Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Revolutionizing vascular surgery: How embracing endovascular techniques saved the specialty

Frank Veith, MD
Physician
February 15, 2023
Share
Tweet
Share

An excerpt from The Medical Jungle: A Pioneering Surgeon’s Battle to Revolutionize Vascular Care and Challenge the Medical Mafia.

Still no matter what anyone said, I knew in my heart that endovascular grafts and endovascular aneurysm repair were going to be a game-changer and that vascular surgeons had to get involved to prevent interventional specialists from taking the lead in this technology. In other words, if vascular surgeons did not embrace endovascular skills and techniques, they would rapidly be replaced by interventionalists in cardiology and radiology, and vascular surgery would become diminished or extinct as a specialty. We would be out of the game. And I did not want this to happen.

I made this point most emphatically in 1996 as the president of the Society for Vascular Surgery. My presidential address to the esteemed SVS was titled: “Charles Darwin and Vascular Surgery.” It was a speech that certainly went against the grain as it dealt with the evolution of vascular surgery and how we had to change and evolve as a specialty in order to survive and prosper.

For starters, you might wonder: What was the possible relevance Darwin, the famous English naturalist and the father of the theory of evolution, could have to vascular surgery?!

I first recounted Darwin’s theory of evolution by natural selection, first formulated in his book, On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life. In this classic volume, published first in 1859, Darwin pointed out the process by which organisms change over time as a result of changes in heritable physical or behavioral traits. Changes that allow an organism to better adapt to its environment will help it survive and have more offspring.

Using Darwin’s work as a metaphor, I likened specialties to species and indicated that medical specialties, like species, had to evolve and become different from their ancestors if they were to avoid extinction and survive. I also made three predictions and associated recommendations for future survival adaptations. Two of these recommendations proved to be unworkable or unsuccessful. One proved to be remarkably right.

One errant recommendation was that we work collaboratively and congenially with interventional radiologists or cardiologists in dedicated vascular centers. The idea was that we could learn from one another, sharing our skill sets for the betterment of all. That kumbaya recommendation proved unworkable because of medical tribalism, competitive human nature, and greed. The three specialties involved in treating blood vessels—vascular surgeons, interventional radiologists, and interventional cardiologists—all wanted to be dominant and in control of patients and the resultant dollars earned.

A second recommendation was that vascular surgery become more independent as a specialty, separate from general and cardiac surgery, just like the specialties of neurosurgery, orthopedics, urology, obstetrics and gynecology, plastic surgery, and cardiothoracic surgery.

As I wrote: “Vascular Surgery’s evolution and separation are inevitable because its members are better adapted, more ‘fit’ by virtue of training and experience to care for vascular disease patients … Darwin would predict that forces of evolution will result in the distinct separation of our specialty … which would eliminate much conflict of interest and probably be best for all concerned,” most notably the vascular patients that we served.

With that point in mind, I knew that we, as vascular surgeons, needed to separate administratively and gain an American Board of Medical Specialties (ABMS)–recognized governing board and Residency Review Committee (RRC). A vigorous attempt to accomplish this was made between 1996 and 2007, but failed. As a result, vascular surgery still remains a subservient subspecialty in North America, although it is not in most other parts of the civilized world.

My third recommendation in 1996 was prophetic and fared better. I predicted an endovascular revolution and recommended that vascular surgeons had to become competent in all endovascular techniques, embracing and practicing these new techniques. Otherwise, they would risk extinction.

In this 1996 address, I predicted that within ten years, 40 percent to 70 percent of the open operations we were then doing would be replaced by endovascular procedures. And many of the remaining “open” operations would be improved and simplified by using the endovascular adjuncts that were available (such as catheters, guidewires, sheaths, digital fluoroscopy, balloons, stents, and EVGs). All this certainly turned out to be true in spades!

Accordingly, in this 1996 address I recommended that vascular surgeons, if they wished to survive, had to become endo-competent, acquiring catheter-guidewire-imaging skills that would enable them to perform all sorts of endovascular treatments.

