Specialty Spotlight

Vascular Surgery

Ms Mary Barry FRCSI (1987), Chair of the Irish Vascular Society.

Mary Barry (FRSCI, MB BCh BAO LRCPI&SI) was appointed Chair of the Irish Vascular Society in January 2022 for a two-year term. She was awarded MCh in Surgery in 1996 and MD in Surgery in 2004. A er completing Basic and Higher Surgical Training in Ireland, she did further training in London’s Hammersmith, Charing Cross and Ealing hospitals and completed a Fellowship in Complex Aortic Surgery at Erasmus University Hospital, Rotterdam, e Netherlands. In 2002, she was appointed Consultant in Vascular Surgery, St Vincent’s University Hospital and UCD Clinical Associate Professor. Her research interests include outcomes from aortic surgery, quality improvement for diabetic foot disease and the biology of carotid artery disease. She has been published extensively in peer-reviewed journals in all of these areas.

STATISTICS ON THE SPECIALTY

How many consultants? Currently there are 33 Consultant Vascular Surgeons in practice in Ireland. How many trainees? 23 Vascular Surgery Trainees. How many fellowships available in Ireland? ere are a small number of fellowships available in Ireland at St James’s Hospital, Beaumont Hospital and University Hospital, Galway. Is there a gap between the number of Consultants in the specialty and the number required? Yes. How many

Consultant posts do you think are likely to become vacant over the

coming years? ere will be a signi cant number of Consultant posts available over the coming years as retiring consultants are replaced and more importantly as new posts are created. Current recommendations from the Vascular Society advise that there should be one vascular surgeon per 100,000 population which with a current population in the Republic of Ireland of just over ve million equates to 50 vascular surgeons.

WHAT ARE THE STRATEGIC INITIATIVES FOR THE SPECIALTY?

Vascular Surgery is a relatively new specialty having gained independent specialty status from the Irish Medical Council in 2014. We aim to ensure that all patients requiring access to vascular surgical care receive the highest quality treatment in a timely, accessible and equitable fashion. We aim to continue to recruit and train highly skilled vascular surgeons in Ireland. A comprehensive Vascular Surgical Curriculum and Vascular Surgical Training Scheme has been implemented since 2014, supported by very committed vascular surgical trainers. By July 2023, four of our vascular surgical trainees will have completed training and achieved CCST, a huge achievement for a new specialty and a tribute to our dedicated Training Programme Directors over the past eight years.

WHAT ARE YOUR KEY OBJECTIVES WHILE IN OFFICE?

• To complete the Model of Care Document for Vascular Surgery by the end of 2022. is will outline how vascular surgical services are to be provided in Ireland over the next ve to ten years. • To maintain the current high standard of training through promotion of in-person training, remote teaching and practical masterclasses throughout the year. • To promote closer collaboration with the European Society of Vascular

Surgery and the Vascular Society of Great Britain and Ireland. is would provide for international training opportunities in Europe and the UK. ese could be in the form of short or longer term fellowships with the option of fellowship exchange programmes. For those consultant vascular surgeons in practice it could also provide opportunities to undertake shortterm sabbaticals to learn new techniques. • To promote more international research collaboration through co-operation with national and international registries.

WHICH PARTICULAR CHALLENGES ARE FACED BY THIS SPECIALTY IN IRELAND AT PRESENT?

Like all surgical specialties the recent pandemic has resulted in signi cant increases in waiting lists for in-patient and out-patient vascular surgical treatment. Patients are presenting with more advanced disease requiring more complex multi-disciplinary care.

As the incidence of diabetes in Ireland continues to increase, the management of diabetic foot complications is a huge challenge and is projected to become an even bigger problem in the coming years. is population now makes up a signi cant proportion of patients requiring revascularisation. • Sta ng shortages – we will need to recruit more Consultant Vascular

Surgeons. More nurses trained in the care of vascular surgery patients, particularly at Clinical Nurse Specialist and Advanced Nurse Practitioner level will be required. Vascular Physiologists are urgently needed to sta vascular laboratories and Clinical Podiatrists will be required in increasing numbers in the hospitals and community services.

