Presidential address: on old dogs and new tricks.

I would like to thank the Society for Clinical Vascular Surgeons membership for the honor of serving as your President this past year. I first became aware of this organization in 1979, when I submitted a paper (unsuccessfully) for the Peter B. Samuels Award. Despite my initial failure to get on the program, I remained interested in the Society and its annual program and have been privileged to attend many of its meetings and count many members as my friends. I have seen the Society for Clinical Vascular Surgery grow to become the second largest vascular society in North America, with more than 950 members. I have witnessed a maturation of the Society and its annual program to its current status, and I am privileged to be a small part of that process. The annual meeting is an opportunity for the President to address a topic of personal or professional interest. Presidential addresses span a broad range of professional, philosophic, and artistic topics. This year, I have chosen to focus on my personal experiences over the past year in the area of endovascular surgery and the influences they have had on my perspective concerning the education of practicing vascular surgeons in this area. Over the last several years, much emphasis has been placed on the need for vascular surgeons to acquire catheter-based skills—appropriately so. The program directors in vascular surgery have made access to adequate endovascular training a requirement for residencies in vascular surgery. Position papers on the requirements for endovascular training have been published. Emphasis has been directed to our new and future trainees, and those currently in practice have been encouraged to gain the requisite experience either in their place of practice with the help of interventional radiologists or cardiologists, or through “mini-fellowships” of 3 to 6 months duration. For many practicing vascular surgeons, these requirements have not proven practicable, and as a consequence, adoption of endovascular therapy by those 10 or more years in practice has been erratic. This will ultimately have a negative effect on the development of vascular surgery. In the body of this address, I will discuss the trials and tribulations of an “old dog” learning the “new tricks” of endovascular therapy. These experiences have caused me to critically reexamine the current recommendations for acquisition of new knowledge by established vascular surgeons. I believe that these recommendations need to be modified and that a fresh look at transfer of new knowledge and techniques to those already in practice is necessary. In my own experience, the prospect of gaining expertise in catheter-based techniques was discouraging. Help from colleagues in radiology was not forthcoming, and conventional wisdom suggested that this was all very complicated, requiring, at a minimum, months away from clinical practice doing specialized “mini-fellowships” designed to accumulate the holy grail of 100 cases. This was not practical for someone with both an established practice and multiple administrative responsibilities. It seemed that the only recourse for this “old dog” was to hire a young well-trained “endo-competent” partner, who would then provide me with clinical training. This decision was a partial, but not complete, answer to the problem. It provided an impetus to our initial endovascular efforts and a dedicated individual who had as his goal the establishment of a program in endovascular surgery. However, the pace of my endovascular training was not significantly increased. My new faculty member was appropriately concerned with the establishment of his own endovascular practice and the training of our fellow. There was little opportunity for me to obtain meaningful hands-on experience. This past July, it became apparent that I needed to independently educate myself in endovascular interventions, particularly aortic stent grafting. Clearly, I had to bite the bullet and try to learn some “new tricks”. Thanks to some of my friends, particularly Frank Veith, Tak Ohki, Larry Hollier, Alan Lumsden, and Sam Money, I had a From the Division of Vascular Surgery, Stony Brook University Hospital and Health Sciences Center. Competition of interest: Dr Ricotta has patent applications filed for an endovascular stapling device and for a novel endovascular graft and is currently trying to bring these concepts to reality by collaborating with Industry. However, no formal collaboration or business relationships currently exist. Presented at the Thirtieth Annual Symposium on Vascular Surgery, Society for Clinical Vascular Surgeons, Las Vegas, Nev, Mar 14-17, 2002. Reprint requests: John J. Ricotta, MD, Department of Surgery, University Hospital and Health Sciences Center, Stony Brook University, Stony Brook, NY 11794-8191 (e-mail: ricotta@surg.som.sunysb.edu). J Vasc Surg 2002;36:657-62. Copyright © 2002 by The Society for Vascular Surgery and The American Association for Vascular Surgery. 0741-5214/2002/$35.00 0 24/6/127960 doi:10.1067/mva.2002.127960