The president-elect of the Society for Vascular Surgery (SVS), Kim Hodgson, begins his year as SVS president in 2019. In this profile interview with Vascular News, Hodgson discusses his career and research interests, how he came to be involved in the SVS, and what his goals are for the coming year.
Having started in biochemistry as an undergraduate student, why did you decide to become a medical doctor, and what led you to vascular surgery?
My interests have always tended towards the biological sciences so my pursuit of medical training following college just seemed like a natural evolution. After briefly flirting with Psychiatry, it was Surgery that captured my attention, and once in residency, Vascular Surgery that provided me with the right mix of technical challenges and opportunities for intellectual growth.
Who were/are your mentors in the vascular field, and how did they shape your career?
As a General Surgery resident in Albany, USA, Alistair Karmody and Dhiraj Shah introduced me to the challenges and rewards of a career in Vascular Surgery. My fellowship training with David Sumner honed those skills and introduced me to the scientific method and the art of writing. My contemporary mentors, Alan Lumsden and Ken Ouriel, teamed up with me to educate and train vascular surgeons about the need to embrace endovascular therapies.
How did your work with the Society for Vascular Surgery (SVS) develop over the years?
My entrée into the SVS was my endovascular skillset, a relative rarity among vascular surgeons at that time. Working in a smaller institution without the rigid specialty politics typically present in the more storied programmes, I was able to enter the endovascular arena very early in my career when only common iliac artery plain angioplasty was being performed and evolve with it. There was great opposition from the leaders of vascular surgery at that time to incorporating endovascular training into vascular surgery fellowship programmes, but the need to do so was recognised by some—as was my ability to contribute in that way.
So began a decade of organising endovascular skills postgraduate courses for members at the Vascular Annual Meeting (VAM), as well as initiatives to promote endovascular training in our fellowship programmes and the vascular surgeons’ role in the delivery of endovascular care, all of which ultimately saved Vascular Surgery from extinction. When the need for a maintenance of certification self-assessment became apparent in the mid-2000’s, I was given the opportunity to expand on my service to the SVS and produced the inaugural edition of the Vascular Education and Self-Assessment Program (VESAP), followed over the next six years by the two editions which I co-edited with John Eidt. From there, I was elected to the SVS Executive Committee in the position of treasurer, followed by my ascension to the vice-president role in 2017 and president-elect in 2018.
As president of the SVS, what are your main goals and how do you hope to realise them?
Over the past several years, the SVS has made substantial investments to promote various facets of overall quality, including the development of our Vascular Quality Initiative, the publication of Clinical Practice Guidelines and Appropriate Use Criteria, the formation of a Quality Council, and the development of a vascular services certification programme with the American College of Surgeons.
These initiatives are all coming together nicely, providing an opportunity for the SVS to distinguish itself and its members as leaders in the delivery of the right vascular care, at the right time, in the right site of service, and by those who have been properly trained and who are monitoring their indications and outcomes. The time is right for an overarching certification programme, which is currently in development, and my goal is to continue to shepherd that process along.
What do you most look forward to at the upcoming Vascular Annual Meeting?
An exciting new addition to the VAM this year is an SVS Foundation Gala: a new opportunity for vascular surgical colleagues to socialise, be entertained, and support the SVS Foundation at what will become our annual SVS Foundation auction of a variety of member artwork and other donated items and services.
What are your current research interests?
My current research focus is clarifying the mortality signal around the use of paclitaxel devices in peripheral arterial disease (PAD). As the leader of the SVS Paclitaxel Safety Task Force, a seasoned team of trialists, statisticians, and vascular surgeons, we are exploiting the unique power of the SVS-VQI to evaluate this critical question with real-world data.
In the last year, which research paper(s) have you found particularly interesting, and why?
The Katsanos meta-analysis which first raised the alarm about a possible paclitaxel mortality signal has certainly been the most provocative publication of late, since it could undermine a promising therapy for PAD. While his meta-analysis is not without its limitations and criticisms, now that the question has been raised there will be no comfort using these devices, receiving these devices, or advancing the development of these devices, until the matter is conclusively resolved.
What do you think are the main challenges facing the vascular field?
