From the Vascular Community

As the BEST-CLI (Best Endovascular vs. Best Surgical Therapy in Patients With Critical Limb Ischemia) trial enters its last phase of new patient enrollment, I thought it was important to reflect on what this trial has meant for both the Vascular Surgery field and for me personally. This trial has been closely examining one of the most commonly treated conditions that we take care of - critical limb ischemia (more recently better described as chronic limb threatening ischemia (CLTI). BEST-CLI (ClinicalTrials.gov Identifier: NCT02060630) has the potential to be one of the most meaningful and impactful trials in the history of our profession, and that of our colleagues who also treat CLTI.  

Unlike many of the industry-sponsored endovascular device trials, vascular surgeons are at the table and are key leaders and enrollers. The results will be quoted for decades and there will be many questions answered that we have not been able to answer before - including questions that were not even on people’s minds when the trial began - such as paclitaxel-related outcomes. This trial will also provide the long-term follow-up that has limited the impact of many other peripheral arterial disease trials.

From a personal point of view, I feel like the BEST trial as always been closely connected to my practice. I have been fortunate to be partners with one of the national principal investigators, Dr. Alik Farber. We enrolled the first patient in the trial in my second month as an attending in August of 2014.  Since then, I have been able to operate on 30 patients that were randomized into the trial. It not only allowed me, as a junior attending, to get involved in a major trial, but also forced me to further develop both my open and endovascular skills so that I could provide the best care to each patient as needed.  

This trial has also moved me to see things more objectively; I am now more aware of my personal treatment biases and try more consciously to suspend them when I have equipoise between treatment options. I also continue to follow patients that I enrolled and treated over 4 years ago. This trial will challenge many wide-spread beliefs, anecdotes, and urban legends in the field of peripheral arterial disease. The results will be scrutinized and analyzed and the results will be debated – particularly by some who do not find their preconceived biases confirmed. 

A trial of this magnitude looking at limb threatening ischemia will most likely never happen again in this country. This is the one time for us as a group of professionals who care for patients with CLTI to do this correctly, rather than rely solely on data from single-arm studies, often industry-sponsored, that are typically focused on device approvals.  

It is key, as we get close to the finish line, that we suspend our preconceived notions and finish enrollment. We need to ensure this trial has adequate power to give us the answers we need the most – how to best take care of the most vulnerable and ill patients that we treat; they will greatly benefit from a clear answer as to how best we should address their limb- and life-threatening problems.  

Jeffrey J. Siracuse, MD
Associate Professor of Surgery
Division of Vascular and Endovascular Surgery
Boston University, School of Medicine
Boston Medical Center
 

As the BEST-CLI (Best Endovascular vs. Best Surgical Therapy in Patients With Critical Limb Ischemia) trial enters its last phase of new patient enrollment, I thought it was important to reflect on what this trial has meant for both the Vascular Surgery field and for me personally. This trial has been closely examining one of the most commonly treated conditions that we take care of - critical limb ischemia (more recently better described as chronic limb threatening ischemia (CLTI). BEST-CLI (ClinicalTrials.gov Identifier: NCT02060630) has the potential to be one of the most meaningful and impactful trials in the history of our profession, and that of our colleagues who also treat CLTI.  

Unlike many of the industry-sponsored endovascular device trials, vascular surgeons are at the table and are key leaders and enrollers. The results will be quoted for decades and there will be many questions answered that we have not been able to answer before - including questions that were not even on people’s minds when the trial began - such as paclitaxel-related outcomes. This trial will also provide the long-term follow-up that has limited the impact of many other peripheral arterial disease trials.

From a personal point of view, I feel like the BEST trial as always been closely connected to my practice. I have been fortunate to be partners with one of the national principal investigators, Dr. Alik Farber. We enrolled the first patient in the trial in my second month as an attending in August of 2014.  Since then, I have been able to operate on 30 patients that were randomized into the trial. It not only allowed me, as a junior attending, to get involved in a major trial, but also forced me to further develop both my open and endovascular skills so that I could provide the best care to each patient as needed.  

This trial has also moved me to see things more objectively; I am now more aware of my personal treatment biases and try more consciously to suspend them when I have equipoise between treatment options. I also continue to follow patients that I enrolled and treated over 4 years ago. This trial will challenge many wide-spread beliefs, anecdotes, and urban legends in the field of peripheral arterial disease. The results will be scrutinized and analyzed and the results will be debated – particularly by some who do not find their preconceived biases confirmed. 

A trial of this magnitude looking at limb threatening ischemia will most likely never happen again in this country. This is the one time for us as a group of professionals who care for patients with CLTI to do this correctly, rather than rely solely on data from single-arm studies, often industry-sponsored, that are typically focused on device approvals.  

It is key, as we get close to the finish line, that we suspend our preconceived notions and finish enrollment. We need to ensure this trial has adequate power to give us the answers we need the most – how to best take care of the most vulnerable and ill patients that we treat; they will greatly benefit from a clear answer as to how best we should address their limb- and life-threatening problems.  

Jeffrey J. Siracuse, MD
Associate Professor of Surgery
Division of Vascular and Endovascular Surgery
Boston University, School of Medicine
Boston Medical Center
 

As the BEST-CLI (Best Endovascular vs. Best Surgical Therapy in Patients With Critical Limb Ischemia) trial enters its last phase of new patient enrollment, I thought it was important to reflect on what this trial has meant for both the Vascular Surgery field and for me personally. This trial has been closely examining one of the most commonly treated conditions that we take care of - critical limb ischemia (more recently better described as chronic limb threatening ischemia (CLTI). BEST-CLI (ClinicalTrials.gov Identifier: NCT02060630) has the potential to be one of the most meaningful and impactful trials in the history of our profession, and that of our colleagues who also treat CLTI.  

Unlike many of the industry-sponsored endovascular device trials, vascular surgeons are at the table and are key leaders and enrollers. The results will be quoted for decades and there will be many questions answered that we have not been able to answer before - including questions that were not even on people’s minds when the trial began - such as paclitaxel-related outcomes. This trial will also provide the long-term follow-up that has limited the impact of many other peripheral arterial disease trials.

From a personal point of view, I feel like the BEST trial as always been closely connected to my practice. I have been fortunate to be partners with one of the national principal investigators, Dr. Alik Farber. We enrolled the first patient in the trial in my second month as an attending in August of 2014.  Since then, I have been able to operate on 30 patients that were randomized into the trial. It not only allowed me, as a junior attending, to get involved in a major trial, but also forced me to further develop both my open and endovascular skills so that I could provide the best care to each patient as needed.  

This trial has also moved me to see things more objectively; I am now more aware of my personal treatment biases and try more consciously to suspend them when I have equipoise between treatment options. I also continue to follow patients that I enrolled and treated over 4 years ago. This trial will challenge many wide-spread beliefs, anecdotes, and urban legends in the field of peripheral arterial disease. The results will be scrutinized and analyzed and the results will be debated – particularly by some who do not find their preconceived biases confirmed. 

A trial of this magnitude looking at limb threatening ischemia will most likely never happen again in this country. This is the one time for us as a group of professionals who care for patients with CLTI to do this correctly, rather than rely solely on data from single-arm studies, often industry-sponsored, that are typically focused on device approvals.  

It is key, as we get close to the finish line, that we suspend our preconceived notions and finish enrollment. We need to ensure this trial has adequate power to give us the answers we need the most – how to best take care of the most vulnerable and ill patients that we treat; they will greatly benefit from a clear answer as to how best we should address their limb- and life-threatening problems.  

Jeffrey J. Siracuse, MD
Associate Professor of Surgery
Division of Vascular and Endovascular Surgery
Boston University, School of Medicine
Boston Medical Center
 

John Lockwood Ochsner, MD, (1927-2018), a world-renowned heart surgeon, will be remembered as a charismatic and skilled surgeon, a dedicated teacher, a loving father, and a role model for the hundreds of surgeons he trained.

Dr. Ochsner was born in 1927 in Madison, Wisc., but was raised in New Orleans. and received his medical degree from Tulane University. He started his surgical residency at the University of Michigan but was drafted into military service during the Korean War. He then completed his residency at Baylor University and received his cardiac training under Michael DeBakey. MD,. Dr. DeBakey was a close family friend who had studied under John’s father at Tulane and had worked in the original Ochsner Clinic. John was very close to Dr. DeBakey, who was also John’s babysitter in early life.

Dr. John, as he was known, grew up in shadow of giants, including his father, Alton, who founded the Ochsner Clinic, and Michael DeBakey who was a protégé of Alton. As John was finishing his training with Dr. DeBakey he was asked to stay on in Houston as a member of Dr. DeBakey’s team. The Ochsner Clinic was expanding rapidly in New Orleans, however, and everyone was desirous of having John return. John initially planned to stay with Dr. DeBakey until the director of the Ochsner Clinic flew to Houston to meet with John to convince him to return to New Orleans. His argument was, “John, you will be a great surgeon wherever you practice, but there is only one hospital that has your name on the front of it!” John returned to the Ochsner Clinic in 1961, where he spent the next 57 years.

John Ochsner was revered as an innovative, energetic and talented surgeon, performing over 12,000 operations, including the first cardiac transplant in the Gulf South. He always said he was happiest in the operating room, and loved teaching young resident surgeons. He believed that “surgery is an art as much as a science. ... You have to improvise almost every case -- no two cases are the same - and that’s where the fun of surgery comes in, making something new that particular moment that you’ve never seen before. ... It’s like opening up a package; it’s always a little different.”

He authored more than 300 peer-reviewed publications and gave innumerable scientific lectures around the world. He served as President of the International Society for Cardiovascular Surgery as well as the American Association for Thoracic Surgery. Over his career, he was elected president of more than 10 medical associations.

John, like his father, was active in many aspects of New Orleans life. He was an avid golfer and tennis player, and was always ready with a joke. He lived life with humor and enthusiasm, and was a member of multiple social clubs, developing lifelong friends from around the world. He was particularly thrilled when he was chosen as Rex, King of Carnival, in 1990, following in the royal footsteps of his father, who was King of Rex in 1948. Both of his granddaughters were presented as Maids of the Rex organization.

John is survived by his wife of over 64 years, Mary Lou Ochsner; a sister, Isabel Mann: two sons, Dr. John Ochsner, Jr., and Frank Ochsner, and two daughters, Joby Ochsner and Dr. Katherine Isabel Ochsner; he has two grandchildren.

