Homans Lecture: Celebrating the past and looking to the future
AT THE 2016 VASCULAR ANNUAL MEETING
In discussing the technological future, Dr. Veith said that by 2026, 75%-95% of all vascular cases requiring more than medical therapy will be treated endovascularly, with perhaps 5% in a hybrid fashion (open plus endovascular), and between 5% and 15% being treated fully by open surgery. This shift away from open surgery is and will continue to cause challenges in training and patient access to open treatment.
He asked the question: How should vascular surgery deal with the decreasing numbers of complex open procedures and who should do them?
“One solution is to have centers to which these patients are sent and in which vascular surgeons seeking this skill can get adequate open training,” he answered.
But the technological future he painted was bright. Not only was the future likely to be filled with new advances in medical therapy, but he also highlighted computer-assisted 3-D–device navigational tools to aid endovascular treatment; advances in robotic guidance to decrease radiation exposure and facilitate device placement; computer-enhanced simulation to improve training and, when patient specific, to allow procedure planning and rehearsal; and even 3-D printed modeling of lesions and blood vessels.
He predicted that the endovascular problems of intimal hyperplasia will be overcome by antiproliferative drugs in all vascular beds – once the best way of getting the best drug to the proper location is found – and that computer-enabled remote monitoring of flows within grafts and stents, perhaps using miniaturized piezoelectric sensors, will allow corrective treatment before occlusion occurs.
Dr. Veith stated that, in his view, to take its proper place, vascular surgery should rise above its subspecialty status in the shadow of general surgery and in its competition with cardiology.
This “will help vascular surgery to flourish and be recognized as the main specialty devoted to patients with noncardiac vascular diseases. Vascular surgery can then fulfill its potential for a brighter future. More importantly, patients and society will be the ultimate beneficiaries,” he concluded.
Dr. Veith reported that he had no conflicts to disclose with regard to his remarks.
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