Peter Taylor, consultant vascular and endovascular surgeon at Guy’s and St Thomas’ NHS Foundation Trust, London, UK, told Vascular News about his start in medicine and vascular surgery, challenges in the field, and his term as President of the Vascular Society of Great Britain and Ireland. Taylor also described how he developed a passion for music after being a chorister in his childhood, and the occasion he played Tchaikovsky to impress his future wife.
When did you decide you wanted a career in medicine and has it lived up to your expectations?
Both my parents were musicians and they sent their first three sons to Durham Cathedral Choir School where we were choristers. I did not like the classics very much and science was introduced into the curriculum during my time there. I found the whole thing fascinating and elected to continue with science as my main subject. The major influence on my early decision to study medicine was my uncle Ernest who was a GP in Slough. He was a livewire and always the centre of attention. I was fortunate enough to go to Cambridge for my undergraduate studies and then on to St Thomas’ for my clinical. Overall I have had a fantastic career and I have enjoyed meeting vascular surgeons from around the world as the technological advances continue at a rapid rate.
Why did you decide to specialise in vascular surgery?
In 1988 a post was advertised for a senior clinical fellow at St Mary’s Paddington to work with Averil Mansfield, John Wolfe and Andrew Nicolaides. I was encouraged by Professor Lord McColl to leave the SE rotation and spend a year learning vascular surgery. I very much enjoyed the first year and stayed a second year. The main operations at that time were femoro-distal grafting, which was a special interest of John Wolfe’s using a variety of vein cuffs. Averil Mansfield had a particular interest in aortic surgery especially thoracoabdominal aneurysms and carotid endarterectomy. I remember very lively neurovascular meetings with Dafydd Thomas and the investigation of choice was intravenous digital subtraction angiography. Sadly this was superseded by duplex scanning imaging which resembled an underwater geographical survey of the Dogger Bank. I returned to Guy’s as a vascular surgeon and replaced Frank Ellis when he retired in 1991.
Which areas of vascular surgery fascinate you most?
I have always been interested in arterial intervention rather than venous. At the time of my appointment to Guy’s and Lewisham Hospitals in 1991 endovascular surgery was only practised in the Ukraine and Argentina. We were fortunate at Guy’s to appoint the first professor of interventional radiology, Professor Andy Adam, who acquired the funds to build a dedicated endovascular suite. This was allocated to the aggressive interventional paediatric cardiologists, Shak Qureshi and Mike Tynan but Andy persuaded them to have a large field so we could start endovascular adult cases. The revolution in endovascular techniques has completely changed my clinical practice over the past 18 years.
On a professional level, what have been your proudest moments?
My proudest moment has to be my election as President of the Vascular Society of Great Britain and Ireland. The annual general meeting in Liverpool in November 2009 attracted an international faculty. The opening speaker was Andy Adam and the first session was jointly held with the British Society of Interventional Radiology (BSIR).
Vascular surgery has undergone many changes over the years – what do you think the most fundamental changes have been?
I gave a recent presentation at the British Association of Day Surgery concerning the impact of technology on the length of stay of vascular patients. I realised that the whole of my practice has completely changed during my career as a consultant. Open surgery for aortic aneurysm and varicose veins has become a rarity in our current clinical practice.
Tell us about the most memorable case you have ever treated?
Early on in my career a young woman arrived in a wheelchair. She was paralysed from the waist down by a bleed from a huge arteriovenous malformation into her spine. Her problem was high output cardiac failure as large branches from her infrarenal aorta filled big aneurysms which had a rapid drainage into the inferior vena cava. She also developed Kasabach-Merritt Syndrome with a consumptive coagulopathy involving clotting factors and platelets. She had been told that there was nothing that medicine could offer her and the cardiologists did not expect her to live for much longer. John Reidy enlisted help from Fred Keller who made a Gianturco stent covered with Dacron. He came over to help us place the device in her infrarenal aorta. Her cardiac output returned to normal levels and she lived for another 14 years.
Who are the people who have influenced you and what advice of theirs do you always remember?
Averil Mansfield and John Wolfe had a great influence on my career in vascular surgery. However, my collaboration with John Reidy, consultant interventional radiologist at Guy’s has undoubtedly been the greatest influence. Together we navigated our way through the endovascular revolution and in particular found a unique niche in thoracic aortic endovascular work. The charitable foundation at Guy’s and St Thomas’ supported our thoracic programme and provided generous funding in order to advance our practice.
What are your current areas of research?
