Michael Jacobs, Chairman and Professor of Surgery, Department of Surgery, Maastricht University Medical Center, The Netherlands, told Vascular News about his foray into the world of vascular surgery, his most memorable case, the advice he always follows, and golf!
When did you decide you wanted a career in medicine and has it lived up to expectations?
At the end of high school, I debated between a medical career and a future as a pilot. I am very happy that I followed the medical path and I would choose for the same direction.
Why did you decide to specialise in vascular surgery?
At an early stage in medical school, I was confronted by a professor in vascular surgery who pulled me in to this fascinating world. Actually he was a general surgeon, but he was most active in vascular procedures. This was in the late Seventies and early Eighties and I have still not come out of this vascular surgical marinade! As soon as I began my general surgical residency, I was offered the chance to perform clinical vascular research, and all this directed me towards vascular surgery as my specialty of choice.
Why is vascular surgery special to you?
In general, the pathophysiological problems in vascular surgical patients are rather straightforward and the solutions relatively simple. The open and endovascular solutions we offer to the patients are logical, easy to explain and a great challenge to perform in the most optimal way. Clinical outcome of our interventions can very well be assessed and the principles of evidence based medicine can be applied. Clinical decision making is therefore undemanding, which makes it a very surveyable profession. Most importantly, the technical aspects of open and endovascular procedures are highly intriguing, requiring adequate tissue handling and perfect surgical skills.
On a professional level, what have been your proudest moments?
There are indeed some moments during the last two decades which brought proud feelings. I remember the very first patient in whom we replaced the entire thoracoabdominal aorta very well. We worked very hard on the infrastructure to perform these procedures and this first patient left the hospital without any complication. It was a victory for the team and we all shared that proud feeling that we achieved our goal. Another professional honour has been the magnificent cooperation with Alain Branchereau with whom I have worked very closely for the last 16 years organising the European Vascular Course. I am proud on what we have achieved and especially about our deep friendship. I deeply regret that he retires this year.
Vascular surgery has undergone many changes over the years – what do you think the most fundamental changes have been?
One of the most fundamental changes is the introduction of prospective studies being launched to answer basic questions. In addition to doing we also started thinking. Before that era, surgical procedures were performed without serious evidence (for example in carotid artery disease) and randomised trials have really changed the vascular surgical mind set.
More clinically, the introduction of the endovascular techniques has dramatically changed our daily practise. Look at the programmes of vascular meetings some 10 years ago and compare with the current schedules, showing that the ratio of open and endo topics has changed impressively.
In your opinion, what are the main trends in vascular surgery at the moment and what can we expect to see in the near future?
Obviously the minimally invasive techniques will develop further, but the future will be dictated by early diagnosis and prevention. Rather than secondary prevention, primary prevention will concentrate on (extremely) early detection of disease and on risk factors causing the potential disease to develop. Gene therapy, in combination with nanotechnology, will finally serve a large portion of our patients. However, degenerative vascular diseases and vascular traumas will remain and will definitely require skilled surgeons to treat them.
What is the most memorable case you have ever treated?
I immediately think of a 25-year-old healthy woman who was referred three weeks after a snowboard accident in the Alps. In a jump, she fell on her back but continued snowboarding. In the evening she became short of breath and decided to drive back home the next day. During the trip she deteriorated and was hospitalised. Besides respiratory problems, she developed cardiac failure but standard diagnostics could not identify the cause of this rapid worsening. Two weeks later a computed tomography scan was performed showing a type A aortic dissection which involved the left coronary artery and also the supra-aortic arteries. She was referred to us and we performed an aortic arch and proximal descending aortic replacement with reconstruction of the left coronary artery. This young lady recovered uneventfully, but several months later she developed acute lethal cerebral infarction and autopsy showed that the dissection extended in to the cerebral vessels. This healthy young woman died from an “innocent” fall on the back causing extensive dissection in the ascending aorta and main side branches. Extremely impressive.
Who are the people who have influenced you?
Many surgical colleagues have had a major impact on my career, including my teacher and chief of surgery in Maastricht, Professor Greep. The most important cardiovascular influence has come from Houston where I trained under Dr Cooley and Dr Reul. They always told me to “Keep it simple”. That was the surgical dictum, especially in the most complex cases and I try to apply this principle as often as possible.
What are your current areas of research?