ARE THERE ANY SUB-SPECIALTY AREAS THAT YOU SEE PARTICULAR NEEDS IN, AND HOW CAN THEY BE ADDRESSED?

Diabetic foot management – this requires urgent development of pathways of care so that this population of patients is seen quickly and treatment commenced as quickly as possible to reduce the risk of lower limb amputation. Development of rapid access multi-disciplinary Diabetic Foot Clinics is a priority. Peripheral Arterial Disease – the majority of patients with PAD can be managed with best medical therapy and exercise programmes. e provision of supervised exercise programmes nationwide would be of huge bene t to this population of patients and greatly enhance their quality of life. Venous Disease – there are now very long waiting lists for patients with varicose veins and venous ulcers. is can be addressed through more e cient and expeditious assessment of these patients using de ned referral pathways. Expansion of more ambulatory facilities to treat these patients by endovenous methods under local anaesthesia would remove the need for access to major theatre facilities and greatly improve e ciency and the patient experience. Closer liaison with Medicine for the Elderly Services – for in-patient vascular surgery patients with dedicated sessions provided by Medicine for the Elderly Consultants should be a priority. is collaboration has been shown internationally to reduce peri-operative complications, reduce length of stay and improve outcomes in this frail elderly population.

WHAT WOULD YOU SAY TO SURGICAL TRAINEES CONSIDERING A CAREER IN THIS SPECIALTY?

Vascular Surgery is a very exciting specialty with an enormous variety of disease presentations. It is constantly evolving with new techniques being developed every year.

It requires a surgeon to be trained to a very high level of surgical technical skill and precision in both open surgical and endovascular procedures. e vascular surgical trainee must now acquire skills not only in surgery but also in endovascular techniques such as peripheral arterial angioplasty, endovenous ablation for varicose veins and endovascular management of abdominal and thoracic aortic aneurysms. e current training scheme provides opportunities not only in learning surgical skills but also to become pro cient in vascular ultrasound, uoroscopy and advanced wire skills.

For those trainees who seek academic advancement with well-established MCh and MD programmes available within Ireland, opportunities are provided. ere are also long-established links with international centres providing excellent opportunities to undertake post-CCST specialist fellowship training in Canada, North America, Europe, the United Kingdom and Australia.

Training as a vascular surgeon requires signi cant commitment and a lot of hard work. However, it is a most rewarding specialty and has the bene t of allowing the surgeon to work with a wide variety of specialties within the hospital.

DATES AND KEY UPCOMING EVENTS TO NOTE

2023 will be very exciting and signi cant for Irish Vascular Surgery with the two major international vascular surgical meetings being held on the island of Ireland. 3 February 2023: Charter Day Meeting, RCSI – Vascular Session: Arti cial Intelligence in Complex Aortic Surgery and Vascular Radiology. Model of Care for Lymphoedema. 26-29 September 2023: European Society of Vascular Surgery Annual Meeting 2023 – Belfast. 22-24 November 2023: e Vascular Society for Great Britain and Ireland Annual Meeting 2023, Convention Centre, Dublin. 2023: New Guideline Publications from European Society of Vascular Surgery (Anti-thrombotic erapy for Vascular Surgery; Management of Descending Aortic Diseases; Management of Peripheral Artery Disease). May 2024: Joint Irish Vascular Society/Northern Ireland Vascular Society (IVS/NIVASC Meeting) – date to be con rmed.

A SPECIAL MENTION

I would like to take the opportunity to send the congratulations of all members of the Irish Vascular Society to Mr Prakash Madhavan, Consultant Vascular and Endovascular Surgeon in St James’s University Hospital who has been awarded a Lifetime Achievement Award at the recent Vascular Society of Britain and Ireland in Brighton in November 2022. Prakash is the rst Irish Vascular Surgeon in the history of the Vascular Society to win this award. It is richly deserved and a testament to Prakash’s unstinting hard work as not only a vascular surgeon but also as an educator, surgical trainer and most of all as a surgical innovator. ■

The vascular surgical trainee must now acquire skills not only in surgery but also in endovascular techniques such as peripheral arterial angioplasty, endovenous ablation for varicose veins and endovascular management of abdominal and thoracic aortic aneurysms.