 Larry H. Hollier, MD, Professor of Surgery, Chancellor, Louisiana State University Health Science Center at New Orleans

John Lockwood Ochsner, MD, (1927-2018), a world-renowned heart surgeon, will be remembered as a charismatic and skilled surgeon, a dedicated teacher, a loving father, and a role model for the hundreds of surgeons he trained.

Dr. Ochsner was born in 1927 in Madison, Wisc., but was raised in New Orleans. and received his medical degree from Tulane University. He started his surgical residency at the University of Michigan but was drafted into military service during the Korean War. He then completed his residency at Baylor University and received his cardiac training under Michael DeBakey. MD,. Dr. DeBakey was a close family friend who had studied under John’s father at Tulane and had worked in the original Ochsner Clinic. John was very close to Dr. DeBakey, who was also John’s babysitter in early life.

Dr. John, as he was known, grew up in shadow of giants, including his father, Alton, who founded the Ochsner Clinic, and Michael DeBakey who was a protégé of Alton. As John was finishing his training with Dr. DeBakey he was asked to stay on in Houston as a member of Dr. DeBakey’s team. The Ochsner Clinic was expanding rapidly in New Orleans, however, and everyone was desirous of having John return. John initially planned to stay with Dr. DeBakey until the director of the Ochsner Clinic flew to Houston to meet with John to convince him to return to New Orleans. His argument was, “John, you will be a great surgeon wherever you practice, but there is only one hospital that has your name on the front of it!” John returned to the Ochsner Clinic in 1961, where he spent the next 57 years.

John Ochsner was revered as an innovative, energetic and talented surgeon, performing over 12,000 operations, including the first cardiac transplant in the Gulf South. He always said he was happiest in the operating room, and loved teaching young resident surgeons. He believed that “surgery is an art as much as a science. ... You have to improvise almost every case -- no two cases are the same - and that’s where the fun of surgery comes in, making something new that particular moment that you’ve never seen before. ... It’s like opening up a package; it’s always a little different.”

He authored more than 300 peer-reviewed publications and gave innumerable scientific lectures around the world. He served as President of the International Society for Cardiovascular Surgery as well as the American Association for Thoracic Surgery. Over his career, he was elected president of more than 10 medical associations.

John, like his father, was active in many aspects of New Orleans life. He was an avid golfer and tennis player, and was always ready with a joke. He lived life with humor and enthusiasm, and was a member of multiple social clubs, developing lifelong friends from around the world. He was particularly thrilled when he was chosen as Rex, King of Carnival, in 1990, following in the royal footsteps of his father, who was King of Rex in 1948. Both of his granddaughters were presented as Maids of the Rex organization.

John is survived by his wife of over 64 years, Mary Lou Ochsner; a sister, Isabel Mann: two sons, Dr. John Ochsner, Jr., and Frank Ochsner, and two daughters, Joby Ochsner and Dr. Katherine Isabel Ochsner; he has two grandchildren.

 Larry H. Hollier, MD, Professor of Surgery, Chancellor, Louisiana State University Health Science Center at New Orleans

John Lockwood Ochsner, MD, (1927-2018), a world-renowned heart surgeon, will be remembered as a charismatic and skilled surgeon, a dedicated teacher, a loving father, and a role model for the hundreds of surgeons he trained.

Dr. Ochsner was born in 1927 in Madison, Wisc., but was raised in New Orleans. and received his medical degree from Tulane University. He started his surgical residency at the University of Michigan but was drafted into military service during the Korean War. He then completed his residency at Baylor University and received his cardiac training under Michael DeBakey. MD,. Dr. DeBakey was a close family friend who had studied under John’s father at Tulane and had worked in the original Ochsner Clinic. John was very close to Dr. DeBakey, who was also John’s babysitter in early life.

Dr. John, as he was known, grew up in shadow of giants, including his father, Alton, who founded the Ochsner Clinic, and Michael DeBakey who was a protégé of Alton. As John was finishing his training with Dr. DeBakey he was asked to stay on in Houston as a member of Dr. DeBakey’s team. The Ochsner Clinic was expanding rapidly in New Orleans, however, and everyone was desirous of having John return. John initially planned to stay with Dr. DeBakey until the director of the Ochsner Clinic flew to Houston to meet with John to convince him to return to New Orleans. His argument was, “John, you will be a great surgeon wherever you practice, but there is only one hospital that has your name on the front of it!” John returned to the Ochsner Clinic in 1961, where he spent the next 57 years.

John Ochsner was revered as an innovative, energetic and talented surgeon, performing over 12,000 operations, including the first cardiac transplant in the Gulf South. He always said he was happiest in the operating room, and loved teaching young resident surgeons. He believed that “surgery is an art as much as a science. ... You have to improvise almost every case -- no two cases are the same - and that’s where the fun of surgery comes in, making something new that particular moment that you’ve never seen before. ... It’s like opening up a package; it’s always a little different.”

He authored more than 300 peer-reviewed publications and gave innumerable scientific lectures around the world. He served as President of the International Society for Cardiovascular Surgery as well as the American Association for Thoracic Surgery. Over his career, he was elected president of more than 10 medical associations.

John, like his father, was active in many aspects of New Orleans life. He was an avid golfer and tennis player, and was always ready with a joke. He lived life with humor and enthusiasm, and was a member of multiple social clubs, developing lifelong friends from around the world. He was particularly thrilled when he was chosen as Rex, King of Carnival, in 1990, following in the royal footsteps of his father, who was King of Rex in 1948. Both of his granddaughters were presented as Maids of the Rex organization.

John is survived by his wife of over 64 years, Mary Lou Ochsner; a sister, Isabel Mann: two sons, Dr. John Ochsner, Jr., and Frank Ochsner, and two daughters, Joby Ochsner and Dr. Katherine Isabel Ochsner; he has two grandchildren.

 Larry H. Hollier, MD, Professor of Surgery, Chancellor, Louisiana State University Health Science Center at New Orleans

SAAVS meeting a success

The Sixth Annual meeting of the South Asian American Vascular Society (SAVVS), an affiliate of the Society for Vascular Surgery, was held on May 31 during the Vascular Annual Meeting.

The Society was formed to provide a forum for scientific, clinical, cultural, charitable and social interaction among American physicians and healthcare providers of South Asian origin involved in the management of vascular disease. SAAVS also works as a forum to collaborate with Vascular Societies across South Asia .

Member benefits include being able to support vascular surgery in our countries of origin; sharing business knowledge and experience with members related to vendors, office practices, and opening centers for access/veins; mentoring of younger surgeons and medical students; assisting with new techniques and endovascular training; guiding job placement, contracts, and privileging issues; networking with friends and colleagues all over the world; taking a greater role in national societies; and taking advantage of the network for assistance in locating/obtaining training positions for family members.

The first annual meeting of the SAAVS was held in 2010. Past Presidents have included Drs. Krishna Jain, Bhagwan Satiani, Brajesh Lal, Anil Hingorani, Dipankar Mukherjee, and Ravi Veeraswamy. During VAM 2017, the current president, Faisal Aziz, MD, of Penn State gave his annual report and the society then inducted its future president Raghu Motaganahalli, MD, from Indiana University into office. Dr. Motaganahalli was also recently appointed as Director of the Division of Vascular Surgery at Indiana University. Peter Lawrence, MD, provided a keynote address highlighting opportunities for conducting research to improve patient care.

Other officers for 2017-2018 include President Elect Sachinder Hans, MD; Secretary Raj Sarkar, MD; Treasurer Krish Soundararajan, MD; Membership Committee: Kapil Gopal, MD, and Syed Alam, MD; Bylaws: Bhagwan Satiani, MD; Industry Relations: Krishna Jain, MD.

A regular feature of the meeting is an abstract/presentation contest for medical students and fellows interested in Vascular Surgery. First place winners from each category are offered cash prizes. In the future, SAAVS plans to have traveling fellowship programs for physicians from South Asia, as well as the United States, for collaborative clinical and educational exchange. Two members have already visited India and Pakistan for collaboration and assistance with endovascular procedures.

The website is www.saavsociety.org

Bhagwan Satiani, MD, The Ohio State University College of Medicine, Columbus.

Study established for “precision” surveillance for PAD

During the Vascular Annual Meeting (VAM) in San Diego, the Centers for Medicaid and Medicaid Services (CMS) announced its decision to reimburse supervised exercise therapy (SET) for beneficiaries with PAD. This decision was based on evidence which concluded that SET improves health outcomes for Medicare beneficiaries with intermittent claudication due to PAD. Up to this point physician-prescribed supervised exercise therapy was only covered exclusively for Cardiac Rehabilitation.

SET for PAD covers up to 36 sessions over a 12 week period if sessions 1) last 30-60 minutes; 2) are conducted in a hospital outpatient setting or physician’s office; and 3) are delivered by qualified auxiliary personnel to ensure benefits exceed harm and if 4) beneficiaries are under the direct supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist who must be trained in both basic and advanced life support techniques. Face-to-face visits with the physician responsible for PAD treatment is required for a SET referral. At this visit, the beneficiary must receive information regarding CV and PAD risk factor reduction, which could include education, counseling, behavior interventions and outcome assessments.

The widespread implementation of SET programs will require the adoption of a functional outcome assessment for PAD.

Here at the Division of Vascular Surgery at Stanford University, we are evaluating the use of a patient’s own smartphone to track and monitor walking activity. The research study called, VascTrac, was developed to provide a more “personalized” approach to surveillance for patients with intermittent claudication in line with precision medicine. We hypothesize that there is a direct correlation between a patient’s walking ability (functional status) and their disease burden.

Vascular surgeons today are finding themselves faced with an increasingly common problem: the “returning patient.” All too often, patients with peripheral artery disease are returning to clinic just months after treatment, frustrated by resurfacing symptoms. What was seemingly a straightforward femoral artery occlusion with an easy stent fix has somehow degraded into disabling claudication (Rutherford Class II/III) in a very short period of time. A staggering number of these patients have perfect-appearing completion angiograms, yet they return to clinic with complete re-occlusions. The tale of mild symptom return, typically beginning several months prior to the current visit, is becoming unsettlingly familiar. Inevitably, the story raises the question: “Why didn’t you come in sooner?”

This frustrating scenario calls for a new paradigm for surveillance of PAD – a more personalized approach in line with precision medicine.

Over the past decade, the prevalence of smartphones and other personal mobile devices has increased at a blistering pace. Today, over 700 million iPhones alone exist worldwide. These devices have an enormous potential to revolutionize the way we deliver care.

