BEST-CLI INVESTIGATORS IMPLORE A MOVE BEYOND ENDO VS. OPEN ‘BATTLE’ IN THE NAME OF SCIENTIFIC ADVANCE

The principal investigators behind the BESTCLI trial struck a conciliatory tone during the inaugural Frank J. Veith Distinguished Lecture yesterday morning in which they laid bare the blood, sweat and tears shed on their journey to complete the landmark study.

The headline findings that emerged out of the trial—that both open and endovascular procedures were equally safe, and that chronic limb-threatening ischemia (CLTI) patients deemed suitable for either approach who had an adequate great saphenous vein experienced better overall clinical outcomes after open bypass surgery— sparked rancor in the interventional surgical communities.

Yet, Alik Farber, MD, and Matthew Menard, MD, used the maiden Veith Lecture to shine a light down a path toward further advances in end-stage peripheral arterial disease (PAD) care.

The pair used the platform to tell the story of their journey in order that others might take the leap of faith they did to tackle “impactful questions in science,” Farber told VAM 2023 attendees.

They first got together to develop the idea for a trial to compare open vs. endo treatment for CLTI in 2007. “It really was the blind leading the just as blind,” quipped Menard. As Farber described, personally he had very little experience in clinical trials at the time. “There was a lot of insecurity,” he said. “Were we really the right people to do this?” he recalled thinking back then.

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13 CLTI Frailty status beats WIfI in all-comers

13 Word on the street VAM attendees chime in on CLTI trials www.vascularspecialistonline.com

Spot Light

Up Today And Tomorrow

FRIDAY KICKS OFF WITH the International Fast Talk Scientific Session at 6:30 a.m. Three breakfast sessions will cover developing a successful and funded clinical research program to improve patient care, fundamentals and advances in managing pulmonary embolism and advocacy work.

Another international session, the International Forum Scientific Session, takes place from 7:15–8 a.m., also in Maryland A.

From 11 a.m.–12:15 p.m., the spotlight belongs to outgoing President Michael C. Dalsing, MD, and his Presidential Address

The Community Practice Section holds its special session for its members from 1:30–3 p.m. At 2:45 p.m. section leaders will announce this year’s recipients of the Excellence in Community Practice Award

From 3:30–5 p.m., the Young Surgeons Section will hear topics relevant to their career stage.

The Exhibit Hall remains open from 9:30 a.m.–5 p.m. The Career Fair (9 a.m.–3 p.m.) and Residency Fair (1:30–3 p.m.) round out the day. SVS Central is open from 9:30 a.m.–5:30 p.m.

Then it’s time to visit the Roaring Twenties, at the SVS Foundation “Great Gatsby Gala” (7–11 p.m.). An After Party takes place 11 p.m.–1 a.m. Saturday.

Saturday, meanwhile, will feature the final two plenaries, the Poster Competition championship, and the Roy Greenberg Distinguished Lecture

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International Chapter

Generational divide:

Medical Editor Malachi Sheahan III, MD

Associate Medical Editors

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| Robert Fitridge, MD | Dennis R. Gable, MD Linda Harris, MD | Krishna Jain, MD Larry Kraiss, MD | Joann Lohr, MD

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| Leila Mureebe, MD | Frank Pomposelli, MD David Rigberg, MD | Clifford Sales, MD Bhagwan Satiani, MD | Larry Scher, MD Marc Schermerhorn, MD | Murray

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Vascular Specialist is the official newspaper of the Society for Vascular Surgery and provides the vascular specialist with timely and relevant news and commentary about clinical developments and about the impact of healthcare policy. Content for Vascular Specialist is provided by BIBA News. Content for the news from SVS is provided by the Society for Vascular Surgery. | The ideas and opinions expressed in Vascular Specialist do not necessarily reflect those of the Society or the Publisher. The Society for Vascular Surgery and BIBA News will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services, or the quality or endorsement of advertised products or services, mentioned herein. The Society for Vascular Surgery headquarters is located at 9400 W. Higgins Road, Suite 315, Rosemont, IL 60018. POSTMASTER: Send changes of address (with old mailing label) to Vascular Specialist, Subscription Services, 9400 W. Higgins Road, Suite 315, Rosemont, IL 60018.

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OLDER-GENERATION VASCULAR SURGEONS ARE KEEN

TO hone their endovascular skills, while the younger generation are looking to develop their capacity to treat aortic pathologies—but surgeons at all stages in their career favour hands-on learning to continue their development.

These are among the key findings of a multi-generational survey of Mexican vascular surgeons, intended to gain a greater understanding of the training and developmental needs of the country’s growing vascular community.

“We are a facing a change in Mexico, where an increase in the number of vascular surgeons is needed, so the response has been to open more hospital programs and more available positions,” Rodrigo Garza-Herrera, MD, representing the Mexican Society for Vascular Surgery, told delegates at yesterday morning’s International Chapter Forum Educational Session.