Our main interest lies in the prevention of ischaemic damage to the intestines, kidneys and spinal cord in patients undergoing thoracoabdominal aortic aneurysm repair. Also, we have an active endovascular programme and perform basic and clinical research on alternative techniques to treat aneurysms.
Outside of medicine, what other interests do you have?
I am addicted to playing golf. As soon as I see a green piece of land with a small flag in the middle, I tend to take the clubs out of the car. Biking on the hills around Maastricht is another favourite activity.
What advice would you give to a young vascular surgeon today?
The first advice would be to be trained in general surgery since the basics and principles of general surgery are of most practical value in vascular procedures. Secondly, choose for a vascular surgical curriculum that comprises the full spectrum of both endovascular and open surgery, in a well-balanced manner. The young vascular surgeon of today and the future should ideally master both approaches. Lastly, be involved, at least to some degree with (clinical) research and educational programmes. Both of these offer continuous update of knowledge in this rapidly changing specialty.
FACT FILE
Education and credentials
1976 Medical study, University of Limburg, Maastricht
1981 Doctorate in Medicine
1982 Medical Doctor degree
1982-1984 Assistant in the department of Surgery and Physiology, Academic Hospital Maastricht (Head Prof. dr. J.M. Greep, Prof. dr. R.S. Reneman)
1984-1989 Resident in the department of Surgery, Academic Hospital Maastricht
(Head Prof. dr. J.M. Greep, Prof. dr. G. Kootstra)
1989-1990 Clinical fellowship, department of Cardiovascular Surgery, Texas Heart
Institute, Houston, Texas USA (Head Dr. D.A. Cooley, Dr. G.J. Reul)
1990 Staff member department of Surgery, Academic Hospital Maastricht
1990-1994 Established Investigator Dutch Heart Foundation (1990 – 1994)
1991-1993 Head of Division Clinical Microcirculation, Cardiovascular Research Institute
Maastricht
1993-2000 Chief of Vascular Surgery, Academic Medical Center, Amsterdam
1995-2000 Professor of Vascular Surgery, University of Amsterdam
1995-present Fellow of The Royal College of Surgeons of England
2000-present Professor and Chief of Surgery, Chairman of the department, Maastricht University Medical Center
2003-2004 Chairman of the department of Cardio-thoracic Surgery, Maastricht University Medical Center
2005-present Professor and Chief of Vascular Surgery, University Hospital Aachen, Germany
Thesis
PhD Thesis, Faculty of Medicine, University of Limburg, Maastricht, The Netherlands, March 29, 1985
Title: Capillary Microscopy and Hemorrheology in Vasospastic and Occlusive Vascular Diseases
Winner of Schoemaker-prize 1985 (best surgical thesis in The Netherlands)
Appointments in medical education
1993-2000 Lecturer in Vascular Surgery, medical curriculum, University of Amsterdam
1994-1998 Coordinator surgical education for medical students, University of Amsterdam
1995-2000 Board member Institute for Medical Education, University of Amsterdam
1995-2000 Chairman Fellowship in Vascular Surgery, University of Amsterdam
2000- Chairman Residency Program Surgery, University Hospital Maastricht
Officer, executive council
1991-1998 Secretary of Netherlands Society of Vascular Surgery
1995-1999 Chairman NWO-Division Peripheral Circulation
1998-2005 Council member European Society for Vascular Surgery
Editorial board
1998-2005 Chairman European Journal of Vascular and Endovascular Surgery
Review, journals
Journal of Vascular Surgery
Memberships
Netherlands Society of Surgery
Netherlands Society of Vascular Surgery
Deutsche Gesellschaft für Gefäßchirurgie
European Society for Vascular Surgery
European Surgical Association
Royal College of Surgeons of England
Denton Cooley Cardiovascular Surgical Society
Société de Chirurgie Vasculaire de langue Francaise
Management positions at this moment, University Hospital Maastricht
Professor and Chairman of the Department of Surgery
Head Intensive Care Cardiovascular Unit
Director Cardiovascular Center Maastricht
Chairman University Medical Center Cardiovascular Unit
Coordinator student program
Member organising committee
Symposium on Thoracic Outlet Syndrome, July 2-3, 1982, Maastricht, The Netherlands
Symposium on Flow and Disease, April 9-11, 1986, Maastricht, The Netherlands
XV European Conference on Microcirculation, September 4-9, 1988, Maastricht, The Netherlands
European Working Group on Critical Leg Ischaemia