In 2014, Apple launched a secure personal mobile health repository called HealthKit, which now comes pre-loaded on every iPhone that is sold. This repository stores data ranging from step counts to blood glucose levels in a secure and structured way. As a bonus, every phone contains accelerometers which passively track a user’s daily activity. On the heels of HealthKit came the Apple ResearchKit framework, launched in 2015 as a means to standardize study enrollment, data collection, storage and transmission on the iPhone. The advent of this new study tool opened the door for remote patient monitoring and “siteless” clinical trials at scale.

These two new platforms have significant implications for health monitoring and diagnosis. While activity is the functional outcome that physicians aim to improve for disabling claudicants, the field currently lacks a means of objectively measuring patient activity and functional outcomes.

Traditional PAD monitoring focuses primarily on vessel patency and ankle brachial indices (ABIs) at 1-, 3-, 6- and 12-month intervals. The problem is that stents don’t fail at 1-, 3-, 6- and 12-month intervals, but ultrasounds and ABI’s require technicians and it’s challenging to perform those more often. There are too many gaps in knowledge, too many black holes, and a more granular approach is required. [NB: Seems to me just adding a 1 month reading would have solved the problem. The rest of the data points are perfect representations of the trend for which VascTrac provides no added benefit. The graph is not needed and would add even more “advertising flair.”

Using activity data as a surrogate for traditional measures of ABIs and vessel patency, we have designed algorithms to passively monitor patients’ daily activity using their personal smartphones. We have implemented these algorithms into an app and have now launched the VascTrac PAD Research Study.

VascTrac is an app available for download from the Apple App Store. Participants need an iPhone 5s (released in 2013) or a newer model. Enrollment, including consent, is all done on the phone. There are three short surveys focused on medical history, surgical history and PAD-specific history (including ABIs). Every two weeks, the app asks patients to perform a 6-minute walk test, and every quarter they are asked to complete the medical, surgical and PAD surveys. However, the majority of activity data is collected passively. Specifically, the app collects total steps per day, distance walked per day, and flights climbed per day and uses an algorithm developed by the team to gather data on a new unique metric, “Max Steps Without Stopping” (MSWS).

A motivated patient can walk 5 miles a day, but he or she may have to stop multiple times along the way. We believe MSWS will help catch the stopping due to the claudication. Patients are provided with a dashboard of their average activity for the week, month and year. They are also provided with links to PAD educational resources.

The VascTrac study is open to all, even non-PAD participants. The inclusion criteria are that a participant must be at least 18 years of age, live in the United States, speak English and have an iPhone 5s or newer model. The ideal patient, however, would be someone who is scheduled for an intervention. This way, the team can obtain a few weeks of baseline activity before evaluating the intervention’s effect on the patient’s functional activity.

Some of the questions our team hopes to answer are, What are the actual effects of our interventions (open vs. bypass) on a patient’s functional capacity? How stable are our interventions relative to a patient’s functional activity? What are the failure modes – is there a gradual decline in activity before failure or an abrupt decline? Can we predict failure of an intervention by doing a regression analysis of a patient’s functional activity trends?

We welcome the participation of any interested providers. More information can be found at www.vasctrac.stanford.edu, where providers can also request recruitment materials. Alternatively, the team can be contacted directly at contact@vasctrac.com.

This is an IRB-approved study and neither the researchers nor the university have any financial disclosures.

Oliver Aalami, MD, Stanford University School of Medicine/Palo Alto.

SAAVS meeting a success

The Sixth Annual meeting of the South Asian American Vascular Society (SAVVS), an affiliate of the Society for Vascular Surgery, was held on May 31 during the Vascular Annual Meeting.

The Society was formed to provide a forum for scientific, clinical, cultural, charitable and social interaction among American physicians and healthcare providers of South Asian origin involved in the management of vascular disease. SAAVS also works as a forum to collaborate with Vascular Societies across South Asia .

Member benefits include being able to support vascular surgery in our countries of origin; sharing business knowledge and experience with members related to vendors, office practices, and opening centers for access/veins; mentoring of younger surgeons and medical students; assisting with new techniques and endovascular training; guiding job placement, contracts, and privileging issues; networking with friends and colleagues all over the world; taking a greater role in national societies; and taking advantage of the network for assistance in locating/obtaining training positions for family members.

The first annual meeting of the SAAVS was held in 2010. Past Presidents have included Drs. Krishna Jain, Bhagwan Satiani, Brajesh Lal, Anil Hingorani, Dipankar Mukherjee, and Ravi Veeraswamy. During VAM 2017, the current president, Faisal Aziz, MD, of Penn State gave his annual report and the society then inducted its future president Raghu Motaganahalli, MD, from Indiana University into office. Dr. Motaganahalli was also recently appointed as Director of the Division of Vascular Surgery at Indiana University. Peter Lawrence, MD, provided a keynote address highlighting opportunities for conducting research to improve patient care.

Other officers for 2017-2018 include President Elect Sachinder Hans, MD; Secretary Raj Sarkar, MD; Treasurer Krish Soundararajan, MD; Membership Committee: Kapil Gopal, MD, and Syed Alam, MD; Bylaws: Bhagwan Satiani, MD; Industry Relations: Krishna Jain, MD.

A regular feature of the meeting is an abstract/presentation contest for medical students and fellows interested in Vascular Surgery. First place winners from each category are offered cash prizes. In the future, SAAVS plans to have traveling fellowship programs for physicians from South Asia, as well as the United States, for collaborative clinical and educational exchange. Two members have already visited India and Pakistan for collaboration and assistance with endovascular procedures.

The website is www.saavsociety.org

Bhagwan Satiani, MD, The Ohio State University College of Medicine, Columbus.

Study established for “precision” surveillance for PAD

During the Vascular Annual Meeting (VAM) in San Diego, the Centers for Medicaid and Medicaid Services (CMS) announced its decision to reimburse supervised exercise therapy (SET) for beneficiaries with PAD. This decision was based on evidence which concluded that SET improves health outcomes for Medicare beneficiaries with intermittent claudication due to PAD. Up to this point physician-prescribed supervised exercise therapy was only covered exclusively for Cardiac Rehabilitation.

SET for PAD covers up to 36 sessions over a 12 week period if sessions 1) last 30-60 minutes; 2) are conducted in a hospital outpatient setting or physician’s office; and 3) are delivered by qualified auxiliary personnel to ensure benefits exceed harm and if 4) beneficiaries are under the direct supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist who must be trained in both basic and advanced life support techniques. Face-to-face visits with the physician responsible for PAD treatment is required for a SET referral. At this visit, the beneficiary must receive information regarding CV and PAD risk factor reduction, which could include education, counseling, behavior interventions and outcome assessments.

The widespread implementation of SET programs will require the adoption of a functional outcome assessment for PAD.

Here at the Division of Vascular Surgery at Stanford University, we are evaluating the use of a patient’s own smartphone to track and monitor walking activity. The research study called, VascTrac, was developed to provide a more “personalized” approach to surveillance for patients with intermittent claudication in line with precision medicine. We hypothesize that there is a direct correlation between a patient’s walking ability (functional status) and their disease burden.

Vascular surgeons today are finding themselves faced with an increasingly common problem: the “returning patient.” All too often, patients with peripheral artery disease are returning to clinic just months after treatment, frustrated by resurfacing symptoms. What was seemingly a straightforward femoral artery occlusion with an easy stent fix has somehow degraded into disabling claudication (Rutherford Class II/III) in a very short period of time. A staggering number of these patients have perfect-appearing completion angiograms, yet they return to clinic with complete re-occlusions. The tale of mild symptom return, typically beginning several months prior to the current visit, is becoming unsettlingly familiar. Inevitably, the story raises the question: “Why didn’t you come in sooner?”

This frustrating scenario calls for a new paradigm for surveillance of PAD – a more personalized approach in line with precision medicine.

Over the past decade, the prevalence of smartphones and other personal mobile devices has increased at a blistering pace. Today, over 700 million iPhones alone exist worldwide. These devices have an enormous potential to revolutionize the way we deliver care.

In 2014, Apple launched a secure personal mobile health repository called HealthKit, which now comes pre-loaded on every iPhone that is sold. This repository stores data ranging from step counts to blood glucose levels in a secure and structured way. As a bonus, every phone contains accelerometers which passively track a user’s daily activity. On the heels of HealthKit came the Apple ResearchKit framework, launched in 2015 as a means to standardize study enrollment, data collection, storage and transmission on the iPhone. The advent of this new study tool opened the door for remote patient monitoring and “siteless” clinical trials at scale.

These two new platforms have significant implications for health monitoring and diagnosis. While activity is the functional outcome that physicians aim to improve for disabling claudicants, the field currently lacks a means of objectively measuring patient activity and functional outcomes.

Traditional PAD monitoring focuses primarily on vessel patency and ankle brachial indices (ABIs) at 1-, 3-, 6- and 12-month intervals. The problem is that stents don’t fail at 1-, 3-, 6- and 12-month intervals, but ultrasounds and ABI’s require technicians and it’s challenging to perform those more often. There are too many gaps in knowledge, too many black holes, and a more granular approach is required. [NB: Seems to me just adding a 1 month reading would have solved the problem. The rest of the data points are perfect representations of the trend for which VascTrac provides no added benefit. The graph is not needed and would add even more “advertising flair.”

Using activity data as a surrogate for traditional measures of ABIs and vessel patency, we have designed algorithms to passively monitor patients’ daily activity using their personal smartphones. We have implemented these algorithms into an app and have now launched the VascTrac PAD Research Study.

VascTrac is an app available for download from the Apple App Store. Participants need an iPhone 5s (released in 2013) or a newer model. Enrollment, including consent, is all done on the phone. There are three short surveys focused on medical history, surgical history and PAD-specific history (including ABIs). Every two weeks, the app asks patients to perform a 6-minute walk test, and every quarter they are asked to complete the medical, surgical and PAD surveys. However, the majority of activity data is collected passively. Specifically, the app collects total steps per day, distance walked per day, and flights climbed per day and uses an algorithm developed by the team to gather data on a new unique metric, “Max Steps Without Stopping” (MSWS).

A motivated patient can walk 5 miles a day, but he or she may have to stop multiple times along the way. We believe MSWS will help catch the stopping due to the claudication. Patients are provided with a dashboard of their average activity for the week, month and year. They are also provided with links to PAD educational resources.

The VascTrac study is open to all, even non-PAD participants. The inclusion criteria are that a participant must be at least 18 years of age, live in the United States, speak English and have an iPhone 5s or newer model. The ideal patient, however, would be someone who is scheduled for an intervention. This way, the team can obtain a few weeks of baseline activity before evaluating the intervention’s effect on the patient’s functional activity.

