Vascular News talks to Fabrizio Benedetti-Valentini, Professor of Vascular Surgery, La Sapienza University, Rome, Italy, current President of the Section of Vascular Surgery of the UEMS, and Past-President of the Italian Society of Vascular and Endovascular Surgery.
From an early age I decided to enter medicine and at the same time to become a surgeon. But of course you cannot become a surgeon without first becoming a doctor. I wanted to have a ‘hands-on’ effect on patients, which is why I choose a career in surgery. I graduated in 1961, at which time there was no specific area of vascular surgery, but I was already very interested in the field. My doctorate thesis was devoted to venous graft bypasses in arteries of medium and small calibre – something that became very fashionable 10 years later. Then I became interested in lesions of the renal arteries since my Professor at the time was interested in hypertension.
Afterwards I had a long period studying cardiac surgery, because I took into consideration becoming a heart surgeon. For this reason I worked at the Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A., which at that time was already a leading institution in cardiac surgery under the Chairmanship of Donald B. Effler. I was awarded a grant from the North Atlantic Organisation so that I could spent two years there, at the time when coronary surgery was developping. I always remember the day when I was involved in one of the first aorto-coronary bypass using a saphenous vein, which was performed by Rene Favaloro. I was very excited for that opportunity; it is still a very pleasant memory.
After a brief staying home I spent one more year at the Department of Cardiovascular Surgery, The Hospital for Sick Children, Toronto – Ontario, Canada. The Chief at that time was William T. Mustard, who was already well known for a special technique for correction of the transposition of the great vessels which is still performed today. It was a very interesting time and the Canadian people were very friendly. I really enjoyed my time in Canada.
In 1969 I came back to Italy to the La Sapienza University in Rome and started working part in cardiac surgery, but also in vascular surgery. Because of local difficulties within the organization it was easier to go ahead with vascular surgery, which became an independent speciality in Italy in 1971. I kept working there at the equivalent level of a lecturer, but not yet as a professor.
Then I proceeded to a new University which was established in the town of L’Aquila, which in English means “the Eagle”. I worked there from 1973 to 1983. I remember that period with pleasure because it was a pioneering experience; they had no established vascular surgery at all. The hospital was an old one with no specialized equipment. So I had to roll up my sleeves and start working very hard to obtain equipment, materials and personnel. All was accomplisted with the help of local institutions and of the pharmaceutical industry, which played a great role there.
At the University of L’Aquila, through national assessment I finally became a Professor in 1975. I was pretty young!
After a few years of being completely involved, not only in the business of my speciality but also in the organization of the University for students, for trainees and so forth I was elected as Dean of the Medical School. In 1981/82 we established a network of vascular surgeons in the region, which included University and regional hospitals, to get students involved in vascular surgery: many of them are still working in vascular surgery today.
In 1984 there became a new position available at the La Sapienza University in Rome for a Professor of Vascular Surgery. This position was specifically concerned with taking care of vascular emergencies: I was appointed to join the Roman Faculty, my alma mater, and I was obviously very proud of that.
At that time I also became involved in the professional matters of vascular surgery, if you prefer union matters. There is a strange relationship between general surgery and vascular surgery or between cardiac surgery and vascular surgery. When the work of a cardiac surgeon becomes short, he becomes interested in vascular surgery. It does alarm me. Cardiac surgeons think, “Well, if I can manage the heart why can’t I manage the popliteal artery?” Which in my opinion is quite naive and arrogant. I had some training in cardiac surgery and I know perfectly how different it is. The general surgeons think that vascular surgery is only a part of their speciality, most of the times not even a difficult one, and want to retain it in their domain. Conversely Vascular Surgery since many years is a very articulate clinical discipline with very specific knowledge and professional skill.
I dedicated many of my efforts to promote Vascular Surgery as an independent speciality in Italy and to form an independent society since up to 1998 we were part of the Thoracic and Cardiovascular Society. We were able to establish our own Society which was called the Italian Society of Vascular and Endovascular Surgery. At the time I had arguments with colleagues whether it should be called simply Society of Vascular Surgery, because there were some debates whether endovascular techniques were part of vascular surgery. Conversely I wanted to emphasize such part of our profession. Now that debate is laughable, but then it was not.