Having witnessed the birth of vascular surgery, I am now bearing witness to the birth of its first offspring: the various facets of vascular surgery that are rapidly becoming our sub-specialties. The field has become so broad that we are now encountering vascular surgeons who only practice relatively small aspects of the field. This will have a profound impact on how we train vascular surgeons in the future, and how and where our vascular patients receive their care. Our other main challenge is our loss of distinction among the vegetable soup of physicians now claiming to be specialists in treating vascular disease. Though we have the distinction of being the only specialty capable of delivering comprehensive vascular care, we need to demonstrate that this equates to better therapeutic decisions, outcomes, and cost-effectiveness.
What new advances and developments do you hope to see in the field over the next five years?
We need to reach clarity about the proper role for endovascular and open surgical revascularisations in an accountable care world. Clearly an endovascular-first approach for all is wasteful, if not harmful, to patients with severe disease, surgical options, and a reasonable life expectancy. This is especially true now that the use of paclitaxel devices is in doubt. While we prefer not to acknowledge it, or to point the finger at one of our competing specialties, a not-insignificant amount of vascular “care” being delivered today brings little value to the patient, yet significant cost to our healthcare system. Though some of this “care” may be provided with the best of intentions, we all know that some is also simply performed for personal gain.
We need a Vascular Centers Certification programme, such as the SVS is working on with the American College of Surgeons, to ensure not just good outcomes, but appropriate indications in the first place. If we do not step up to the plate and regulate ourselves, someone else will be happy to step in and do so for us—and I bet we will not like the form it takes.
Could you tell us about a particularly memorable case you have had, and what you learned from it?
Most of our patients have created their own disease through socially irresponsible behaviours, which gives us a little insulation from guilt if their outcomes from our treatment are sub-optimal, which they eventually will be. These are the bulk of our patients and they all blur together because their dismissal of recommended lifestyle changes means that their clinical course over time is predictably poor. The patients that distinguish themselves in my memory are the innocent victims of an accident whose life or limb I have been able to save, or the patients who actually listened to my warnings and quit smoking. In contrast to the unreformed group, these patients generally do well, and make me feel great for what I have been able to do for them when I see them in follow-up.
What advice would you give to physicians and vascular specialists who are at the beginning of their career?
You are entering a career that will likely span over 30 years; do not expect to be practising the same vascular surgery at the end of your career that you have been trained to practice today. Keep your mind open to potentially new therapies, but do not jump on every bandwagon without careful consideration about what is best for your patients. Rarely is the hype around a new therapy proportional to the value it brings to the patient or the healthcare system.
Outside of work, what are your interests and how do you most like to spend your time?
My principal interests outside of medicine are travel and photography, which I originally embraced in my youth as a shared hobby with my father in the days of darkrooms and chemicals. Having travelled to and photographed all seven continents I have abundant material to work on for years to come. Much of my work is done in my home office surrounded by my pet toucan Gizmo and parrots Hooter, Harley, and Yodi.
Current professional appointments
2010–Present: Associate Program Director, Vascular Surgery Residency Program, Southern Illinois University School of Medicine (Springfield, USA)
2009–Present: David S. Sumner Professor of Vascular and Endovascular Surgery, Southern Illinois University (Springfield, USA)
1999–Present: Chairman, Division of Peripheral Vascular Surgery, Southern Illinois University School of Medicine (Springfield, USA)
1998–Present: Professor of Surgery, Section of Peripheral Vascular Surgery, Southern Illinois University School of Medicine (Springifield, USA)
1987–Present: Director of Non-Invasive Vascular Laboratory, Memorial Medical Center (Springfield, USA)
Society for Vascular Surgeryappointments (selected)
2017–2018: Vice President
2015–Present: Foundation Board of Directors
2014–2017: Finance Committee Chair
2014-2017: CoEditor-in-Chief of VESAP-3
2011-2014: CoEditor-in-Chief of VESAP-2
2011–2012: SVS Vascular Chairs
2008-2011: Editor-in-Chief of VESAP-1
2007–2016: Education Council as VESAP
Other society appointments (selected)
2004–2008: Communications Committee Chairman, International Society for Vascular Surgery
2003–2006: Specialty Society Governor, American College of Surgeons
2000–2005: Programme Committe, The American Association for Vascular Surgery
2002–2003: President, Society for Clinical Vascular Surgery (SCVS)
2014–2018: SIU Department of Surgery Teaching Award, Resident Teaching Award
2011: Society for Vascular Surgery Volunteerism Award
2009: Recipient of the David S. Sumner, M.D. Endowed Chair in Endovascular and Vascular Surgery
2006: Senior Researcher of the Year 2005–2006, Department of Surgery, SIU School of Medicine