Hence Verhagen talks to Vascular News about his career in vascular surgery to date. He lauds the impact of the shift from open to endovascular techniques, but stresses that treatment results must get “a lot more durable” in the future, and encourages those starting a career in vascular surgery to go out of their comfort zone “regularly”. The incoming 2021 president of the European Society for Vascular Surgery (ESVS), Verhagen considers what he would like to achieve in this role and what we can expect from the upcoming annual meeting, which, like many other meetings in the wake of COVID-19, will be a virtual event.
What led you to become a vascular surgeon?
I had the pleasure of meeting Professor Bert Eikelboom early during my time at medical school. He inspired me and offered me the opportunity to do a few research programmes. After a few years, he offered me a PhD position. Eikelboom was a prominent leader in the field of endovascular repair of the aorta in the Netherlands and Europe and his work convinced me that I should pursue a career in vascular surgery.
Who have been your professional mentors, and what lessons did you learn from them?
I actually had a few mentors that were, in different ways, crucial to key decisions in my career. The first was Bert Eikelboom, as mentioned above. The second was Professor Theo van Vroonhoven, my trainer and mentor in general surgery. He was a vascular surgeon as well and was co-founder of the Dutch Vascular Society. He taught me never to settle for any result less than 100% and was a very inspiring surgeon. The third was Professor Jan Blankensteijn, who guided me through the first years of vascular surgery, both clinically as well as scientifically. An exceptionally talented person, I learned a huge amount from him. He also introduced me to my fourth mentor, Professor Geoff White from the Royal Prince Alfred Hospital, Sydney, Australia, who was the friendliest and most inspiring surgeon I have ever met. He introduced me at the right time and in the right place to the whole aortic endovascular revolution. He turned out to be the most influential person for my further career. We became very close over the years and so did our families. I still think about him (and miss him) every day. The fifth mentor is Professor Frans Moll, who I worked with in Utrecht, the Netherlands. We share the same professional hobbies and passion and we turned out to be quite a successful team. He pushed my career further in an incredible way. I admire—and try to copy—his never ending desire to innovate, improve, and keep on learning new techniques and technologies. Again, a very inspiring and charming surgeon.
What are the most significant ways you have seen the vascular field develop over the course of your career?
Obviously, the whole shift from open to endovascular techniques revolutionised the vascular surgery arena. It made the profession so much more interesting and appealing. When I look at all the minimally invasive interventions we do, how this impacts the life of our patients and their relatives, and the enthusiasm with which the young vascular surgeons master these techniques, I can be proud that I was part of this huge change in landscape. What a difference this is from my first few years in the field!
What developments would you most like to see realised in the next decade?
We are doing alright but treatment results need to get a lot better and a lot more durable. There is still a lot to gain there. I cannot think of a world where we go back to open surgery. I really do not see a push towards open surgery, the way that the UK National Institute for Health and Care Excellence (NICE) has tried to accomplish, for example.
They do have a point though: for a variety of reasons, many—particularly young—vascular surgeons are hesitant to do open repair, resulting in endovascular treatments with very moderate results that probably should not have been done. The answer is to make endovascular treatment better and more durable, not to turn the clock back.
Which new paper presentation has caught your attention?
The Katsanos paper [Katsanos et al, “Risk of death following application of paclitaxel-coated balloons and stents in the femoropopliteal artery of the leg: A systematic review and meta-analysis of randomised controlled ttrials,” Journal of the American Heart Association, December 2018] is in my top 5% because really, nobody truly understands what is happening there, which makes it very interesting.
What do you hope to achieve as president of the ESVS?
My goal is an even better connection between the ESVS, the academy, and young vascular surgeons for whom the additional value of an ESVS membership is more clear. Furthermore, I will also try to further professionalise the way the ESVS is run, and make improvements to the business model to have a more sustainable organisation. Finally, reaching out to other professional societies including cardiology, radiology, vascular medicine, angiology, and cardiothoracic surgery to establish better interaction is high on our agenda.
What has been the proudest moment of your career to date?
There are so many proud moments, I really could not pick one above the other: from seeing your fellow perform a successful intervention, saving a patient’s life during an emergent intervention, to presenting important new data on a conference. So much to be proud of!
What are your current areas of research and work?
I am still mainly focussed on aortic pathology, both clinically as well as scientifically. I am considering a change of focus, but it is too early to say.
What advice would you give someone starting their career in vascular surgery?
Make sure to keep an open mind to change and go out of your professional comfort zone regularly, which is the only way to truly learn and stay young.
What are the biggest challenges currently facing vascular surgery?
Inconvenience. In general, vascular surgery groups are too small to have decent on-call rosters. Many, especially young people, see that as a huge disadvantage, which is driving many away from this great profession.
Could you tell us about one of your most memorable cases?
I keep on seeing memorable cases, some with exceptionally successful outcomes, some (sometimes unexpectedly) not so. Even after more than 20 years, new clinical issues appear regularly and that makes is so interesting and impossible to get bored.
How do you like to spend your time outside of work?
Outside of work (and that is a challenge) my hobbies and interests include spending time with my four children, sports, and travelling. We recently started the Erasmus MC – Medtronic Academy for optimising vascular disease awareness and education in sub- Saharan Africa: a wonderful educational programme with hopefully a large impact on many lives in that particular area of the world.
What has been the fallout of COVID-19 for vascular patients?
All elective interventions were stopped. Interventions were only considered if aneurysms reached a diameter of 7cm or larger. Patients with symptomatic carotid stenoses or limb threatening ischaemia were intervened on as before COVID-19. For now, it is impossible to know what the extent of the “collateral damage” is or will be in the near future. Many vascular surgeons have noticed that outpatient wound care was suboptimal the last months resulting in an increase in patients with very severe wound problems recently.
What form will the ESVS annual meeting take this year?
We have chosen to opt for a completely digital ESVS Month! Every Tuesday and Thursday between 29 September and 22 October, the ESVS will welcome vascular surgeons, vascular surgeons in training, vascular nurses and sonographers, and other related specialists during its live webinars and interactive educational sessions. The programme committee has done an incredible job in selecting an ultra-educational and inspiring programme.