ADVERTISEMENT

Although this recommendation was greeted with disdain and strongly resisted by many senior vascular surgeons at the time, this resistance was gradually overcome. Our specialty has embraced the endovascular revolution and become endo-competent. This is why vascular surgery is doing as well as it is today. Indeed, vascular surgeons often lead in developing many of the evolving endovascular procedures that are currently the standard of care.

Yet this speech, like the one two years before, was greeted as far-fetched and wrong-headed by many of the vascular leaders of the day—certainly by the older ones. But no matter. Here it is twenty-six years later and up to 80 to 95 percent of all vascular lesions are or will be best treated by endovascular means, though some vascular patients still require open operations.

Frank Veith is a vascular surgeon and author of The Medical Jungle: A Pioneering Surgeon’s Battle to Revolutionize Vascular Care and Challenge the Medical Mafia.

Prev

Navigating institutional betrayal in health care [PODCAST]

February 14, 2023 Kevin 0
…
Next

Lessons from a civil rights icon: How to lift as we climb

February 15, 2023 Kevin 0
…

Tagged as: Surgery

Post navigation

< Previous Post
Navigating institutional betrayal in health care [PODCAST]
Next Post >
Lessons from a civil rights icon: How to lift as we climb

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

Related Posts

  • Why cataract surgery is more complicated than it should be

    Brian C. Joondeph, MD
  • Robotic surgery’s impact on training the next generation of surgeons

    Barry Greene, MD
  • Women in surgery: a tweet to action

    Sarah Shubeck, MD and Arielle Kanters, MD
  • Americans and Canadians use more post-surgery opioid pain pills

    Julie Appleby
  • The necessity for the globalization of surgery and its barriers

    Jeremy Goodwin
  • This patient got an estimate before surgery. The bill was so much more.

    Rachel Bluth

More in Physician

  • When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise

    Muhamad Aly Rifai, MD
  • How grief transformed a psychiatrist’s approach to patient care

    Devina Maya Wadhwa, MD
  • Fear of other people’s opinions nearly killed me. Here’s what freed me.

    Jillian Rigert, MD, DMD
  • What independent and locum tenens doctors need to know about fair market value

    Dennis Hursh, Esq
  • How one simple breakfast question can transform patient care

    Dr. Damane Zehra
  • Nurses are the backbone of medicine—and they deserve better

    Matthew Moeller, MD
  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Why no medical malpractice firm responded to my scientific protocol

      Howard Smith, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Bridging the digital divide: Addressing health inequities through home-based AI solutions

      Dr. Sreeram Mullankandy | Tech
  • Past 6 Months

    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • How to build a culture where physicians feel valued [PODCAST]

      The Podcast by KevinMD | Podcast
  • Recent Posts

    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Reimagining diabetes care with nutrition, not prescriptions

      William Hsu, MD | Conditions
    • Why funding cuts to academic medical centers impact all of us [PODCAST]

      The Podcast by KevinMD | Podcast
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise

      Muhamad Aly Rifai, MD | Physician
    • How grief transformed a psychiatrist’s approach to patient care

      Devina Maya Wadhwa, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Why no medical malpractice firm responded to my scientific protocol

      Howard Smith, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Bridging the digital divide: Addressing health inequities through home-based AI solutions

      Dr. Sreeram Mullankandy | Tech
  • Past 6 Months

    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • How to build a culture where physicians feel valued [PODCAST]

      The Podcast by KevinMD | Podcast
  • Recent Posts

    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Reimagining diabetes care with nutrition, not prescriptions

      William Hsu, MD | Conditions
    • Why funding cuts to academic medical centers impact all of us [PODCAST]

      The Podcast by KevinMD | Podcast
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise

      Muhamad Aly Rifai, MD | Physician
    • How grief transformed a psychiatrist’s approach to patient care

      Devina Maya Wadhwa, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...