Some of the questions our team hopes to answer are, What are the actual effects of our interventions (open vs. bypass) on a patient’s functional capacity? How stable are our interventions relative to a patient’s functional activity? What are the failure modes – is there a gradual decline in activity before failure or an abrupt decline? Can we predict failure of an intervention by doing a regression analysis of a patient’s functional activity trends?

We welcome the participation of any interested providers. More information can be found at www.vasctrac.stanford.edu, where providers can also request recruitment materials. Alternatively, the team can be contacted directly at contact@vasctrac.com.

This is an IRB-approved study and neither the researchers nor the university have any financial disclosures.

Oliver Aalami, MD, Stanford University School of Medicine/Palo Alto.

SAAVS meeting a success

The Sixth Annual meeting of the South Asian American Vascular Society (SAVVS), an affiliate of the Society for Vascular Surgery, was held on May 31 during the Vascular Annual Meeting.

The Society was formed to provide a forum for scientific, clinical, cultural, charitable and social interaction among American physicians and healthcare providers of South Asian origin involved in the management of vascular disease. SAAVS also works as a forum to collaborate with Vascular Societies across South Asia .

Member benefits include being able to support vascular surgery in our countries of origin; sharing business knowledge and experience with members related to vendors, office practices, and opening centers for access/veins; mentoring of younger surgeons and medical students; assisting with new techniques and endovascular training; guiding job placement, contracts, and privileging issues; networking with friends and colleagues all over the world; taking a greater role in national societies; and taking advantage of the network for assistance in locating/obtaining training positions for family members.

The first annual meeting of the SAAVS was held in 2010. Past Presidents have included Drs. Krishna Jain, Bhagwan Satiani, Brajesh Lal, Anil Hingorani, Dipankar Mukherjee, and Ravi Veeraswamy. During VAM 2017, the current president, Faisal Aziz, MD, of Penn State gave his annual report and the society then inducted its future president Raghu Motaganahalli, MD, from Indiana University into office. Dr. Motaganahalli was also recently appointed as Director of the Division of Vascular Surgery at Indiana University. Peter Lawrence, MD, provided a keynote address highlighting opportunities for conducting research to improve patient care.

Other officers for 2017-2018 include President Elect Sachinder Hans, MD; Secretary Raj Sarkar, MD; Treasurer Krish Soundararajan, MD; Membership Committee: Kapil Gopal, MD, and Syed Alam, MD; Bylaws: Bhagwan Satiani, MD; Industry Relations: Krishna Jain, MD.

A regular feature of the meeting is an abstract/presentation contest for medical students and fellows interested in Vascular Surgery. First place winners from each category are offered cash prizes. In the future, SAAVS plans to have traveling fellowship programs for physicians from South Asia, as well as the United States, for collaborative clinical and educational exchange. Two members have already visited India and Pakistan for collaboration and assistance with endovascular procedures.

The website is www.saavsociety.org

Bhagwan Satiani, MD, The Ohio State University College of Medicine, Columbus.

Study established for “precision” surveillance for PAD

During the Vascular Annual Meeting (VAM) in San Diego, the Centers for Medicaid and Medicaid Services (CMS) announced its decision to reimburse supervised exercise therapy (SET) for beneficiaries with PAD. This decision was based on evidence which concluded that SET improves health outcomes for Medicare beneficiaries with intermittent claudication due to PAD. Up to this point physician-prescribed supervised exercise therapy was only covered exclusively for Cardiac Rehabilitation.

SET for PAD covers up to 36 sessions over a 12 week period if sessions 1) last 30-60 minutes; 2) are conducted in a hospital outpatient setting or physician’s office; and 3) are delivered by qualified auxiliary personnel to ensure benefits exceed harm and if 4) beneficiaries are under the direct supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist who must be trained in both basic and advanced life support techniques. Face-to-face visits with the physician responsible for PAD treatment is required for a SET referral. At this visit, the beneficiary must receive information regarding CV and PAD risk factor reduction, which could include education, counseling, behavior interventions and outcome assessments.

The widespread implementation of SET programs will require the adoption of a functional outcome assessment for PAD.

Here at the Division of Vascular Surgery at Stanford University, we are evaluating the use of a patient’s own smartphone to track and monitor walking activity. The research study called, VascTrac, was developed to provide a more “personalized” approach to surveillance for patients with intermittent claudication in line with precision medicine. We hypothesize that there is a direct correlation between a patient’s walking ability (functional status) and their disease burden.

Vascular surgeons today are finding themselves faced with an increasingly common problem: the “returning patient.” All too often, patients with peripheral artery disease are returning to clinic just months after treatment, frustrated by resurfacing symptoms. What was seemingly a straightforward femoral artery occlusion with an easy stent fix has somehow degraded into disabling claudication (Rutherford Class II/III) in a very short period of time. A staggering number of these patients have perfect-appearing completion angiograms, yet they return to clinic with complete re-occlusions. The tale of mild symptom return, typically beginning several months prior to the current visit, is becoming unsettlingly familiar. Inevitably, the story raises the question: “Why didn’t you come in sooner?”

This frustrating scenario calls for a new paradigm for surveillance of PAD – a more personalized approach in line with precision medicine.

Over the past decade, the prevalence of smartphones and other personal mobile devices has increased at a blistering pace. Today, over 700 million iPhones alone exist worldwide. These devices have an enormous potential to revolutionize the way we deliver care.

In 2014, Apple launched a secure personal mobile health repository called HealthKit, which now comes pre-loaded on every iPhone that is sold. This repository stores data ranging from step counts to blood glucose levels in a secure and structured way. As a bonus, every phone contains accelerometers which passively track a user’s daily activity. On the heels of HealthKit came the Apple ResearchKit framework, launched in 2015 as a means to standardize study enrollment, data collection, storage and transmission on the iPhone. The advent of this new study tool opened the door for remote patient monitoring and “siteless” clinical trials at scale.

These two new platforms have significant implications for health monitoring and diagnosis. While activity is the functional outcome that physicians aim to improve for disabling claudicants, the field currently lacks a means of objectively measuring patient activity and functional outcomes.

Traditional PAD monitoring focuses primarily on vessel patency and ankle brachial indices (ABIs) at 1-, 3-, 6- and 12-month intervals. The problem is that stents don’t fail at 1-, 3-, 6- and 12-month intervals, but ultrasounds and ABI’s require technicians and it’s challenging to perform those more often. There are too many gaps in knowledge, too many black holes, and a more granular approach is required. [NB: Seems to me just adding a 1 month reading would have solved the problem. The rest of the data points are perfect representations of the trend for which VascTrac provides no added benefit. The graph is not needed and would add even more “advertising flair.”

Using activity data as a surrogate for traditional measures of ABIs and vessel patency, we have designed algorithms to passively monitor patients’ daily activity using their personal smartphones. We have implemented these algorithms into an app and have now launched the VascTrac PAD Research Study.

VascTrac is an app available for download from the Apple App Store. Participants need an iPhone 5s (released in 2013) or a newer model. Enrollment, including consent, is all done on the phone. There are three short surveys focused on medical history, surgical history and PAD-specific history (including ABIs). Every two weeks, the app asks patients to perform a 6-minute walk test, and every quarter they are asked to complete the medical, surgical and PAD surveys. However, the majority of activity data is collected passively. Specifically, the app collects total steps per day, distance walked per day, and flights climbed per day and uses an algorithm developed by the team to gather data on a new unique metric, “Max Steps Without Stopping” (MSWS).

A motivated patient can walk 5 miles a day, but he or she may have to stop multiple times along the way. We believe MSWS will help catch the stopping due to the claudication. Patients are provided with a dashboard of their average activity for the week, month and year. They are also provided with links to PAD educational resources.

The VascTrac study is open to all, even non-PAD participants. The inclusion criteria are that a participant must be at least 18 years of age, live in the United States, speak English and have an iPhone 5s or newer model. The ideal patient, however, would be someone who is scheduled for an intervention. This way, the team can obtain a few weeks of baseline activity before evaluating the intervention’s effect on the patient’s functional activity.

Some of the questions our team hopes to answer are, What are the actual effects of our interventions (open vs. bypass) on a patient’s functional capacity? How stable are our interventions relative to a patient’s functional activity? What are the failure modes – is there a gradual decline in activity before failure or an abrupt decline? Can we predict failure of an intervention by doing a regression analysis of a patient’s functional activity trends?

We welcome the participation of any interested providers. More information can be found at www.vasctrac.stanford.edu, where providers can also request recruitment materials. Alternatively, the team can be contacted directly at contact@vasctrac.com.

This is an IRB-approved study and neither the researchers nor the university have any financial disclosures.

Oliver Aalami, MD, Stanford University School of Medicine/Palo Alto.

In memoriam: Edward B. Diethrich

Edward B. Diethrich, MD, the world-renowned cardiovascular/endovascular surgeon, inventor, and philanthropist, succumbed after a brave fight with a brain tumor on February 23, 2017, at the age of 81.

Dr. Diethrich was a pioneer in noninvasive cardiovascular and vascular disease diagnosis and innovative in surgical and endovascular therapy. He obtained his undergraduate and medical degrees at the University of Michigan and completed his surgical residency at St. Joseph’s Mercy Hospital in Ann Arbor and the Henry Ford Hospital in Detroit. He went on to complete his cardiovascular surgery training under Michael DeBakey at the Baylor College of Medicine in Houston, where he played an important role in the development of human heart transplantation.

Ali F. AbuRahma, MD

Charleston, WV 25304

In memoriam: Edward B. Diethrich

Edward B. Diethrich, MD, the world-renowned cardiovascular/endovascular surgeon, inventor, and philanthropist, succumbed after a brave fight with a brain tumor on February 23, 2017, at the age of 81.

Dr. Diethrich was a pioneer in noninvasive cardiovascular and vascular disease diagnosis and innovative in surgical and endovascular therapy. He obtained his undergraduate and medical degrees at the University of Michigan and completed his surgical residency at St. Joseph’s Mercy Hospital in Ann Arbor and the Henry Ford Hospital in Detroit. He went on to complete his cardiovascular surgery training under Michael DeBakey at the Baylor College of Medicine in Houston, where he played an important role in the development of human heart transplantation.

Ali F. AbuRahma, MD

Charleston, WV 25304

In memoriam: Edward B. Diethrich

Edward B. Diethrich, MD, the world-renowned cardiovascular/endovascular surgeon, inventor, and philanthropist, succumbed after a brave fight with a brain tumor on February 23, 2017, at the age of 81.

