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Interview with Giorgio Biasi, MD

ISVS POSITION REGARDING SESSIONS & CONGRESS

Introducing the ISVS Women's Committee

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Chaired by Allison Halliday, MD (United Kingdom)

NEW! ANNOUNCING THE

PROMISING INVESTIGATOR AWARDS

JOAN L. AND DR. JULIUS H. JACOBSON II

July 18, 2008: Through a generous contribution made by Joan L. and Dr. Julius H. Jacobson II, every year, The International Society for Vascular Surgery will award two (2) ISVS junior members, $1,000 each, for research projects on "Vascular Biology and/or Microcirculation" to acknowledge their work.

The first award will be presented to one winner at the ISVS meeting, (based on the best oral presentation, at the X Pan American Congress on Vascular and Endovascular Surgery (Rio de Janeiro - Brazil) taking place October 28 - November 1, 2008).   Your work will be considered for publication in "VASCULAR"). Please download and follow the instructions on how to compete for this award.

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THE FUTURE IS ENDOVASCULAR SCHOLARSHIP AWARD

MADE POSSIBLE THROUGH A MEDICAL EDUCATION GRANT FROM MEDTRONIC

July 18, 2008: Through a generous medical education grant provided by Medtronic, we are pleased to announce that ISVS member junior candidates applying to the September 2009 6 month fellowship training program at AZ Saint-Blasius, Dendermonde, Belgium, will now have an opportunity to win a generous scholarship to offset costs. Log in to the ISVS members portal to complete the fellowship training application.

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ISVS FELLOWSHIP TRAINING PROGRAM

The ISVS fellowship program was established to offer Society members an opportunity to acquire training in endoVascular Surgery that they would not otherwise be able to obtain in their own institution / training program.

Some are intended for relatively inexperienced trainees and will offer a broad introduction to the principles and practice of endovascular therapy. Others are intended for more senior trainees or for those who have completed their training in Vascular Surgery. These will offer comprehensive training in all aspects of endovascular therapy and/or specific training in complex interventions such as CAS, EVAR and Subintimal Angioplasty.

Currently we have fellowships at the following institutions:

• Cleveland Clinic (Cleveland, OH) USA (3 month program)-Next opening October 2009
• St. Blasius Hospital in Dendermonde, Belgium (6 month program) - Next opening September 2009
• San Gerardo Teaching Hospital, University of Milan, Italy (3 month program) - Next opening January 2009
• Hospital Clinic of Barcelona, Barcelona, Spain (6 months, maximum 24 months) - Next opening September 2008

Inquire: isvs@isvs.com

 

Position Statement
Vascular Surgery as a Separate Specialty

The International Society for Vascular Surgery (ISVS) was formed in 2003 by a group of individuals determined to equip vascular surgeons to face the future with confidence. At that time, Vascular Surgery was facing an uncertain future because of advances in endovascular treatment of diseases normally dealt with by open surgery. Interventional radiologists and cardiologists were starting to treat patients normally dealt with by vascular surgeons and profound changes in the education and training of vascular surgeons were needed. With appropriate changes in training, vascular surgeons could offer patients a full spectrum of treatments including medical therapy and endovascular or open surgery which interventionalists and cardiologists could never do. Some progress in this direction has been made worldwide but in order to achieve our aims it is essential that we have full control of our destiny and especially our training and to that end it is vital that we become an independent specialty worldwide. Unfortunately this has still not happened and the time has come for vascular surgeons everywhere to try and do something about it. It is not surprising that the most progress has been made in countries where Vascular Surgery is already a specialty in its own right. In order to help others to achieve specialty status it might be worthwhile going over some of the reasons why we are in our current position in some countries and the arguments that could be made to change things.

