Vascular surgery – it’s personal

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Let’s get personal for a moment. The next time you walk past your local cancer center, pay attention to the signs, the branding, and the message. I’ll bet you won’t have to look too hard to see reference to personalized or precision medicine. Our oncology colleagues have completely invested in these principles and it’s easy to see why.

The concept of personalized medicine involves therapeutic strategies that take individual variability into account. Along with advances in patient care this strategy has resonated with patients, funding agencies, philanthropists, and governments. Most recently, President Obama announced a new precision medicine initiative in his State of the Union Address, and this month we’ve seen these ideas reflected in Vice President Biden’s “moonshot” to cure cancer.

Dr. Thomas L. Forbes

Dr. Thomas L. Forbes

All well and good, but what about vascular surgery? Let’s see – making therapeutic decisions at the individual patient level, taking patient variability into account, whether its anatomy, comorbidities, genetic profile – isn’t this what we do every day? Of course, it is! We just haven’t been as forthright in owning it or broadcasting it.

If we think about it, we are further along the path to personalized vascular therapy than we think (Vascular. 2016 Jan 13. pii:1708538115624810). In a practical sense, we do it every day, whether its custom devices for aortic therapy, applying data from registries and randomized, controlled trials to individual patients, or using genetic information to make recommendations regarding medical, surgical, or endovascular therapy, we regularly make recommendations “taking individual patient variability into account.”

There are ongoing advances in all of these areas by our innovative vascular surgery colleagues. Dr. Benjamin W. Starnes is using 3-D printing to develop custom templates for personalized “point of care” aortic endograft fenestration (J Vasc Surg. 2015;61:1637-41). Genetic variability is being considered when applying medical therapy, known as pharmacogenetics, but also when applying surgical therapy, as “surgicogenetics.”

A prime example is the pioneering work led by Dr. Michael S. Conte and the late Dr. Alexander Clowes, who are attempting to explain some of the variability in outcomes following infrainguinal bypass surgery by differences in a single nucleotide polymorphism (J Vasc Surg. 2013 May;57:1179-85). Genetics drives surgical outcomes, surgicogenetics indeed!

These are just some of the examples of “Personalized Vascular Therapy” that all vascular surgeons practice to a certain extent and where there are lively areas of investigation.

So the time has come for us to not only practice personalized medicine, but to own it, to broadcast it, to leverage it, as well. Personalized Vascular Therapy has a nice ring to it, don’t you think? We do it, let’s not by shy about it.

Dr. Forbes is professor and chair of the division of vascular surgery at the University of Toronto.

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