Dr. Diethrich was a pioneer in noninvasive cardiovascular and vascular disease diagnosis and innovative in surgical and endovascular therapy. He obtained his undergraduate and medical degrees at the University of Michigan and completed his surgical residency at St. Joseph’s Mercy Hospital in Ann Arbor and the Henry Ford Hospital in Detroit. He went on to complete his cardiovascular surgery training under Michael DeBakey at the Baylor College of Medicine in Houston, where he played an important role in the development of human heart transplantation.

Ali F. AbuRahma, MD

Charleston, WV 25304

Editors note: The following are a selection of responses from the SVS membership sent to Dr. Peter Lawrence based upon his article in a recent issue of Vascular Specialist on the topic of the abuse of peripheral artery disease stenting in Medicare patients.

Despite the unfortunate press, we as a more global medical vascular community are unable to police our own. I have been involved in two specific instances in which inappropriate and overuse of endovascular therapy has been addressed. Unfortunately, these practitioners continue to perform unindicated procedures while hospitals and state medical boards refuse to act.

What is Medicare to do when our own medical regulatory bodies fail to act on behalf of patients and the payor? The two routes of targeting practitioners through Medicare high outliers and legal recourse for poor outcome in unindicated procedures will remain until our societies (this includes SVIR and ACC) decide to collaborate and ensure appropriate practice. Simply stating that SVS has guidelines in place will not solve the problem.

Jason M. Johanning, M.D., Omaha, Neb.

My office of five vascular surgeons actually has an in-office procedure suite. We have converted about 30%-40% of our minimally invasive patient care to this setting. In review of what we have done, we have actually decreased the cost of patient care as there is no facility or hospital add-on charge. Our cost per patient is actually about one-third of what is typically charged by the hospital, and our quality based on our independent QA is the same in our office setting as it is in the hospital. These types of settings can significantly reduce health care costs if done in the proper fashion.

Dennis Fry, M.D., West Des Moines, Iowa

The comments in the article that hospitals confer a greater degree of oversight seems to come right from the AHA. The problem is not office-based procedures but the ethics of fraudulent practices, something that occurs in and among hospitals as well. Hospitals can be as much driven by case volume, even at academic centers, as are the practices of private outpatient procedures.

Paul Gagne, M.D., Darien, Conn.

I cannot help but wonder how our specialty’s lack of identity – and thus lack of appreciation of its responsibility and role in public awareness – has contributed to this scenario. Our inclusion under the umbrella of the American Heart Association, again without any designation of our separate identity, leads only to more confusion about our specialty in the eyes of the public.

The SVS must address its lack of a public identity in a more forceful manner. Unfortunately, it’s biggest hurdle in this may well be the hospital-employed vascular surgeons who cannot fight the administrators marketing theme of “Heart and Vascular,” implying to the public that we are all one, “like the cardiologists do” as many patients state. This is not to fault anyone, but it is to awaken our leadership to the need to establish a separate, independent “awareness” vehicle to better craft our identity as a separate specialty to the entire nation.

It will take time but will be a project which, when done properly, we will never regret. It calls for a board heavily weighted toward the independent vascular surgeons, who try daily, with limited resources, to accomplish this.

Carlo Dall’Olmo, M.D., Flint, Mich.

What the article misrepresents is that this happens only in outpatient labs. The same thing occurs, albeit to a lesser degree, in our hospitals. I am glad to see no vascular surgeons were named. I am also glad they are starting to shine a light on the massive ongoing fraud in EVLT and RF ablation procedures. This is particularly bad in Florida. I wonder if SVS can come up with some response to suggest ways to police this behavior. None of us want more government oversight, but it seems like something needs to be done at the state board level to better regulate these procedures.

Geoffrey L. Risley, M.D., Jacksonville, Fla.

I think most members of SVS have intimate knowledge of a handful of physicians in their communities whose practices would be considered abusive, if not overtly fraudulent. We have struggled locally with the belief that we, as ethical and well-reasoned providers, should have some obligation to report these providers to someone. However, there are no acceptable mechanisms with which to do so, and there is a sense that this would not be accepted well by our colleagues.

We also do not want to be written off as disgruntled competitors. Physicians have never done a good job of policing themselves. Maybe articles like this can be a springboard to discuss ways to reign in the outlier providers in our communities.

Steven Merrell, M.D., Murray, Utah

I agree with Dr. Lawrence 100%. We need the SVS to be a major speaker in this debate. We have to give patients the confidence that they are being cared for by physicians who are not only capable to diagnose the problem but are also able to care for it in the most appropriate fashion. We need to silence the naysayers and the media hogs by developing a method so that surgeons who care for vascular patients in an office-based vascular suite are certified by the Society in the form a Center of Excellence designation. Initial certification would be followed by ongoing proactive reviews on a serial basis. I would ask that the leaders of our society take a step toward developing the concept of this certification body as soon as possible. We need to police ourselves and this may be the way to do it.

Thank you in advance for your attention and ongoing vigilance for the vascular surgical community.

Khash Salartash, M.D., Galloway, N.J.

Editors note: The following are a selection of responses from the SVS membership sent to Dr. Peter Lawrence based upon his article in a recent issue of Vascular Specialist on the topic of the abuse of peripheral artery disease stenting in Medicare patients.

Despite the unfortunate press, we as a more global medical vascular community are unable to police our own. I have been involved in two specific instances in which inappropriate and overuse of endovascular therapy has been addressed. Unfortunately, these practitioners continue to perform unindicated procedures while hospitals and state medical boards refuse to act.

What is Medicare to do when our own medical regulatory bodies fail to act on behalf of patients and the payor? The two routes of targeting practitioners through Medicare high outliers and legal recourse for poor outcome in unindicated procedures will remain until our societies (this includes SVIR and ACC) decide to collaborate and ensure appropriate practice. Simply stating that SVS has guidelines in place will not solve the problem.

Jason M. Johanning, M.D., Omaha, Neb.

My office of five vascular surgeons actually has an in-office procedure suite. We have converted about 30%-40% of our minimally invasive patient care to this setting. In review of what we have done, we have actually decreased the cost of patient care as there is no facility or hospital add-on charge. Our cost per patient is actually about one-third of what is typically charged by the hospital, and our quality based on our independent QA is the same in our office setting as it is in the hospital. These types of settings can significantly reduce health care costs if done in the proper fashion.

Dennis Fry, M.D., West Des Moines, Iowa

The comments in the article that hospitals confer a greater degree of oversight seems to come right from the AHA. The problem is not office-based procedures but the ethics of fraudulent practices, something that occurs in and among hospitals as well. Hospitals can be as much driven by case volume, even at academic centers, as are the practices of private outpatient procedures.

Paul Gagne, M.D., Darien, Conn.

I cannot help but wonder how our specialty’s lack of identity – and thus lack of appreciation of its responsibility and role in public awareness – has contributed to this scenario. Our inclusion under the umbrella of the American Heart Association, again without any designation of our separate identity, leads only to more confusion about our specialty in the eyes of the public.

The SVS must address its lack of a public identity in a more forceful manner. Unfortunately, it’s biggest hurdle in this may well be the hospital-employed vascular surgeons who cannot fight the administrators marketing theme of “Heart and Vascular,” implying to the public that we are all one, “like the cardiologists do” as many patients state. This is not to fault anyone, but it is to awaken our leadership to the need to establish a separate, independent “awareness” vehicle to better craft our identity as a separate specialty to the entire nation.

It will take time but will be a project which, when done properly, we will never regret. It calls for a board heavily weighted toward the independent vascular surgeons, who try daily, with limited resources, to accomplish this.

Carlo Dall’Olmo, M.D., Flint, Mich.

What the article misrepresents is that this happens only in outpatient labs. The same thing occurs, albeit to a lesser degree, in our hospitals. I am glad to see no vascular surgeons were named. I am also glad they are starting to shine a light on the massive ongoing fraud in EVLT and RF ablation procedures. This is particularly bad in Florida. I wonder if SVS can come up with some response to suggest ways to police this behavior. None of us want more government oversight, but it seems like something needs to be done at the state board level to better regulate these procedures.

Geoffrey L. Risley, M.D., Jacksonville, Fla.

I think most members of SVS have intimate knowledge of a handful of physicians in their communities whose practices would be considered abusive, if not overtly fraudulent. We have struggled locally with the belief that we, as ethical and well-reasoned providers, should have some obligation to report these providers to someone. However, there are no acceptable mechanisms with which to do so, and there is a sense that this would not be accepted well by our colleagues.

We also do not want to be written off as disgruntled competitors. Physicians have never done a good job of policing themselves. Maybe articles like this can be a springboard to discuss ways to reign in the outlier providers in our communities.

Steven Merrell, M.D., Murray, Utah

I agree with Dr. Lawrence 100%. We need the SVS to be a major speaker in this debate. We have to give patients the confidence that they are being cared for by physicians who are not only capable to diagnose the problem but are also able to care for it in the most appropriate fashion. We need to silence the naysayers and the media hogs by developing a method so that surgeons who care for vascular patients in an office-based vascular suite are certified by the Society in the form a Center of Excellence designation. Initial certification would be followed by ongoing proactive reviews on a serial basis. I would ask that the leaders of our society take a step toward developing the concept of this certification body as soon as possible. We need to police ourselves and this may be the way to do it.

Thank you in advance for your attention and ongoing vigilance for the vascular surgical community.

Khash Salartash, M.D., Galloway, N.J.

Editors note: The following are a selection of responses from the SVS membership sent to Dr. Peter Lawrence based upon his article in a recent issue of Vascular Specialist on the topic of the abuse of peripheral artery disease stenting in Medicare patients.

Despite the unfortunate press, we as a more global medical vascular community are unable to police our own. I have been involved in two specific instances in which inappropriate and overuse of endovascular therapy has been addressed. Unfortunately, these practitioners continue to perform unindicated procedures while hospitals and state medical boards refuse to act.

What is Medicare to do when our own medical regulatory bodies fail to act on behalf of patients and the payor? The two routes of targeting practitioners through Medicare high outliers and legal recourse for poor outcome in unindicated procedures will remain until our societies (this includes SVIR and ACC) decide to collaborate and ensure appropriate practice. Simply stating that SVS has guidelines in place will not solve the problem.

Jason M. Johanning, M.D., Omaha, Neb.

My office of five vascular surgeons actually has an in-office procedure suite. We have converted about 30%-40% of our minimally invasive patient care to this setting. In review of what we have done, we have actually decreased the cost of patient care as there is no facility or hospital add-on charge. Our cost per patient is actually about one-third of what is typically charged by the hospital, and our quality based on our independent QA is the same in our office setting as it is in the hospital. These types of settings can significantly reduce health care costs if done in the proper fashion.