Although Vascular Surgery has been established for over 50 years it remains in many parts of the world a part of General Surgery. This is because General Surgery was the over-arching specialty for many of the areas of surgery which have since achieved recognition in their own right; these of course include subjects such as Orthopaedics, Urology, Cardiac Surgery, Neurosurgery etc. General Surgery used to be the ideal way of dealing with surgery in general when there were no specialties and one surgeon could deal with everything because often little was known about the subject and the great surgeons of yester year were truly general surgeons often doing pioneering operations as they went along and dealing with most things that came their way. However, there have been huge changes in technology, anaesthesia, instrumentation and the approach to surgery which means that this is no longer a viable proposition. Many parts of the old General Surgery have already recognised this and after a struggle usually led by one or two far sighted individuals managed to achieve independence and then progressed with great benefit to their patients.

The whole idea of a specialty called "General Surgery" in this day and age is nonsense. The title is so confusing that no one can even define what it means but the best attempts usually come down to abdominal surgery. Even this attempt at rationalisation is ridiculous as we have to exclude the specialties of Urology and Gynaecology so why not simply consign General Surgery to the dustbin where it belongs and call it gastrointestinal surgery and the rest can be separate specialties as they should be. If this is so obvious why has it not happened yet? The reasons are complex but often relate either to apathy , a desire to maintain the status quo for reasons of power and influence or because change would be too difficult. Apathy is easy to deal with but opposing firmly entrenched power brokers is not. The reasons why it might create difficulty relate to the problem of providing emergency care to small communities which can easily be resolved in a variety of ways.

Why should Vascular Surgery became a specialty as opposed to being part of an umbrella organisation such as General Surgery? There are several obvious reasons why it should be separate and the most important is patient care. It is no longer acceptable for patients to be exposed to surgeons who are unable to give them the best possible treatment. Surgery is now so complex that only specialists can really treat certain conditions properly. More and more ,publications are showing that outcomes are unit and volume dependant so that only those who do a lot of cases can get the results our patients deserve. This depends on cases being referred to a vascular surgeon in significant numbers rather than small numbers being sent to several general surgeons. How can a general surgeon who has not been exposed to all the training needed to deal with the complexity of Vascular Surgery offer the patient a good deal? Because of the enormous expansion in Vascular Surgery it is no longer possible for any general surgical trainee to learn the subject properly. This is partly because the time allowed for training is getting less year by year and in Europe will soon be only 48 hours, a figure which will inevitably be followed in other countries .It is only possible to learn one specialty properly in this time because surgeons need "hands on" experience to do operations safely , reading a book will not do. Add to this the fact that Vascular Surgery has undergone an endovascular revolution and you have an additional problem because training has to change even more rapidly and effectively than before. Finally, it is vital that any subject is in control of its own destiny. In this way leaders can emerge and progress be made in research to make treatments even better. Fundamental decisions need to be made about the levels of training, special centres to handle complex procedures and training in Laparoscopic surgery etc. How can a general surgeon who is often a gastrointestinal surgeon understand all of this let alone make sensible suggestions to take matters forward.

Many parts of the world have recognised these problems and made Vascular Surgery a specialty . It is no coincidence that in those countries research flourishes, recruitment of trainees increases and treatments improve. It is time that vascular surgeons all over the world, now escape from the constricting influence of General Surgery and in some countries Cardiovascular Surgery so that patients can benefit. National societies in countries where Vascular Surgery is still not a specialty should now declare their intention to make it one and join the ISVS to convince governments to recognise the potential harm to patients if the system is allowed to continue in its present form. No one would let a mechanic who usually services a ford service their Rolls Royce, they would go to a specialist .It would appear that when it comes to patients almost anyone will do.

Since 2003, the ISVS objectives were to take Vascular Surgery forward on an international basis to face the challenges ahead. For the reasons outlined above we need to make Vascular Surgery a specialty worldwide and then bring together the international community of vascular surgeons to speak with a single voice on training, standards and access to education.. At the moment, because of the influence of General Surgery and to a lesser extent Cardiovascular Surgery, our aims cannot be fully realised. We can only do this if we are a single specialty and you are asked to do what you can in your country by lobbying your surgical organisations colleges and governments to make it happen. The ISVS is here to help in these efforts. Engage our support!

