Anthony Comerota, director Jobst Vascular Center, The Toledo Hospital, Toledo, USA, believes that interdisciplinary collaboration will yield the largest clinical dividends in vascular disease management. He spoke to Vascular News on his career, influences, research and interests outside medicine including sports and baking.
When did you decide you wanted to pursue a career in medicine?
Early in my high school years, I knew I wanted to be a physician, since they were the individuals most highly respected in our community and were by far the most dedicated to their profession. As my high school years progressed, however, I decided to pursue engineering, since that also was an area of interest but would only require four years of post high school education.
During the summer between my junior and senior years of high school, I attended a National Science Foundation science and engineering programme at Oklahoma State University. I recognised that the engineers who were contributing to their field and had the responsibility of teaching others had PhDs. I realised then that selecting a career should be based upon internal desire rather than the number of years of education required to reach the ultimate goal. It was then that I set my sights on a career in medicine.
I must say that it has been a privilege to be a part of the medical profession. I have received much more than I have contributed.
Why did you decide to specialise in vascular surgery?
As a medical student on surgical rotations, I had exposure to vascular surgery. This exposure was extended early in my surgical residency. It was then that I recognised that the vascular procedures were among the most complicated, carried the greatest potential morbidity and mortality, but also offered the most gratification, when procedures were performed properly. Vascular surgeons were capable of doing all general surgery (if necessary) and all vascular. This was appealing at the time, although I have not performed general surgery procedures in over 20 years.
Who has had the greatest impact on your career as a vascular surgeon?
I have had the privilege of meeting and working with many of the great vascular surgeons who laboured to establish our subspecialty and made enormous contributions to get us where we are today. The single individual, however, who has had the greatest impact on me, was my mentor as a vascular fellow, Dr John J Cranley. I learned from him the value of honesty and integrity. He always emphasised that we needed to “do what was right”.
Another individual who I hold in high regard is Dr Thomas Fogarty. Tom and I have a common bond, which is Dr Cranley. When Tom was a medical student at the University of Cincinnati, he got to know Dr Cranley when he worked in the operating room at Good Samaritan Hospital as a scrub tech. It was there that the Fogarty catheter was used for the first time. Tom has made enormous contributions to our field and likely has made more contributions to vascular surgery than any other single individual (although most of his contributions do not carry his name). Despite his enormous success, he still holds Dr Cranley in high regard and carries the ideals of excellence in patient care as a top priority.
How has vascular surgery evolved since your career began?
The rapid evolution to endovascular treatment of most forms of vascular disease is the obvious answer, along with major advances in pharmacotherapy. Unfortunately, I see vascular surgeons becoming less interested in the haemodynamics of vascular disease. Interest in the importance of studying the patient’s pathophysiology and their underlying haemodynamics seems to be waning.
Another major area of change is in the education of vascular surgeons. Although we are now only in the fourth year of the 0–5 vascular surgery residency, I predict this will be the educational programme of the future for the majority of vascular surgeons. Shortening the vascular education to a total of five years and shortening the work week to a maximum of 80 hours will necessarily curtail the exposure of future vascular surgeons in a variety of areas.
However, current educational opportunities and techniques are so much more efficient than they were 25 years ago. Our students, residents and fellows can learn a great deal more per unit time than prior generations.
What has given you the most gratification as a vascular surgeon?
Of course, patient care is always rewarding and should be mentioned first. Aside from good patient outcomes, my greatest gratification is my involvement in the education of vascular residents and fellows. Having the opportunity to contribute to their education, to the way they think about vascular disease and their approach to its management is both a privilege and a responsibility. It may sound a bit patriarchal; however, I look upon my former fellows as professional offspring. Observing their clinical and academic accomplishments is exceptionally gratifying.
Participation in important clinical trials which are likely to change patient care is another source of professional gratification. Such trials include those sponsored by the National Institutes of Health in addition to well designed non-federally funded trials.
Participation on Guideline Writing Committees at the national and international level is also very gratifying, since these guidelines are likely to impact patient management.
What are your areas of current research?
