Giancarlo Biamino, Department of Cardiovascular Medicine, Clinica Montevergine, Mercogliano, Italy, began his career as a cardiologist. In the 80s, the first uses of endovascular treatment for peripheral arterial disease impelled him to specialise in angiology. In this interview with Vascular News, Biamino speaks about the things that influenced him, memorable cases, the future of endovascular intervention and his interest in music and sports.
When did you decide you wanted a career in medicine? Why cardiology and angiology?
If I remember correctly, I was 16 or 17 years old when I read a book about an English doctor working in London. I was so attracted by all the professional and ethical problems of his activity, that I was already making the decision to follow this career. For me, it was a complex and long way, starting in a small city like Bolzano.
Why cardiology? It was the fascination with this complex system – described by H Harvey only 100 years after the discovery of America – that stimulated my imagination and interest. My interest in angiology came a bit later. After many years of work in the cardiology field and searching for new ways in the interventional world, I realised around 1985–1986 that the possibilities offered by endovascular treatment of peripheral obstructive arterial disease were underestimated and not very well valued.
Who has inspired you in your career and what advice of theirs do you remember today?
To answer this question I would have to mention a long list of teachers. I will limit my list to two people. OH Gauer, my professor and mentor in physiology, motivated me to understand the pathophysiology of the blood circulation in detail. He insisted on intensive research work and admonished me continuously: “Remember that unpublished data are data that do not exist.”
The second inspiration was G Hartzler with B Rutherford in Kansas City who taught me in 1983 the really (at the time) rudimentary percutaneous coronary intervention and he showed me that the only way to improve is to work “harder, longer, better”. This is the definitive motto of my career.
What have your proudest moments been?
It is difficult to answer this question without giving the impression of being a poser or a big mouth. Probably the proudest moments are connected to the global development of LINC (Leipzig Interventional Course). In fact, the success of this event is the result of a fruitful interaction of work with all my friends in Leipzig, and in particular, with Dierk Scheinert, who had the energy and support to transform our ideas into reality, maintaining a very high scientific and ethical level.
How has angiology evolved since you began your career?
Personally I can make only some remarks in relation to interventional angiology. The evolution in this field, particularly in the last 10 years, has been simply dramatic. If you just compare the TASC recommendations of 2000 with those of 2007 you can immediately recognise what has happened.
I suppose that we had never observed such impressive technological changes as happened in the last two decades. However, we have to remain critical. We must demonstrate the real validity of all the new technologies on the basis of scientific data. Enthusiasm is as essential as scepticism.
What have your most memorable clinical cases been?
I would like to mention two cases. One is my first recanalisation of an occluded popliteal artery (6cm long) with a multifibre Excimer Laser catheter in January 1989 (Ted Diethrich was present in the cath lab). The second case was a successfully treated external iliac perforation after stent implantation in a non-operable patient because of an antecedent replacement of the bladder; a horror trip of 20 minutes. It was my first implantation of a covered stent!
How do you see the endovascular field developing in the future?
This is one of the most interesting and delicate questions today. My answer is relatively simple: the field of endovascular therapy is more than huge with a perspective of growth in the number of patients for decades to come. The need for endovascular specialists should be clear for everybody. Therefore it is mandatory to train young people, overcoming all the obstacles of the past between the different disciplines. In my opinion the CX Symposium and LINC are excellent examples applying the motto “education, education, education”.
You developed your career in Germany and Italy. Do you see differences in terms of approach in these two countries?
The two countries are of course not equal. However, the enthusiasm of young people is present in both systems. Personally I have to stress that it was a great change at the end of my career to have the opportunity to move to Italy and contribute successfully to build peripheral programmes in different centres from Turin to Palermo, having a limited experience.
It was also great to have the opportunity to work with and to motivate such a large number of young colleagues to start the peripheral journey. I am now proud to observe that they were able reach an international level of quality with a good scientific activity. I hope that I can maintain this connection for some more time.
Economical and structural differences may have an impact for the future.
Which technique or technology had a profound effect on your career?
I would like to mention two: the Excimer Laser technology and the proximal cerebral protection during carotid artery stenting.
