What’s new in vascular surgery

The past year has been one of significant activity in vascular surgery, on the organizational, clinical, and research levels. Perhaps the most significant development of the year was the decision by the two major national vascular societies, the Society for Vascular Surgery and the American Association for Vascular Surgery (AAVS), to combine to form one organization with a coordinated strategic plan to enhance development of the specialty of vascular surgery in the future. This effort, which was led by the executive leadership of the two societies, was ratified by the membership at the conjoined annual meeting in June 2003. The resulting merged society, which will retain the name of the Society for Vascular Surgery, has moved its executive offices to Chicago in the building owned by the American College of Surgeons. This was done to provide a greater focus for the new Society (SVS) and to enhance the relationship between vascular surgery and the American College of Surgeons. The newly reorganized SVS will focus on advancing excellence and innovation in vascular health and reinforcing the position of vascular surgeons as leaders in vascular health care. The SVS has established six critical strategic initiatives for implementation over the next 2 years: modification and improvement of the current training paradigm in vascular surgery, enhancement of educational programs in vascular disease, strengthening communication between vascular surgery and government at all levels, increasing public awareness of vascular disease and the role of vascular surgeons in improving vascular health, improving communications between the vascular surgical community and industry, and merging the foundations of the two organizations. This proactive approach is designed to position the community of vascular surgeons for success and growth over the next decade. In the past year a political action committee has been established by the SVS to enhance communication with legislators at local, regional, and national levels. Activities of the current Government Relations Committee helped to reverse the proposed cut in reimbursement by CMS for the year 2003 and supported the recent Medicare bill that reversed proposed cuts in reimbursement for 2004. There will be a modest gain, as a result, in reimbursement for vascular codes in 2004. Efforts are also underway to increase public awareness of vascular disease and to promote screening of high-risk groups of the Medicare population for both carotid stenosis and abdominal aortic aneurysm. In addition to these sociopolitical developments, there have been a number of specific advances in vascular research and clinical care. These will be summarized briefly in this article. Developments in vascular disease: high-risk groups, risk-factor reduction, and general medical therapy Vascular surgeons have traditionally managed both medical and surgical vascular disease. The field of vascular medicine includes identification of patients at high risk, and risk-factor reduction has become increasingly important over the last decade. The dawn of the genomic era has prompted a search for genetic polymorphisms that could be used to predict the risk of future cardiovascular events. Over the past year, publications have focused on genomic analysis of patients with myocardial infarction, 1 stroke, 2 and hypertension. 3 In a study from the University of Pittsburgh, Kibbe and colleagues 4 demonstrated that screening for the methylene tetrahydro-folate reductase (MTHFR) gene may be useful in identifying patients at increased risk of postoperative graft thrombosis and Brown and associates 5 correlated changes in the interleukin (IL)-10 gene with