography existed, but it’s risky, painful, expensive and it’s a little complicated. So, now [with the lab and ultrasound], we have non-invasive things that allow for better diagnosis, follow-up and management of patients.”
The rise of CEA helped push the vascular specialty further forward, Goldstone said. “After all, we are a surgical specialty, and known by the operations we do, and one of the most common and distinctive is CEA,” he explained. “It put vascular surgeons into contact with other people, in other specialties, and elevated the profession beyond its own little cocoon, as maybe a little different from general surgery. It put vascular surgery as a profession on the map in a broader sense.”
Goldstone also focused on important developments in venous disease treatment, referencing how the surgeon for whom the lecture is named, John Homans, MD, had a special interest in veins. “One was the Greenfield filter, because PE is still a common problem and still can be deadly,” he noted. “In the old days, they were tying off veins to prevent clots from going to the lung, and there had been a bunch of efforts to do things to the vena cava that didn’t work very well, and then Greenfield came up with this filter that really changed the management of that condition.”