In April, at the CX Symposium, you criticised the use of atherectomy devices. Can you explain why?
During my intervention at CX 2011, my criticism was not directed against an atherectomy device per se, but against the fact that for several years “data” have been continuously presented without a real scientific comparison. As long as we do not have data from randomised studies, the scientific level will remain poor and we cannot pursue reimbursement, at least in Europe. The 510K cannot determine the scientific value of a tool.
The Excimer Laser, science fiction fantasy or practical tool?
The Excimer Laser is also an atherectomy system, to ablate or dissolve the obstructing sclerotic material. In my experience, it is a very valuable tool, but again, we do not have evidence based on randomised studies.
What are your current areas of research?
My interest at the moment is dedicated to drug-eluting balloons. Our experience in subinguinal recanalisation is very exciting. However, again we have to wait for the validated data of ongoing studies before we can express a final recommendation for the different indications.
What is the most interesting paper you have come across recently?
It is a difficult question. Maybe the report on the CREST study linked to the latest guidelines for carotid artery stenting.
What advice would you give to young doctors interested in minimally invasive medicine?
My personal advice is to try to spend a relatively long period (at least one year) in a centre with a high volume of interventions. Young vascular surgeons should also spend some time in a coronary cath lab learning all the tricks for using the different diagnostic catheters and guidewires. Young cardiologists have to realise that peripheral interventions require a deep knowledge of the anatomy and pathophysiology of the different regions: e.g. tibial arteries have the same dimensions as coronary arteries, but they are completely different.
Outside of medicine, what are your interests?
My interests outside of medicine are manifold, I would like to mention two areas: classic music with particular interest for Gustav Mahler as composer and Claudio Abbado as conductor, and I am still active in sport such as alpine (downhill) and cross country skiing as well as golf.
Professor of Internal Medicine, Cardiology, Angiology Education
1959–1965 Medicine, Freie Universität (FU) of Berlin, Germany
1965 Medical state examination Germany
1965–1970 Doctorate, PhD habilitation in “Physiology and clinical Physiology”
1973 Italian state examination
1975 PhD, Habilitation of internal medicine
2006–Mar 2011 Chairman, Gruppo Villa Maria Endovascular, Cortignola, Italy
2004–present Clinical and Scientific Consulting, Clinica Montevergine, Department of Cardiovascular Medicine, Mercogliano, Italy
2002–2006 Director, Department for Clinical and Interventional Angiology, Heart Center Leipzig, Germany
1965–1969 Scientific assistant, Institute of Physiology, Freie Universität of Berlin
1969 Guest assistant at the Physiological Institute of the University Göteborg, Sweden
1969–1971 Medical assistant at the Medical Clinic and Policlinic/Klinikum Steglitz of the FU Berlin
1971 Nomination as assistant professor at the FU Berlin
1972 Granting of Italian doctorate for medicine and surgery from the medical faculty of University Turin, Italy
1973 Approval as internist by the Ärztekammer Berlin
1976–1977 Head physician at the Heart Centre in Munich
1978 Nomination to the extraordinary professor at the FU Berlin
1979 Nomination as full professor for Internal Medicine and Cardio-Pulmonology
1980 Permanent head-deputy, Dept of Internal Medicine and Cardio-Pulmonology, FU Berlin
Mar–Oct 1984 Guest professor at the Mid American Heart Institution in Kansas City, USA
1986–1989 Medical director of the CVLA-project at the Laser-Medizin-Zentrum Berlin
1989–1996 Head of the Dept. Laser Angioplasty, Universitätsklinikum Rudolf Virchow/ Wedding, Zentralinstitut für Röntgendiagnostik
1996 – 1998 Director, Dept for Clinical and Interventional Angiology, Virchow Klinikum, Medizinische Fakultät der Humbold-Universität zu Berlin
1998–2001 Head of Cardiovascular Unit Villa Cherubini, Florence, Italy
1998–2001 Head of the Dept for Vascular Intervention Centre for Cardiology and Vascular Intervention, Prof Mathey/Prof Schofer & Partner, Hamburg, Germany