Dennis Fry, M.D., West Des Moines, Iowa

The comments in the article that hospitals confer a greater degree of oversight seems to come right from the AHA. The problem is not office-based procedures but the ethics of fraudulent practices, something that occurs in and among hospitals as well. Hospitals can be as much driven by case volume, even at academic centers, as are the practices of private outpatient procedures.

Paul Gagne, M.D., Darien, Conn.

I cannot help but wonder how our specialty’s lack of identity – and thus lack of appreciation of its responsibility and role in public awareness – has contributed to this scenario. Our inclusion under the umbrella of the American Heart Association, again without any designation of our separate identity, leads only to more confusion about our specialty in the eyes of the public.

The SVS must address its lack of a public identity in a more forceful manner. Unfortunately, it’s biggest hurdle in this may well be the hospital-employed vascular surgeons who cannot fight the administrators marketing theme of “Heart and Vascular,” implying to the public that we are all one, “like the cardiologists do” as many patients state. This is not to fault anyone, but it is to awaken our leadership to the need to establish a separate, independent “awareness” vehicle to better craft our identity as a separate specialty to the entire nation.

It will take time but will be a project which, when done properly, we will never regret. It calls for a board heavily weighted toward the independent vascular surgeons, who try daily, with limited resources, to accomplish this.

Carlo Dall’Olmo, M.D., Flint, Mich.

What the article misrepresents is that this happens only in outpatient labs. The same thing occurs, albeit to a lesser degree, in our hospitals. I am glad to see no vascular surgeons were named. I am also glad they are starting to shine a light on the massive ongoing fraud in EVLT and RF ablation procedures. This is particularly bad in Florida. I wonder if SVS can come up with some response to suggest ways to police this behavior. None of us want more government oversight, but it seems like something needs to be done at the state board level to better regulate these procedures.

Geoffrey L. Risley, M.D., Jacksonville, Fla.

I think most members of SVS have intimate knowledge of a handful of physicians in their communities whose practices would be considered abusive, if not overtly fraudulent. We have struggled locally with the belief that we, as ethical and well-reasoned providers, should have some obligation to report these providers to someone. However, there are no acceptable mechanisms with which to do so, and there is a sense that this would not be accepted well by our colleagues.

We also do not want to be written off as disgruntled competitors. Physicians have never done a good job of policing themselves. Maybe articles like this can be a springboard to discuss ways to reign in the outlier providers in our communities.

Steven Merrell, M.D., Murray, Utah

I agree with Dr. Lawrence 100%. We need the SVS to be a major speaker in this debate. We have to give patients the confidence that they are being cared for by physicians who are not only capable to diagnose the problem but are also able to care for it in the most appropriate fashion. We need to silence the naysayers and the media hogs by developing a method so that surgeons who care for vascular patients in an office-based vascular suite are certified by the Society in the form a Center of Excellence designation. Initial certification would be followed by ongoing proactive reviews on a serial basis. I would ask that the leaders of our society take a step toward developing the concept of this certification body as soon as possible. We need to police ourselves and this may be the way to do it.

Thank you in advance for your attention and ongoing vigilance for the vascular surgical community.

Khash Salartash, M.D., Galloway, N.J.

In November last year, one of the highly prestigious National Medals of Technology and Innovation was presented to Thomas J. Fogarty, Fogarty Institute for Innovation, for his innovations in minimally invasive medical devices. U.S. President Obama presided at the ceremony and presented the award.

Dr. Fogarty is chairman, director and founder of the Fogarty Institute for Innovation, and has served as a founder, chairman, or board member of over 30 business and research companies. During the past 40 years, he acquired 135 surgical patents, including the Fogarty balloon catheter and the Aneurx Stent Graft, an endovascular device that replaces open surgery for aortic aneurysm.

Courtesy of the National Science and Technology Medals

Along with the recently awarded National Medal of Technology and Innovation, he has received the Jacobson Innovation Award of the American College of Surgeons and the 2000 Lemelson-MIT prize for Invention and Innovation. He was inducted into the Inventors Hall of Fame in 2001.

Surgeon who saved Pope’s life thanked

Dr. Juan Carlos Parodi today is a prominent figure in the world vascular community, one famous for his work in the development of endovascular aortic aneurysm repair (EVAR) several decades ago.

But it was an emergency gall bladder operation many years ago, which he performed in his native Argentina, that caused him to rise to a unique prominence, illustrated in a more recent visit to Vatican City, where he had a 40-minute private audience with Pope Francis.

Courtesy of Marta Di Gaetano

Dr. Parodi explained: “In 1980 I was called to treat a poor priest with a gangrenous cholecystitis caused by Clostridium. I took care of him without charging him, and after days of dialysis he survived. I forgot the experience until one day I received a call telling me that the poor priest I took care of became the Pope Francis. He invited me to visit him in the Vatican, and I went to visit him last year.

“Pope Francis received me saying: Welcome the surgeon who saved my life coming in the middle of the night to do an operation without asking for any compensation! I told him that as a physician we help people who need us, regardless of the lack of payment capacity. I was honored by being invited by him,” Dr. Parodi added.

Currently, Dr. Parodi is a professor of surgery at the University of Buenos Aires, and chief of vascular surgery at the Sanatorio Trinidad, Buenos Aires.

In November last year, one of the highly prestigious National Medals of Technology and Innovation was presented to Thomas J. Fogarty, Fogarty Institute for Innovation, for his innovations in minimally invasive medical devices. U.S. President Obama presided at the ceremony and presented the award.

Dr. Fogarty is chairman, director and founder of the Fogarty Institute for Innovation, and has served as a founder, chairman, or board member of over 30 business and research companies. During the past 40 years, he acquired 135 surgical patents, including the Fogarty balloon catheter and the Aneurx Stent Graft, an endovascular device that replaces open surgery for aortic aneurysm.

Courtesy of the National Science and Technology Medals

Along with the recently awarded National Medal of Technology and Innovation, he has received the Jacobson Innovation Award of the American College of Surgeons and the 2000 Lemelson-MIT prize for Invention and Innovation. He was inducted into the Inventors Hall of Fame in 2001.

Surgeon who saved Pope’s life thanked

Dr. Juan Carlos Parodi today is a prominent figure in the world vascular community, one famous for his work in the development of endovascular aortic aneurysm repair (EVAR) several decades ago.

But it was an emergency gall bladder operation many years ago, which he performed in his native Argentina, that caused him to rise to a unique prominence, illustrated in a more recent visit to Vatican City, where he had a 40-minute private audience with Pope Francis.

Courtesy of Marta Di Gaetano

Dr. Parodi explained: “In 1980 I was called to treat a poor priest with a gangrenous cholecystitis caused by Clostridium. I took care of him without charging him, and after days of dialysis he survived. I forgot the experience until one day I received a call telling me that the poor priest I took care of became the Pope Francis. He invited me to visit him in the Vatican, and I went to visit him last year.

“Pope Francis received me saying: Welcome the surgeon who saved my life coming in the middle of the night to do an operation without asking for any compensation! I told him that as a physician we help people who need us, regardless of the lack of payment capacity. I was honored by being invited by him,” Dr. Parodi added.

Currently, Dr. Parodi is a professor of surgery at the University of Buenos Aires, and chief of vascular surgery at the Sanatorio Trinidad, Buenos Aires.

In November last year, one of the highly prestigious National Medals of Technology and Innovation was presented to Thomas J. Fogarty, Fogarty Institute for Innovation, for his innovations in minimally invasive medical devices. U.S. President Obama presided at the ceremony and presented the award.

Dr. Fogarty is chairman, director and founder of the Fogarty Institute for Innovation, and has served as a founder, chairman, or board member of over 30 business and research companies. During the past 40 years, he acquired 135 surgical patents, including the Fogarty balloon catheter and the Aneurx Stent Graft, an endovascular device that replaces open surgery for aortic aneurysm.

Courtesy of the National Science and Technology Medals

Along with the recently awarded National Medal of Technology and Innovation, he has received the Jacobson Innovation Award of the American College of Surgeons and the 2000 Lemelson-MIT prize for Invention and Innovation. He was inducted into the Inventors Hall of Fame in 2001.

Surgeon who saved Pope’s life thanked

Dr. Juan Carlos Parodi today is a prominent figure in the world vascular community, one famous for his work in the development of endovascular aortic aneurysm repair (EVAR) several decades ago.

But it was an emergency gall bladder operation many years ago, which he performed in his native Argentina, that caused him to rise to a unique prominence, illustrated in a more recent visit to Vatican City, where he had a 40-minute private audience with Pope Francis.

Courtesy of Marta Di Gaetano

Dr. Parodi explained: “In 1980 I was called to treat a poor priest with a gangrenous cholecystitis caused by Clostridium. I took care of him without charging him, and after days of dialysis he survived. I forgot the experience until one day I received a call telling me that the poor priest I took care of became the Pope Francis. He invited me to visit him in the Vatican, and I went to visit him last year.

“Pope Francis received me saying: Welcome the surgeon who saved my life coming in the middle of the night to do an operation without asking for any compensation! I told him that as a physician we help people who need us, regardless of the lack of payment capacity. I was honored by being invited by him,” Dr. Parodi added.

Currently, Dr. Parodi is a professor of surgery at the University of Buenos Aires, and chief of vascular surgery at the Sanatorio Trinidad, Buenos Aires.

Baylor Vascular Fellows 50th Anniversary

On May 20, alumni and friends of Baylor University Medical Center’s vascular fellowship program gathered to celebrate the 50th anniversary of the program and commemorate the man who created it, Dr. Jesse Thompson. Dr. Thompson, who passed away in 2008, was a founding editor for the Journal of Vascular Surgery and president of the Society of Vascular Surgery.

Courtesy of Baylor University Medical Center

In 1964, he established the country’s second vascular fellowship program at Baylor. Since then, approximately 100 vascular surgeons have received their training in this program. Its alumni include Dr. Larry Hollier, Dr. Hugh Trout, and Dr. Jonathan Towne.

The reunion was held at the Dallas Country Club with more than 140 in attendance, including Dr. Thompson’s children and grandchildren. The program’s first, middle, and last (i.e., most recent) fellows also attended. The following day Baylor hosted the Jesse E. Thompson, MD Lectureship and Speaker Symposium.

Dr. Spence Taylor was the visiting professor, delivering an address entitled "Surgeons as Leaders: Lessons Learned While Building a Medical School."