I am privileged to work with a large and dedicated group of clinical researchers at the Jobst Vascular Institute. Participation in well designed clinical trials is a priority as results from these trials are likely to lead to the most dramatic changes in patient care. I am interested in evaluating the physiologic response to intervention and there remain areas in the non-invasive diagnosis of vascular disease that we have not yet conquered, such as the diagnosis of venous obstruction and its impact on venous physiology in individual patients.
I continue to be impressed with the impact pharmacologic agents (antithrombotics) have on vascular disease and patient outcomes, and pursue studies in this area. The adverse effects of acute and chronic occlusion of the iliofemoral venous segment remains under appreciated by many physicians. This is an ongoing area of clinical research.
Where do you see the biggest gains in the management of vascular disease?
I believe that interdisciplinary collaboration will yield the largest clinical dividends. I have had the privilege of working with colleagues in internal medicine (vascular medicine), haematology, and interventional radiology when I was at Temple University.
Interdisciplinary collaboration continues with colleagues in vascular medicine, interventional radiology and cardiology. I believe that such collaboration allows each specialist to achieve more than they could individually thereby catapulting advances in patient care.
Outside of medicine what other interests do you have?
I have always been interested in sports, participating in football, basketball, baseball and tennis at the high school and collegiate levels. Currently my sports activities are limited to tennis, skiing and being an enthusiastic spectator. I enjoy baking in all of its forms. I have a particular penchant, however, for chocolate recipes.
Perhaps my greatest interest outside of my profession is watching my children and their families grow personally and professionally. It is humbling to observe that they are developing into a better parent than I was; however, I expect to set a very high bar for them as a grandparent.
- Temple University School of Medicine, Philadelphia, Pennsylvania
- Resident in Surgery, Temple University Hospital
- American Cancer Society fellow, instructor of Surgery, Temple University Hospital
- Vascular surgery fellow, Good Samaritan Hospital (Dr John J Cranley), Cincinnati, Ohio
- Assistant professor of Surgery, Temple University School of Medicine
- Associate professor of Surgery, Temple University School of Medicine
- Professor of Surgery, Temple University School of Medicine
1984-2002 Chief of Vascular Surgery, program director of Vascular Surgery,
Temple University Hospital
2002-Present Director, Jobst Vascular Institute, Toledo
Programme director of Vascular Surgery
Adjunct professor of Surgery, University of Michigan, Ann Arbor
American Surgical Association, Society of Vascular Surgery-Distinguished Member, American College of Surgeons (Fellow), American Venous Forum – Past President, Peripheral Vascular Surgery Society – Past President, Philadelphia Academy of Surgery – Past President, Delaware Valley Vascular Society – Past President, American Heart Association, Society of University Surgeons, American College of Cardiology (Fellow), European Venous Forum (Honorary Fellow), Australasian College of Surgeons (Honorary Fellow), Society of Clinical Vascular Surgery, Society of Vascular Medicine, Midwest Vascular Surgery Society, American College of Phlebology, American Board of Phlebology, Association of Program Directors of Vascular Surgery, American College of Chest Physicians, International Society of Vascular Surgery
Jonathan Rhodes Lecture (Philadelphia Academy of Surgery), Wiley F Barker Lecture (University of California Los Angeles), Max Gaspar Lecture (University of Southern California), Scott Tulman Lecture (Buffalo Medical Group and Buffalo Surgical Society), Smithwick Lecture (Boston University School of Medicine), Rosenbaum Lecture (Cedars Sinai Medical Center, Los Angeles), Geza DeTakats Lecture (University of Illinois), John J Cranley Lecture (Good Samaritan Hospital, Cincinnati)
UCLA, University of Chicago, University of Oregon, University of Arkansas, Brigham and Women’s Hospital, University of Mississippi, University of Queensland, New Jersey College of Medicine and Dentistry, University of Manitoba, New York University, University of Alabama, University of Rochester, Emory University, Mayo Clinic, University of Illinois, Cleveland Clinic, University of Pennsylvania, University of Southern California