What you need to know about vascular Surgery

Vascular surgery is a surgical subspecialty in which diseases of the vascular system, or arteries, veins and lymphatic circulation, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. https://en.m.wikipedia.org/wiki/Vascular_surgery

History of Vascular Surgery

In 1990, Dr H. Brownell Wheeler, was the first to pose the question, “Should vascular surgery become an independent specialty?” in a presentation at the Critical Issues Forum at the Society for Vascular Surgery (SVS).1 At that time, there were only 1045 surgeons with added or special qualifications in vascular surgery, nowhere near enough to handle all of the 547 000 vascular procedures done in nonfederal acute care hospitals that year. Even so, fewer than 10% of general surgeons in 1989 did 10 or more index vascular cases each year and 70% did not do a single aortic aneurysm.

At the same time, less than 10% of vascular surgeons did 10 or more of the most common general surgical procedures. Despite these findings, Dr Wheeler concluded that, “Organizationally, for purposes of accreditation and certification, there is no reason for vascular surgery to break off from the main body of general surgery.”

Six years later, in Dr Frank Veith’s well-known and prescient 1996 SVS presidential address: “Charles Darwin and Vascular surgery,” Veith outlined three steps that vascular surgery needed to take to advance and preserve our specialty or face certain extinction.2 First, vascular surgeons must acquire endovascular skills. Second, we must form multidisciplinary vascular disease centers. Third, we must change the relationship between vascular surgery as represented by the SVS/ISCVS and the bodies that govern it. His address concluded with the thought that, “Darwin would predict that Vascular Surgery would evolve into its own specialty, with its own board and residency review committee and that this would most benefit vascular patients.”

Later that same year, the American Board of Vascular Surgery (ABVS) was incorporated by the two major vascular societies, the SVS and the North American Chapter of the International Society for Cardiovascular Surgery (NA-ISCVS).3 Its purpose was to have a dialogue with the American Board of Surgery and its associated Residency Review Committee, about the training of vascular surgeons and possible application to become a member board of the American Board of Medical Specialties (ABMS). It is only with recognition by the ABMS that a specialty can become an independent examining board, with its own, American College of Graduate Medical Education-approved Residency Review Committee.

In a 1997 survey sent to all practicing vascular surgeons in the United States and Canada sponsored by the SVS, NA-ISCVS, and Association of Program Directors in Vascular Surgery (APDVS), 91% of all American Board of Surgery (ABS) credentialed vascular surgeons favored the formation of an independent ABVS.3 The American Board of Surgery rejected this idea. Instead, the ABS created the Vascular Surgery Sub-Board in 1998, later termed the Vascular Surgery Board of the ABS (VSB-ABS), with the mandate to advise the ABS on all issues related to vascular surgery. The ABS selected both the members and Chair of the sub-board with some input from the 2 major vascular societies. And although, vascular leadership recommended that the new VSB be allowed to manage all issues regarding training and certification of vascular surgeons, this suggestion was also rejected by the ABS.

Notwithstanding a second survey of SVS members in 2000, which showed continued support for an independent board, the majority of societal leadership voted for a 2-year moratorium on additional funding for the ABVS, and further, for continued support of the relatively unempowered VSB-ABS. This was a divided and ugly era for vascular surgery, pitting the leaders of our specialty against one another and the wishes of membership. In 2002, after some of the vascular societal leadership infighting had resolved, the executive councils of the major vascular societies came together with the APDVS in support of moving forward with applying to the ABMS for an independent ABVS.

The response from the ABS to the application was swift and highly unsupportive. In a memo to all ABS members, ABS executive director Walter Ritchie came out firmly against an independent board as “not in the best interests of general surgery, vascular surgery, the Board movement, or the public.”3 Without the support of the ABS, the negative response to the ABVS application by the American Board of Medical Specialists was not unexpected. Where did that leave us?

Conclusion

 It is time for us to be on our own as well and do the things we need to do to have our own identity. We need to forge our futures by ourselves for ourselves with the help of our friends and the surgical family at large along the way. I, like all of you, love our chosen profession and I truly believe in my heart, arteries, and veins that, if we act together and focus our energies on what I have discussed with you today, standing on our own and delivering our message, then the future of vascular surgery as a profession and as a service to patients everywhere is extremely bright.

It has been a distinct pleasure and privilege to serve as your forty-sixth president of the SCVS. An honor that I have cherished and will never forget. Dr Alan M Dietzek

https://www.jvascsurg.org/article/S0741-5214(18)32460-1/fulltext

40 thoughts on “What you need to know about vascular Surgery

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