So, may be as a result, I became the first President of our independent Society and started facing the many problems of a newborn institution: continuing medical education (CME) for vascular surgeons, training programmes, certification, accreditation, a textbook, guidelines for vascular and endovascular surgery, relationship with Governmental Institution, with other European Countries and relationship with other specialities. The first program and system for CME was established, guidelines were worked out and published, independence for Vascular Surgery was implemented both in Universities and in General Hospitals and I also became soon involved with the Division and Board of Vascular Surgery of the UEMS (Union Europ©enne des M©decins Sp©cialistes or European Union of Medical Specialists) which was established in 1993 under the leadership of Roger Greenhalgh.
The first impact was rough because the Division and Board was operating and assessment called the European Board of Surgery Qualification (EBSQ)-Vasc, which looked to me in competition with our national speciality diploma and was open to general surgeons. But then I realized that setting standards, possibly high ones, was good for our profession and that being “European” was useful at the national level in any country of the European Union (EU).
Some people were not happy whit this, but like it or not Europe was coming, so it was necessary to get in touch. If you want to take advantage of that you must be part of it.
The title of Fellow of the European Board of Vascular Surgery (FEBVS) at present has no real legal value, but very likely it will soon be recognized by many European nations and therefore it will acquire a very special meaning because it will be possible to spend it for appointements both in the health systems and in the academic field. So this is what we are working towards.
In 2002 I was elected President of the Division of Vascular Surgery of the UEMS and I was very grateful to all my Colleagues, Representatives of all Countries of the EU, for giving me the possibility to work and be more effective in the defence and promotion of Vascular Surgery.
One big problem arose catching obviously my attention: the proposal for a new Directive of the European Commission on Professional Qualifications downgraded Vascular Surgery to a minor speciality, actually keeping it in the field of General Surgery. It dove me crazy! It was march 2002 and it took more than three years to reverse that position. The Executive Council of the UEMS was very helpful and we gave great contribution. All Representatives from every country lobbied some of their own politicians; I lobbied some of the Italian Members of the European Parliament and Christos Liapis, who at that time was Secretary General of our Division, did the same with the Greek Members. Moreover the referee of the Committee for Legal Affairs of the European Parliament happened to be the Mayor of a small town close to Rome and a friend of mine….. but this is life! So we were able to get together a lot of people interested and active, from lawyers to chemists, from engineers to accountants, and have our views presented in the appropriate ways and to the right persons, which resulted in the inclusion of Vascular Surgery in the list of the independent monospecialities in the EU. Such decision was reached in July 2005!
At the same time, in a sort of parallel way, I thought that the position of Vascular Surgeons within the UEMS was no longer the appropriate one. In that union of specialists every major independent speciality has a Section which may be divided into Divisions corresponding to subspecialities and we were just a Division associated with the Section of Surgery. I decided that, Vascular Surgery being come of age, the moment was ripe to try and reach section status. Even as a school boy I was always unsatisfied with performance, results, updating, explanations …… may be I am a trouble maker. Nevertheless the goal was worth the effort on a complicated matter in a minefield full of antibodies. Eventually in October 2004 the Management Council of the UEMS reached what was called an “historic decision”: it declared Vascular Surgery as a main monospeciality and granted it Section status.
Independence comes with great advantages for Vascular Surgery both in the academic and in the professional field, both at the national and at the european level. We can decide about teaching positions, curricula and training, setting standards for certification and accreditation, judging quality of care, working out guidelines, talking to governmental institutions on our own, managing relationships with other specialities. I am very satisfied. All Vascular Surgeons should be satisfied.
Our goal now is to unite all vascular professions “under the same roof”. This can lead to the formation of multidisciplinary Vascular Centres where to provide the patients with the best care. Straight to this target our Section, in collaboration with the International Union of Angiology, has just completed the “Guidelines for the Organization of Vascular Centres in Europe”, which are on one side suggestions and advice on how a Centre devoted to vascular care should be built, and on the other hand they are stated parameters to judge for the certification of a Vascular Centre at European level. Our Guidelines have been submitted to the President and to the Secretary General of the UEMS in order to obtain formal approval from the Management Council. Further step may be to take the document straight to the European Government and have it translated into a Directive.
So I am going to be very busy in the future!
Born: Oct 12th 1936 Spoleto (PG), Italy
Medical degree: 20 November 1961 – “La Sapienza” University Medical School, Rome , Italy