“Go for it!” Michael Jenkins urges anyone looking to start a career in medicine, highlighting that the COVID-19 pandemic has put into sharp focus its “vocational and worthwhile nature”. Over the course of his own career to date, Jenkins has seen the shift towards a more minimally-invasive endovascular approach, but stresses that “there is still much work to be done” in this field, predicting a “temporary swing” back in favour of open surgery for some aortic conditions. Currently, Jenkins is president of the Vascular Society of Great Britain and Ireland (VSGBI) and has overseen a “busy year” at its helm. He anticipates the upcoming annual meeting—the first face-to-face VSGBI gathering following a two-year, COVID-19-induced hiatus—will be a highlight of his presidency.
Why did you decide to pursue a career in medicine and why, in particular, did you choose to specialise in vascular surgery?
I was good at science at school and it was then natural to aim for medicine. Subconsciously, there may have been an influence from the fact my father died of a sudden myocardial infarction (MI) when I was only four years old. I went in to medicine, always with a view to do surgery. My twin brother was of the same mind and we gravitated towards vascular and cardiac surgery as we both enjoyed the technical challenges. We realised we should choose different paths to avoid confusion though! He is now a cardiac surgeon at the Royal Papworth Hospital in Cambridge, UK.
Who have been your career mentors?
I think I have always learned something from everyone I have worked for, but was always particularly impressed by good operators as I saw how their patients did better postoperatively. My early experience at the beginnings of endovascular aneurysm repair (EVAR) using homemade devices with Mo Adiseshia was memorable as was my time at the Royal Brompton Hospital (London, UK) with Magdi Yacoub and Chris Lincoln. Visits to Hazim Safi in Houston, USA, were always inspirational as well.
What has been the most important development in vascular surgery during your career to date?
Clearly the shift towards a more minimally-invasive endovascular approach has been a game changer. This has introduced both new techniques and technology and is a big advantage for some patients. It is disappointing that the initial promise has not translated to a durable solution for all though. There is still much work to be done as our patients are surviving longer and deserve longer lasting treatments.
How do you anticipate the field might change in the next decade, and what development would you most like to see realised?
I think there will be a temporary swing back in favour to open surgery for some aortic conditions, but I am confident stent grafts will evolve to overcome some of the current deficiencies. Vascular disease is also changing as we move from the smoking era. With an ageing population and more cross-sectional imaging, we will see more aortic dissection patients, but also, the diabetic and obesity epidemics will lead to more distal occlusive disease as well. It is also interesting to watch the landscape of deep venous disease to see if more active treatment of acute and chronic venous thrombosis will improve longer-term outcomes.
What are the biggest challenges currently facing vascular surgery?
I think globally this depends on the local healthcare sector. Typically, most arterial patients are elderly and undergo expensive treatments. It can be difficult to make the fiscal case sometimes as traditional cost-effectiveness calculations are not helpful, so having to be the patient advocate all the time can be challenging. Workforce demands are also an increasing challenge, certainly in the UK. Newly-appointed consultants are probably better trained than ever before, but less experienced and need mentoring. At the other end of the scale, senior surgeons are not incentivised to stay (the inverse is probably true) and this needs to be addressed urgently to avoid a workforce crisis.
What are your current areas of research?
I am involved in a number of registries and trials of new endovascular devices. My main interest at the moment however is looking at how the aortic neck responds over time and the impact of this on the seal zone, both after standard EVAR and fenestrated EVAR (FEVAR) more proximally. It is interesting how we compare endovascular and open repair as treatments for aneurysms, but sometimes forget the completely different way in which this is achieved. I am also now convinced that aortic diameter at the seal zone is much more important than we previously believed and that staying within the confines of the instructions for use (IFU) is crucial to improve durability.
In the last year, which new research paper has caught your attention?
I think it would be fair to say that my interest has been dominated recently by global COVID-19 developments rather than anything specifically vascular. New data regarding the emergence of new variants and the science behind vaccine development has been fascinating.
Has COVID-19 provoked new ways of working for the vascular surgeon long term?
It certainly provoked new ways of working during the lockdown episodes. Having to make decisions under such circumstances was refreshing in that it bypassed some of the red tape which can sometimes delay introduction of new ways of working. Emergency treatment actually became easier as it was not competing with elective activity. Hot clinics and direct entry of patients into accelerated pathways have been very successful and I am hopeful some of these changes will endure, but dealing with the backlog of cases (in some specialties) cannot be underestimated.
What have been the highlights of your VSGBI presidency?
It has been a busy year as it has included the second wave of the COVID-19 pandemic, crafting the response to it and then dealing with how to prioritise cases on waiting lists. It has also coincided with the release of the new vascular curriculum, the three-year cycle of a rewrite of the Provisional of Vascular Services (POVS) document and our new UK vascular journal, the first issue of which will hopefully coincide with our annual scientific meeting in December. We are aiming for a jam-packed full on face-to-face meeting in Manchester, UK, in December (after a two year COVID-19 gap) so that will certainly be the highlight.
Could you tell us about one of your most memorable cases?
I invest a lot of energy in to all my complex cases so it is then a pleasure to see them again when they return to clinic. I suppose the ones that stick in the mind the most are the really unusual ones. About five years ago, I had to deal with a six-year-old boy with a mid-thoracic stenosis who had been stented in Poland with restenosis down to a pinhole. He had poor renal perfusion, raging hypertension and crippling claudication. I did a bypass and left the graft long enough in a loop in the chest to allow him to grow. A recent scan (now a pretty tall 11-year-old) has confirmed it has worked well. An upcoming case looks as if it will be a memorable one as well—a nine-year-old boy (unclear diagnosis) with a 9cm abdominal aortic aneurysm (AAA) and bilateral 7cm renal artery aneurysms.
What has been your proudest moment of your career to date?
Undoubtedly, being elected as president of the VSGBI by my peers. It is humbling and an honour.
What advice would you give to someone looking to start a career in medicine?
Go for it! Although hard work, it is worth it. Both my sons are currently in medical school and loving it. Medicine has to be one of the most interesting careers available—the vocational and worthwhile nature of a career in medicine has been highlighted by recent pandemic experiences. It also allows such varied options from academia, pure science, community-based work in addition to the more well-known spheres of general practice and hospital work.
What are your hobbies and interests outside of medicine?
I enjoy the mountains and wild places. I did a lot of climbing previously in Wales, Scotland, the Pyrenees and the Alps. Trashing my hands every weekend was not the best preparation for surgery though so I do much less, but still enjoy getting to the wilder areas of the country and love skiing. I have recently taken up cycling (mainly to complete the Hebridean challenge for the Circulation Foundation—visit www. justgiving.com/fundraising/circulationfoundation-outerhebrideschallenge if you would like to donate!) and really love it. I also enjoy motorsport, both watching and participating in track driving events and have always enjoyed the design, technical aspects and aesthetics of fast, beautiful cars.