24
June
Issue
18 78
Interview
Profile
Tilo Kölbel
Coming from a family of medical professionals, Tilo Kölbel was destined to become one himself. He tells Vascular News about his journey to becoming a vascular surgeon, the proudest moments in his career and the research that he is currently doing, as well as his interests outside of medicine.
Why did you decide you wanted a career in medicine, and why in particular did you choose to enter the vascular field? My medical career was guided by serendipity, mostly. I was exposed to the medical profession throughout my childhood; with my father being an orthopaedic surgeon and my mother a general practitioner. Patients, treatments, and reimbursement issues were topics of everyday dinner conversations throughout my childhood. I never thought of becoming a physician myself until friends convinced me to sign up for the medical school admission-tests at the last minute. Fortunately, with good marks, I gained the option to enter medical school directly. All surgical fields I worked in were interesting and I would have been happy with a career in urology, orthopaedic surgery, or general surgery. But I chose vascular surgery because I noticed that the general surgeons I worked with during my training were overly cautious of vascular damage. So much so, that they sometimes limited surgery just to stay safely away from major vasculature. The limitations I witnessed helped me understand that vascular surgery experience would make me a better surgeon; and allow me to perform surgery as extensively as necessary.
Who have been your most important career mentors and what lessons did they teach you?
Many colleagues taught and influenced me throughout my career. Bengt Lindblad gave me confidence in operating and stimulated my curiosity for research. Mats Lindh taught me the principals of vascular interventions and shared his vast knowledge on interventional materials with me. Krassi Ivancev inspired and encouraged me to change what requires change, and that endurance can overcome most hurdles. Martin Malina believed in my ideas and encouraged my steps forward in device-development. Sebastian Debus gave me the opportunity to co-develop a cutting-edge aortic programme and to refine treatment principles in complex aortic therapies. But perhaps the most vital lessons come from experience. With every case, I learn something new alongside the colleagues I have the privilege of working with. And most importantly, my patients continue to teach me to value their health and wellbeing, and that every aortic case needs to be judged individually with respect to their needs.
How have you seen the field develop during the course of your career?
I began to follow aortic treatment techniques and principles in 2004 when I moved to the Malmö Vascular Center in Sweden. Most basic treatment principles and techniques were already established at that point—and, in all areas, refinement and technical improvements have characterised the development trend since then. Fenestrated and branched aortic endografts have been applied to all areas of the aorta since. A major breakthrough for proximal aortic therapies, in my memory, was the use of trans-cardiac access techniques; such as the transseptal and transapical access techniques used for structural heart interventions. At the same time, open and hybrid techniques have developed around frozen elephant trunk.
What new vascular technology are you watching closely and why?
Not all patients are suitable for endovascular repair due to anatomical reasons and certain comorbidities. I follow closely developments such as the spider-graft for thoraco-abdominal repair to improve open surgical and hybrid techniques—in hopes of offering less invasive treatments for patients who are currently contraindicated for endovascular repair. But some of the techniques and implants, especially those which promise easy solutions for complex problems—like the Multilayer Flow Modulator or simple aortic arch stents for type A aortic dissection—should be watched with caution, as the described mechanism of action may be both unproven and far too optimistic to be true. My interest in new developments for this space is motivated by the fact that I frequently have to deal with failed previous repairs. Aneurysm sac-filling technologies are also of interest, and I am glad to see that more companies are developing polymers that may work without a bag and independently of the main graft. Lastly, cerebral protection devices have become frequently used tools in transcatheter aortic valve implantation (TAVI). I follow this technology with great interest as we will need to focus more on safeguarding neurological outcomes in thoracic endovascular aneurysm repair (TEVAR) in the near future.
What is the most interesting paper or presentation that you have seen recently?
In the British Journal of Surgery, AH Perera et al present a study on neurological outcome after TEVAR with a surprisingly high frequency of new silent brain infarctions, over 80%, with presentation of neurocognitive decline of the same frequency. This study uses up-to-date examination to get a realistic impression of the neurologic damage during TEVAR.
What are your current research interests?
My main research interests lie in a number of different areas: Stroke prevention in TEVAR, the role of air embolism and techniques to prevent stroke together with Fiona Rohlffs and Vladimir Makaloski. Clinical outcomes of complex aortic arch intervention together with Nikos Tsilimparis. Development of a new hybrid-graft for thoracoabdominal aortic aneurysm (TAAA) repair: the Spider-graft together with Sebastian Debus and Sabine Wipper. Spinal cord ischaemia prevention techniques in porcine models together with Sabine Wipper. Trans-femoral access for branched EVAR in TAAA with Nikolaos Tsilimparis. False lumen occlusion techniques together with Fiona Rohlffs.
What were the aims and findings of the Stroke from Thoracic Endovascular Procedures (STEP) collaboration?
The STEP study aims to reduce the risk of stroke during TEVAR. Early goals of the initiative are to define best
practices in TEVAR; identify stroke-prevention strategies; and define meaningful outcome measures in cooperation with vascular and cardiovascular surgeons, clinical neurologists, cardiologists, and manufacturers of endografts. The main findings are that, among a group of 18 world-experts nominated by stent graft manufacturers, a significant experience with aortic arch endografting exists. There was broad consensus in some areas like anticoagulation during treatment and the use of cardiac output reduction in proximal landing zones. No consensus exists, presently, in revascularisation strategies of the left subclavian artery, which may play a significant role in stroke. Additional first-phase results were highlighted during the STEP-presentations at the 2018 Charing Cross Symposium.