Signed By
Giorgio M. Biasi, MD – President (Italy)
Sir Peter RF Bell, MD-Immediate Past President (United Kingdom)
Martin Malina, MD-Vice President (Sweden)
Vincent Riambau, MD-Vice President (Spain)
Frank J. Veith, MD-Treasurer (USA)
Rajiv Parakh, MD-Secretary (India)

It was a great honour for me to be appointed President of the ISVS following the presidency of Sir Peter Bell, who gave an imprint of scientific excellence with an international flavour.

The Society was established in 2003 and already in the vascular community everybody is talking about it, which is a sign of great vitality and impact on the needs of the entire international vascular community. The ISVS is the only international society totally devoted to vascular surgeons and to the unique and fascinating evolution that we are all going through with the advent of endoluminal procedures.

The endovascular journey started some 20 years ago and fortunately has not yet ended. Some conceived the idea, put it into practice and then started their journey together with many companions, vascular surgeons, cardiologists and radiologists, to mention just a few, sharing their enthusiasm and talent.

What will be the role of Vascular Surgery in the future is not yet known but the ISVS, although with no intent of corporatism, is standing to assert the reasons and duties of the category.

Perhaps a new figure will prevail, the Interventional Vascular Specialist (IVS), not a vascular surgeon but certainly not an interventional radiologist nor an interventional cardiologist.

The pure endovascular approach for the repair of vascular lesions will be part of the main. A wide range of hybrid procedures will be more and more required and the 'pure vascular surgeon' as well as 'pure interventional cardiologist or radiologist' will not suffice and inevitably will be destined to disappear.

The ISVS will accompany all of us on this fascinating journey, keeping all members continuously informed on "What’s Going on in the World" through a bulletin from the Society on the ISVS web page but mainly through the organization of congresses, seminars, master-courses with hands-on sessions, etc., privileging those areas worldwide which are emerging and rapidly developing.

Please join us on this exciting journey!

Giorgio M. Biasi, MChir, President ISVS

Many of you are already aware of increasing attempts by national vascular societies to "internationalise" themselves by trying to attract overseas members. The main goals and concern of national societies is to focus in on national rather than international Vascular Surgery issues, as this must remain their primary concern.

Because of this drive by national societies to gain new overseas members, I thought it appropriate to remind you of the mission of the ISVS, which is different to that of national societies. National societies rightly have a duty to look after members of their geographical area as well as do their best to ensure that they prosper. The hard work that they do must be recognized and applauded because it is helping to take our specialty forward.

I can speak with some authority in this area, as I was a founding member of the European Society for Vascular Surgery (ESVS). My colleagues and I founded the ESVS because we wanted to improve science and Vascular Surgery in Europe, which the Society has done and continues to do very well.

This year, the ISVS has a number of important objectives that can clearly benefit our specialty universally: The first is to ensure that Vascular Surgery becomes a specialty worldwide. This may also be the objective of many other national societies, but not all of them and in many places Vascular Surgery remains in the shadow of General or Cardiovascular with little prospect of becoming what it must be a stand alone specialty.

For example, Vascular Surgery remains a subspecialty of General Surgery in the United States and although some surgeons are trying to change this there, remains resistance from the higher echelons of the surgical establishment. In the UK for many years, the vascular society was against separate specialisation but this has now changed and attempts are being made to persuade the colleges to recognise it as a separate specialty. Until the attitude of those societies who do not currently represent a separate specialty changes, there seems little point in them or any other national society to promote themselves as an international body fighting for universal independence.

It must be emphasized that our mission is to try to make Vascular Surgery a specialty worldwide, which is essential if we are going to survive. Moreover, we also want to raise standards and offer members an opportunity to be involved in training programmes to access techniques, which they cannot access at home. This will particularly help members in developing countries. Finally, we also hope in the future to send council members to developing countries to assist them in their programmes. Vascular Surgery is under threat worldwide and unless it is coordinated properly in an international manner with access to training in particular and specialty status, it may not survive in the long term.