Aortic dissection remains one of the most complex and underrated diseases treated by vascular surgeons. There are huge advances being made in imaging, particularly with magnetic resonance and the new high resolution computed tomography scanners. We have a fruitful collaboration with the Rayne Institute at St Thomas’ Hospital and together with King’s College London we have been designated an academic health science centre. The emphasis here is on bringing clinical research from the bench to the bedside and endovascular surgery ticks all the boxes with regard to this.
For patients with carotid disease, what treatment options you think will prevail, stenting or surgery?
I think the latest results from the ICSS (International Carotid Stenting Study) trial have put a large stake through the heart of carotid stenting. This goes some way to address the imbalance caused by the SAPPHIRE trial. I have no doubt that carotid stenting in certain patients will be the treatment of choice but it will not replace carotid endarterectomy.
What are your expectations on endovascular treatment of the aortic arch?
The aortic arch remains very challenging for endovascular treatment. One of the major problems is the high incidence of stroke associated with these procedures. This requires either better prophylactic measures to prevent stroke or more effective treatment for early stroke.
You are concluding your term as President, Vascular Society of Great Britain and Ireland 2008–2009. What have your greatest achievements been?
I have established a research committee to co-ordinate national research and to increase the profile of the Circulation Foundation. We have agreed to have reciprocal members on the councils of the BSIR and the Vascular Society. The Lifetime Achievement Awards were given for the first time to Brian Heather and Malcolm Simms. The separation of vascular from general surgery continues but I hope I have contributed to this work in progress.
What makes the annual Thoracic Masterclass held at Guy’s Hospital such a prestigious event?
We attract a high quality international faculty and encourage active audience participation in an atmosphere which is friendly and informal. The 2010 meeting will focus on aortic dissection.
You have an ARCM (Associate of the Royal College of Music) performer diploma for piano. Tell us about your interest in music, and who your favourite composers are.
There was great competition between myself and my older brother when it came to taking piano exams. We were both awarded music scholarships to the King’s School, Canterbury, where we were taught by Ronald Smith who was a fabulous pianist who specialised in works by Alkan. I stayed on at school specifically to do the diploma which was awarded in 1973. My three brothers attended Music College and I was therefore the black sheep in this respect. My father encouraged us all to play a stringed instrument and I played the violin in various orchestras. I gained a choral exhibition to Emmanuel College and sang regularly in the choir. I decided to play Tchaikovsky’s First Piano Concerto in order to impress my future wife, Kok-tee. I thought she could sight read the orchestral reduction but after only two bars she threw the music over the top of the piano claiming it was too difficult. I eventually performed this with both the college orchestra and the Staffordshire County Music Orchestra conducted by my father.
I have a broad taste in music ranging from early 16th century composers through to Benjamin Britten. We regularly attend operatic and musical concerts in London.
Besides medicine and music, what other interests do you have?
We have a group of long established friends who share our interest in travel and the arts. One of the great advantages of participating in vascular meetings is the opportunity to visit art galleries, museums and fine restaurants across the world.
1997–Present Consultant vascular and endovascular surgeon, Guy’s and St Thomas’ NHS Foundation Trust
1991 Senior lecturer and consultant vascular surgeon, Guy’s and Lewisham Hospitals
1990 Senior registrar vascular surgery, Guy’s Hospital
1988 Senior clinical vascular fellow, St Mary’s Hospital
1984 Registrar rotation, Guy’s Hospital
Prizes and scholarships
James IV Travelling Scholarship 1999-2000:
June 2000 Memorial Hermann Hospital, Houston, Texas, USA – Professor Hazim Safi
September 2000 Mayo Clinic, Rochester, Minnesota, USA – Professor Peter Glovitski
December 2000 Prince Alfred Hospital, Sydney, Australia – Professors John Harris, Jim May and Geoffrey White
Houston Methodist Hospital, Baylor Medical School: Prof Alan Lumsden, and the Memorial Hermann Hospital, Prof Hazim Safi, May 2005
2006–7 Vice-president elect of the Vascular Society of Great Britain and Ireland
2007–8 President elect of the Vascular Society of Great Britain and Ireland
2008–9 President of the Vascular Society of Great Britain and Ireland
Author of 41 book chapters, 78 peer reviewed papers, 42 reviews and editorials, 56 case reports and letters, and 133 published abstracts presented at various national and international meetings.
Invited speaker at national and international meetings comprising 63 lectures over the last five years.
Teaching and education
Regular contributor to national teaching courses on vascular surgical topics and techniques
Convenor of Thoracic Masterclass held annually at Guy’s Hospital
Examiner for undergraduate medical students
Examiner of MD and MS theses. Supervisor of MS thesis
Regular referee for seven journals
Vascular Society, European Society of Vascular Surgeons, International Society of Endovascular Specialists, Society of Vascular Surgeons, Association of Surgeons of Great Britain and Ireland.