Garza-Herrera explained that the number of vascular surgeons practicing in Mexico is expected to expand rapidly in the coming years, from around 1,100 now to more than 1,600 by 2026. Consequently, the millennial generation—those born between 1980–1996—will make up a greater proportion of the workforce by the end of the decade, in creasing from 43% at the current count, to an estimated 63% in 2026.

To understand whether these demographic changes will impact the training needs of its vascular community, the Mexican Society has surveyed all of the vascular surgeons practicing within the country, and the results of the survey have informed the development of new training initiatives and programs. The work has also shone a light on some important differences—and similarities—spanning the generational divide.

In total, 356 individuals took part in the survey, pre- continued from page 1 biology and expecting to be a scientist, before making “potentially one of the most consequential decisions of [his] life” and taking the Medical College Admissions Test (MCAT), thus launching a long and celebrated career in vascular surgery.

Alongside his personal and professional journey to SVS president, Dalsing will deliver a sweeping history of vascular surgery, and outline how the twists and turns of certain decades were pivotal in defining vascular surgery as the distinct specialty that it is today, as well as some of the challenges that it presently faces.

In the 1940s, he will say, vascular surgery was “coming of age.” In the 1970s and early 1980s, training, certification, and defining the specialty took “center stage,” and the endovascular revolution of the 1990s and 2000s, he will continue, saw a vascular surgery field that was “changing fast.”

The president, who is professor emeritus in the Division of Vascular Surgery at Indiana University School of Medicine in Indianapolis, will reflect on his current position within the vascular surgery field, paying honorable mention a “long list” of individuals who have influenced his career over the years. He will dominantly male (74%) and mainly from the millennial generation (46%), followed by generation X (34%) and those from the baby boomer generation (20%).

The survey suggests that there is a far greater proportion of women entering Mexico’s vascular surgery field, with men outnumbering women 8:1 in the boomer generation, compared to 1.6:1 in among the millennials, a trend that Garza-Herrera said he “hopes to see continuing.” also describe the “immense joy” at seeing the next generation of vascular surgery residents and fellows serve their communities as “compassionate and skilled vascular surgeons,” in addition to being “exceptional people.”

Surgeons were also polled on their academic needs, with seven key fields identified for them to prioritize their areas of strength and weakness, including: venous pathology, open arterial surgery, endovascular therapy, vascular access, aortic disease, vascular anomalies and advanced wound care.

Venous pathology was reported as the biggest strength in 41% of participants, whereas the greatest weakness was vascular malformation, chosen by 52% of respondents—an area that was particularly pronounced among millennials, 63% of whom selected this criteria. The survey asked participants to identify the areas where they felt the greatest need for improvement, to which 54% felt that they need to improve their endovascular skills, and 32% felt that an increased competence in treating vascular malformations is needed.

“Baby boomers showed the highest need for improving endovascular skills and millennials showed the highest need to improve their capacities in the treatment of aortic pathology,” Garza-Herrera commented, pointing out a generational difference highlighted through the survey responses.

Results from the survey, which was conducted in 2020, have already shaped training initiatives being put into practice in Mexico.

Dalsing’s talk will argue that vascular surgery is “unique” as a specialty, in that it involves the care of a patient from initial contact to the end of their life. As a result, specialists “must master several dissimilar skillsets requiring years of training.”

The specialty is, however, a “hidden gem,” Dalsing will say, which he highlights as a problem.

“In general, people do not know what we do,” meaning the specialty risks being “overlooked as a needed partner in discussions about our patients’ care.”

And this is all in the context of an aging population and its “increasing demands,” being served by a “finite” number of providers.

This is where the SVS comes in, Dalsing will state, with its role extending far beyond the calendar highlight that is VAM. “SVS is literally reinventing itself as it evolves and moves forward to integrate dozens of new innovative ideas currently under consideration for implementation. This process happens year over year. We are coming of age as a mature organization,” he will tell attendees.

And who but the SVS will advocate for the interests of vascular surgeons? Dalsing will ask. “No one!” He will stress that the SVS is a small group that “must speak with a strong and unified voice to be heard,” all in the interest of vascular patients, as well as members’ wellbeing.

“We are the champions of quality vascular care. We must embrace this role and encourage those who want to be on the vascular team,” Dalsing will say.

He will express his belief in the need to market to the general population—a seemingly “unattainable” goal by his own admission, but one he feels is the “endgame” if there is a desire to be recognized as the “undisputed champions of quality vascular care.”

He will define the scope, the added value the specialty brings, and a general impression of the players involved. The next steps? According to Dalsing, “defining the rules of engagement and tactics to be used for success” with education as a “centrepiece” of this effort.