In Memoriam: Dr. John J. Bergan

Vascular pioneer Dr. John J. Bergan died June 11, 2014. Dr. Bergan began his career as a clinical assistant in surgery at Northwestern University Medical School. He served as the chief of the Division of Transplantation at Northwestern University Medical School from 1969 to 1976. When the Division of Vascular Surgery was formed in 1976, Dr. Bergan was appointed as the first division chief. Along with Dr. James Yao, Dr. Bergan established one of the earliest clinical vascular fellowship programs that same year, at Northwestern. In 1989, Dr. Bergan left Northwestern for southern California.

Courtesy of Baylor University Medical Center

Dr. Bergan was instrumental in founding and developing many new societies and publications, including Midwestern Vascular Surgical Society. He also participated in the development of many practice guidelines including a method for data retrieval using computer programming and guidelines for venous disease diagnosis and treatment. He served as president of numerous societies, including SVS and the American Venous Forum.

We are truly grateful for all that he has contributed, and he will be sorely missed.

–Dr. Mark Eskandari

Baylor Vascular Fellows 50th Anniversary

On May 20, alumni and friends of Baylor University Medical Center’s vascular fellowship program gathered to celebrate the 50th anniversary of the program and commemorate the man who created it, Dr. Jesse Thompson. Dr. Thompson, who passed away in 2008, was a founding editor for the Journal of Vascular Surgery and president of the Society of Vascular Surgery.

Courtesy of Baylor University Medical Center

In 1964, he established the country’s second vascular fellowship program at Baylor. Since then, approximately 100 vascular surgeons have received their training in this program. Its alumni include Dr. Larry Hollier, Dr. Hugh Trout, and Dr. Jonathan Towne.

The reunion was held at the Dallas Country Club with more than 140 in attendance, including Dr. Thompson’s children and grandchildren. The program’s first, middle, and last (i.e., most recent) fellows also attended. The following day Baylor hosted the Jesse E. Thompson, MD Lectureship and Speaker Symposium.

Dr. Spence Taylor was the visiting professor, delivering an address entitled "Surgeons as Leaders: Lessons Learned While Building a Medical School."

In Memoriam: Dr. John J. Bergan

Vascular pioneer Dr. John J. Bergan died June 11, 2014. Dr. Bergan began his career as a clinical assistant in surgery at Northwestern University Medical School. He served as the chief of the Division of Transplantation at Northwestern University Medical School from 1969 to 1976. When the Division of Vascular Surgery was formed in 1976, Dr. Bergan was appointed as the first division chief. Along with Dr. James Yao, Dr. Bergan established one of the earliest clinical vascular fellowship programs that same year, at Northwestern. In 1989, Dr. Bergan left Northwestern for southern California.

Courtesy of Baylor University Medical Center

Dr. Bergan was instrumental in founding and developing many new societies and publications, including Midwestern Vascular Surgical Society. He also participated in the development of many practice guidelines including a method for data retrieval using computer programming and guidelines for venous disease diagnosis and treatment. He served as president of numerous societies, including SVS and the American Venous Forum.

We are truly grateful for all that he has contributed, and he will be sorely missed.

–Dr. Mark Eskandari

Baylor Vascular Fellows 50th Anniversary

On May 20, alumni and friends of Baylor University Medical Center’s vascular fellowship program gathered to celebrate the 50th anniversary of the program and commemorate the man who created it, Dr. Jesse Thompson. Dr. Thompson, who passed away in 2008, was a founding editor for the Journal of Vascular Surgery and president of the Society of Vascular Surgery.

Courtesy of Baylor University Medical Center

In 1964, he established the country’s second vascular fellowship program at Baylor. Since then, approximately 100 vascular surgeons have received their training in this program. Its alumni include Dr. Larry Hollier, Dr. Hugh Trout, and Dr. Jonathan Towne.

The reunion was held at the Dallas Country Club with more than 140 in attendance, including Dr. Thompson’s children and grandchildren. The program’s first, middle, and last (i.e., most recent) fellows also attended. The following day Baylor hosted the Jesse E. Thompson, MD Lectureship and Speaker Symposium.

Dr. Spence Taylor was the visiting professor, delivering an address entitled "Surgeons as Leaders: Lessons Learned While Building a Medical School."

In Memoriam: Dr. John J. Bergan

Vascular pioneer Dr. John J. Bergan died June 11, 2014. Dr. Bergan began his career as a clinical assistant in surgery at Northwestern University Medical School. He served as the chief of the Division of Transplantation at Northwestern University Medical School from 1969 to 1976. When the Division of Vascular Surgery was formed in 1976, Dr. Bergan was appointed as the first division chief. Along with Dr. James Yao, Dr. Bergan established one of the earliest clinical vascular fellowship programs that same year, at Northwestern. In 1989, Dr. Bergan left Northwestern for southern California.

Courtesy of Baylor University Medical Center

Dr. Bergan was instrumental in founding and developing many new societies and publications, including Midwestern Vascular Surgical Society. He also participated in the development of many practice guidelines including a method for data retrieval using computer programming and guidelines for venous disease diagnosis and treatment. He served as president of numerous societies, including SVS and the American Venous Forum.

We are truly grateful for all that he has contributed, and he will be sorely missed.

–Dr. Mark Eskandari

Vascular pioneer, Dr. John J. Bergan, died on June 11th, 2014.

Dr. Bergan’s illustrious career spanned more than 50 years. He completed his residency at Chicago Wesley Memorial Hospital in 1959 and began his medical career as a clinical assistant in surgery at Northwestern University Medical School. He rose through the ranks at Northwestern and served as the chief of the Division of Transplantation at Northwestern University Medical School from 1969 to 1976. When the Division of Vascular Surgery was formed in 1976, Dr. Bergan was appointed as the first division chief (1976-1988). Along with Dr. James Yao, Dr. Bergan established one of the earliest clinical vascular fellowship programs in 1976 at Northwestern. This fellowship program was the genesis for many future leaders of vascular surgery. In 1989, Dr. Bergan left Northwestern for southern California where he concentrated on developing clinical and basic research in venous disease.

Dr. Bergan was instrumental in founding and developing many new societies and publications, including Midwestern Vascular Surgical Society. He also participated in the development of many practice guidelines including a method for data retrieval using computer programming and guidelines for venous disease diagnosis and treatment. He served as president of numerous societies, including the Society for Vascular Surgery, the American Venous Forum, American Venous Forum Foundation, Midwestern Vascular Surgical Society, European-American Venous Symposium, Gulf Coast Vascular Society, Chicago Surgical Society, Lymphedema Association of North America, and Southern California Vascular Surgical Society.

In his career, he authored and co-authored more than 750 publications, including peer-reviewed journal articles, scientific reports, editorials, and book chapters, as well as editing over 35 books. He was invited to speak to professional audiences all over the world and received numerous national and international honors and awards, including the Rovsing Silver Medal from the Danish Surgical Society, Honorary Fellowship in the Royal College of Surgeons of England, and the Lifetime Achievement Award from the International Society for Endovascular Surgery.

Dr. Bergan was a world renowned leader and contributor to the field of Vascular Surgery. He was a prolific scholar, tireless investigator, eloquent speaker, and dedicated educator. When asked what was the most rewarding experience in his long, successful career, Dr. Bergan responded "to teach". We are truly grateful for all that he has contributed and he will be sorely missed.

The Memorial and Celebration of Dr. Bergan\'s life will be held on July 7, 2014, 4:00pm, at the Chicago Yacht Club - Belmont at the Lake (not the Monroe Street clubhouse). If you are able to attend, please send a note to BerganMemorial@gmail.com so that plans can be made accordingly since space may be limited.

In lieu of flowers, Dr. Bergan’s family has asked that you please make a contribution to the:

John J. Bergan, MD Lectureship

Northwestern University Feinberg School of Medicine.

Address: 420 E. Superior Street

Rubloff Building, 9th Floor

Chicago, Illinois 60611

If you would like to leave a message for Dr. Bergan’s family or share a remembrance of him, you may do so at http://www.caringbridge.org/visit/johnjbergan/guestbook.

Dr. Eskandari is The James S.T. Yao, MD, PhD Professor of Education in Vascular Surgery, chief and program director, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago.

Vascular pioneer, Dr. John J. Bergan, died on June 11th, 2014.

Dr. Bergan’s illustrious career spanned more than 50 years. He completed his residency at Chicago Wesley Memorial Hospital in 1959 and began his medical career as a clinical assistant in surgery at Northwestern University Medical School. He rose through the ranks at Northwestern and served as the chief of the Division of Transplantation at Northwestern University Medical School from 1969 to 1976. When the Division of Vascular Surgery was formed in 1976, Dr. Bergan was appointed as the first division chief (1976-1988). Along with Dr. James Yao, Dr. Bergan established one of the earliest clinical vascular fellowship programs in 1976 at Northwestern. This fellowship program was the genesis for many future leaders of vascular surgery. In 1989, Dr. Bergan left Northwestern for southern California where he concentrated on developing clinical and basic research in venous disease.

Dr. Bergan was instrumental in founding and developing many new societies and publications, including Midwestern Vascular Surgical Society. He also participated in the development of many practice guidelines including a method for data retrieval using computer programming and guidelines for venous disease diagnosis and treatment. He served as president of numerous societies, including the Society for Vascular Surgery, the American Venous Forum, American Venous Forum Foundation, Midwestern Vascular Surgical Society, European-American Venous Symposium, Gulf Coast Vascular Society, Chicago Surgical Society, Lymphedema Association of North America, and Southern California Vascular Surgical Society.

In his career, he authored and co-authored more than 750 publications, including peer-reviewed journal articles, scientific reports, editorials, and book chapters, as well as editing over 35 books. He was invited to speak to professional audiences all over the world and received numerous national and international honors and awards, including the Rovsing Silver Medal from the Danish Surgical Society, Honorary Fellowship in the Royal College of Surgeons of England, and the Lifetime Achievement Award from the International Society for Endovascular Surgery.

Dr. Bergan was a world renowned leader and contributor to the field of Vascular Surgery. He was a prolific scholar, tireless investigator, eloquent speaker, and dedicated educator. When asked what was the most rewarding experience in his long, successful career, Dr. Bergan responded "to teach". We are truly grateful for all that he has contributed and he will be sorely missed.

The Memorial and Celebration of Dr. Bergan\'s life will be held on July 7, 2014, 4:00pm, at the Chicago Yacht Club - Belmont at the Lake (not the Monroe Street clubhouse). If you are able to attend, please send a note to BerganMemorial@gmail.com so that plans can be made accordingly since space may be limited.

