Veith’s Viewpoint: Vascular Surgery and Creativity

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Vascular surgery is an exciting field. It also faces enormous challenges. These include a difficult economic climate and intense competition from other specialties, both interventional and surgical. Vascular surgery has certain assets, such as its commitment only to the management of vascular disease and its ability to provide medical, open surgical and interventional treatments, depending on which is best for the patient. However, these assets are balanced by liabilities, such as impaired access to interventional suites, the public perception that other specialties can provide better less invasive treatments, and weak influence or power within institutions or departments.

These liabilities are real and impact on both individual vascular surgeons and the specialty as a whole. It is because of these liabilities that vascular surgery has only maintained a degree of stability despite the enormous growth in the number of vascular patients and the introduction of exciting new means of treating these patients less invasively, more safely and more effectively.

Dr. Frank J. Veith

How can we overcome these liabilities and make our specialty survive and prosper? The answer is creativity. If we develop new and better ways to manage and treat vascular patients and let the world know we are the innovators, our specialty will grow and prosper. Patients will seek out those that developed the new and better treatments and come to them. Having more patients needing treatment will increase the influence and power of vascular surgeons within institutions and departments.

Let’s look at some examples. I have had experience with three. The first was so-called limb salvage surgery. In the 1960s and 1970s, no one was interested in patients with toe and foot gangrene. However, as techniques were developed to improve the limb circulation in such patients, they flocked to those who could provide these treatments, even though many physicians and surgeons expressed doubts and skepticism about their value.

Later, when less invasive interventional treatments were also developed for improving the circulation, again patients sought out the centers that could provide them. Sure, the open and endovascular treatments for these ischemic problems were difficult to perform. They required skill and commitment. But when they worked, patients found out about them and requested them. The skeptics were eventually proven wrong, and creativity was rewarded.

However, even today skeptics exist with regard to some newer endovascular treatments below the inguinal ligament. I suspect they will again be proven wrong as the treatments improve and indications for use are crystalized.

A second example was endovascular grafts and EVAR. In the beginning, after Juan Parodi’s first demonstration of feasibility, these procedures were regarded with enormous skepticism and even derision. Complications and failures were highlighted by many. But as the techniques and devices were made better, results improved. Innovating vascular surgeons and centers gained in stature, and their patient loads increased. Creativity in developing new and better treatments reaped its rewards for individual surgeons, institutions, and our specialty.

A third example is the newer endovenous treatments to ablate the greater saphenous and other veins less invasively. These treatments work, and because of their less invasive nature, patients seek out those who perform them. This has opened up a new treatment area of opportunity for vascular surgeons. It now comprises a large portion of many vascular surgeons’ practices.

The three examples I have mentioned are now accepted areas of treatment in vascular surgery – all introduced largely by vascular surgeons. All three have also been adopted by other specialists, and there is nothing wrong with that. However, what are we to do about the uncertain future?

We vascular surgeons must continue to be creative. We must devise newer and better techniques for treating vascular disease. We must publicize and document the fact that these innovations have been made by vascular surgeons. This requires not only scientific publication but also an effective public relations campaign on all levels.

For vascular surgeons these new or better techniques can be medical, interventional or open surgical. Examples of medical treatment are those that slow the growth of aneurysms or the development and progression of atherosclerotic lesions.

Patients will seek out these creative improvements and come to the practitioners or centers that provide them. When they do, they will also return when they need a subsequent intervention or open surgical treatment. Our success as vascular surgeons will be enhanced.

The same is true for innovative, safer or better endovascular or open surgical procedures. When properly documented in the scientific peer-reviewed literature and appropriately publicized in the lay media, this creativity will enhance the stature and importance of Vascular Surgery.

Even though we exist in a highly competitive and difficult environment, this creativity more than anything else will help individual vascular surgeons and vascular surgery in general to survive and prosper.n

Dr. Frank J. Veith is Professor of Surgery at New York University Medical Center and the Cleveland Clinic. He is an associate medical editor for Vascular Specialist.

The ideas and opinions expressed in Vascular Specialist do not necessarily reflect those of the Society or publisher.

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