In lieu of flowers, Dr. Bergan’s family has asked that you please make a contribution to the:

John J. Bergan, MD Lectureship

Northwestern University Feinberg School of Medicine.

Address: 420 E. Superior Street

Rubloff Building, 9th Floor

Chicago, Illinois 60611

If you would like to leave a message for Dr. Bergan’s family or share a remembrance of him, you may do so at http://www.caringbridge.org/visit/johnjbergan/guestbook.

Dr. Eskandari is The James S.T. Yao, MD, PhD Professor of Education in Vascular Surgery, chief and program director, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago.

Vascular pioneer, Dr. John J. Bergan, died on June 11th, 2014.

Dr. Bergan’s illustrious career spanned more than 50 years. He completed his residency at Chicago Wesley Memorial Hospital in 1959 and began his medical career as a clinical assistant in surgery at Northwestern University Medical School. He rose through the ranks at Northwestern and served as the chief of the Division of Transplantation at Northwestern University Medical School from 1969 to 1976. When the Division of Vascular Surgery was formed in 1976, Dr. Bergan was appointed as the first division chief (1976-1988). Along with Dr. James Yao, Dr. Bergan established one of the earliest clinical vascular fellowship programs in 1976 at Northwestern. This fellowship program was the genesis for many future leaders of vascular surgery. In 1989, Dr. Bergan left Northwestern for southern California where he concentrated on developing clinical and basic research in venous disease.

Dr. Bergan was instrumental in founding and developing many new societies and publications, including Midwestern Vascular Surgical Society. He also participated in the development of many practice guidelines including a method for data retrieval using computer programming and guidelines for venous disease diagnosis and treatment. He served as president of numerous societies, including the Society for Vascular Surgery, the American Venous Forum, American Venous Forum Foundation, Midwestern Vascular Surgical Society, European-American Venous Symposium, Gulf Coast Vascular Society, Chicago Surgical Society, Lymphedema Association of North America, and Southern California Vascular Surgical Society.

In his career, he authored and co-authored more than 750 publications, including peer-reviewed journal articles, scientific reports, editorials, and book chapters, as well as editing over 35 books. He was invited to speak to professional audiences all over the world and received numerous national and international honors and awards, including the Rovsing Silver Medal from the Danish Surgical Society, Honorary Fellowship in the Royal College of Surgeons of England, and the Lifetime Achievement Award from the International Society for Endovascular Surgery.

Dr. Bergan was a world renowned leader and contributor to the field of Vascular Surgery. He was a prolific scholar, tireless investigator, eloquent speaker, and dedicated educator. When asked what was the most rewarding experience in his long, successful career, Dr. Bergan responded "to teach". We are truly grateful for all that he has contributed and he will be sorely missed.

The Memorial and Celebration of Dr. Bergan\'s life will be held on July 7, 2014, 4:00pm, at the Chicago Yacht Club - Belmont at the Lake (not the Monroe Street clubhouse). If you are able to attend, please send a note to BerganMemorial@gmail.com so that plans can be made accordingly since space may be limited.

In lieu of flowers, Dr. Bergan’s family has asked that you please make a contribution to the:

John J. Bergan, MD Lectureship

Northwestern University Feinberg School of Medicine.

Address: 420 E. Superior Street

Rubloff Building, 9th Floor

Chicago, Illinois 60611

If you would like to leave a message for Dr. Bergan’s family or share a remembrance of him, you may do so at http://www.caringbridge.org/visit/johnjbergan/guestbook.

Dr. Eskandari is The James S.T. Yao, MD, PhD Professor of Education in Vascular Surgery, chief and program director, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago.

More than 100 investigators, students, and trainees with an interest in translational research attended the Vascular Research Initiatives Conference (VRIC) in Toronto. Held one day before the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology Meeting, VRIC fosters interaction among top scientists of diverse disciplines who are investigating peripheral vascular disease and its treatments.

"Everyone made outstanding presentations of cutting-edge research findings," said Dr. John Curci, course director. "Two themes showing promise in translational research are the use of stem cells to alter vascular disease progression and the evaluation of microRNA in diseased tissue and circulation, which may lead to better understanding of disease pathology as well as novel diagnostic testing strategies."

Courtesy SVS

For the first time, a scientific poster session was added at VRIC, and according to Dr. Curci, it stimulated significant discussion. Additional opportunities for interaction occurred during the group luncheon and postmeeting gathering.

"VRIC’s unique value as a meeting stems from its primary focus on translational research," Dr. Curci said. "Almost by definition, translational research requires a community of interactive and collaborative scientists to identify and develop promising therapeutic and diagnostic technologies. The VRIC meeting has evolved to put that collaborative interaction as a central feature."

VRIC is also dedicated to stimulating and encouraging interest in research among aspiring academic vascular surgeons. Each year, the SVS Foundation supports travel scholarships for the top-scoring abstracts submitted by trainees to attend VRIC. The travel scholarship includes complimentary registration to VRIC and the ATVB meeting, along with a $1,000 award for conference travel. Recipients of this year’s VRIC trainee travel scholarship are:

SVS

• Dr. M. Freeman, University of Tennessee Medical Center - Knoxville

Title: Androgen Deficiency Influences Matrix Metalloproteinase Expression and Intimal Hyperplasia Development after Vascular Injury

• Moritz Lindquist Liljeqvist, Karolinska Institutet - Sweden

Title: Finite Element Models With Patient Specific Wall Strength Estimations Improve Growth Predictions of Abdominal Aortic Aneurysms

• Dr. Andrea Obi, University of Michigan

Title: Endothelial Dysfunction Potentiates Deep Venous Thrombosis in a Mouse Model of Sepsis

• Dr. Jonathan R. Thompson, University of Nebraska Medical Center

Title: Mortality Rates of Patients With Peripheral Arterial Disease Are Predicated by The Respiratory Activities of The Gastrocnemius Mitochondrial Complexes I and IV

The next VRIC will be held May 6, 2015, in San Francisco.

More than 100 investigators, students, and trainees with an interest in translational research attended the Vascular Research Initiatives Conference (VRIC) in Toronto. Held one day before the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology Meeting, VRIC fosters interaction among top scientists of diverse disciplines who are investigating peripheral vascular disease and its treatments.

"Everyone made outstanding presentations of cutting-edge research findings," said Dr. John Curci, course director. "Two themes showing promise in translational research are the use of stem cells to alter vascular disease progression and the evaluation of microRNA in diseased tissue and circulation, which may lead to better understanding of disease pathology as well as novel diagnostic testing strategies."

Courtesy SVS

For the first time, a scientific poster session was added at VRIC, and according to Dr. Curci, it stimulated significant discussion. Additional opportunities for interaction occurred during the group luncheon and postmeeting gathering.

"VRIC’s unique value as a meeting stems from its primary focus on translational research," Dr. Curci said. "Almost by definition, translational research requires a community of interactive and collaborative scientists to identify and develop promising therapeutic and diagnostic technologies. The VRIC meeting has evolved to put that collaborative interaction as a central feature."

VRIC is also dedicated to stimulating and encouraging interest in research among aspiring academic vascular surgeons. Each year, the SVS Foundation supports travel scholarships for the top-scoring abstracts submitted by trainees to attend VRIC. The travel scholarship includes complimentary registration to VRIC and the ATVB meeting, along with a $1,000 award for conference travel. Recipients of this year’s VRIC trainee travel scholarship are:

SVS

• Dr. M. Freeman, University of Tennessee Medical Center - Knoxville

Title: Androgen Deficiency Influences Matrix Metalloproteinase Expression and Intimal Hyperplasia Development after Vascular Injury

• Moritz Lindquist Liljeqvist, Karolinska Institutet - Sweden

Title: Finite Element Models With Patient Specific Wall Strength Estimations Improve Growth Predictions of Abdominal Aortic Aneurysms

• Dr. Andrea Obi, University of Michigan

Title: Endothelial Dysfunction Potentiates Deep Venous Thrombosis in a Mouse Model of Sepsis

• Dr. Jonathan R. Thompson, University of Nebraska Medical Center

Title: Mortality Rates of Patients With Peripheral Arterial Disease Are Predicated by The Respiratory Activities of The Gastrocnemius Mitochondrial Complexes I and IV

The next VRIC will be held May 6, 2015, in San Francisco.

More than 100 investigators, students, and trainees with an interest in translational research attended the Vascular Research Initiatives Conference (VRIC) in Toronto. Held one day before the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology Meeting, VRIC fosters interaction among top scientists of diverse disciplines who are investigating peripheral vascular disease and its treatments.

"Everyone made outstanding presentations of cutting-edge research findings," said Dr. John Curci, course director. "Two themes showing promise in translational research are the use of stem cells to alter vascular disease progression and the evaluation of microRNA in diseased tissue and circulation, which may lead to better understanding of disease pathology as well as novel diagnostic testing strategies."

Courtesy SVS

For the first time, a scientific poster session was added at VRIC, and according to Dr. Curci, it stimulated significant discussion. Additional opportunities for interaction occurred during the group luncheon and postmeeting gathering.

"VRIC’s unique value as a meeting stems from its primary focus on translational research," Dr. Curci said. "Almost by definition, translational research requires a community of interactive and collaborative scientists to identify and develop promising therapeutic and diagnostic technologies. The VRIC meeting has evolved to put that collaborative interaction as a central feature."

VRIC is also dedicated to stimulating and encouraging interest in research among aspiring academic vascular surgeons. Each year, the SVS Foundation supports travel scholarships for the top-scoring abstracts submitted by trainees to attend VRIC. The travel scholarship includes complimentary registration to VRIC and the ATVB meeting, along with a $1,000 award for conference travel. Recipients of this year’s VRIC trainee travel scholarship are:

SVS

• Dr. M. Freeman, University of Tennessee Medical Center - Knoxville

Title: Androgen Deficiency Influences Matrix Metalloproteinase Expression and Intimal Hyperplasia Development after Vascular Injury

• Moritz Lindquist Liljeqvist, Karolinska Institutet - Sweden

Title: Finite Element Models With Patient Specific Wall Strength Estimations Improve Growth Predictions of Abdominal Aortic Aneurysms

• Dr. Andrea Obi, University of Michigan

Title: Endothelial Dysfunction Potentiates Deep Venous Thrombosis in a Mouse Model of Sepsis

• Dr. Jonathan R. Thompson, University of Nebraska Medical Center

Title: Mortality Rates of Patients With Peripheral Arterial Disease Are Predicated by The Respiratory Activities of The Gastrocnemius Mitochondrial Complexes I and IV

The next VRIC will be held May 6, 2015, in San Francisco.