Vascular News talks to Professor Jesper Swedenborg, Department of Vascular Surgery at the Karolinska Hospital in Stockholm and President of European Society for Vascular Surgery (ESVS), about why he entered vascular surgery, his experiences in the United States and his views on the future direction of the ESVS…
When did you first decide you wanted a career in medicine?
After I finished Swedish type of school matriculation, which is what you do at 18 years’ of age, I applied for education in medicine. My interest in medicine first came from an interest in natural sciences. I thought that medicine was a good mix between humanism and natural sciences so I guess that’s what decided it.
Why did you decide to enter vascular science in particular?
When I finished medical school, I got some smaller jobs in surgery and in order to get the license to practice medicine in Sweden you had to have three months surgery, three months internal medicine and three months of optional type. I did some surgery and liked it, so then decided to do vascular surgery. I started research in blood clotting and I did that for my PhD thesis. Since I was going to be a surgeon and had knowledge in blood clotting it was natural to go into cardiovascular surgery.
Can you tell us about your time in America – what was different about vascular surgery in the US and what skills did you learn?
My first visit to the US was purely for my research year at UCLA. And my second visit to Rochester New York was due to the fact that when I did my surgery at a smaller hospital in Stockholm and finished my thesis, I was offered a job at the Karolinska University Hospital (Sweden) and worked at the Department of General Surgery. I thought I was going into cardiac surgery at that time but eventually I changed and went into peripheral vascular instead.
I was asked whether I would like to start a Peripheral Vascular Surgery unit within the Department of General Surgery. I was quite flattered by that so I said ‘ok’, and then I was given two options: I could either train in vascular surgery within the Department of Cardio-Thoracic Surgery at the Karolinska, or I could go to Rochester New York and work with Dr Charles Rob. The choice was pretty easy, it was more fun to go to the US.
Were there significant differences between Sweden and the US?
At that time, vascular surgery in Sweden was a little bit behind the US and indications for procedures were different. They were more liberal in the US whereas in Sweden we were more careful before we decided to perform a procedure, so I think that’s one of the big differences. Another difference was, and I guess it’s still the same thing, that there’s more focus on the doctor. You have one particular doctor who takes care of you and more focus on private practice in the US, as compared to Sweden. In Sweden we have tried to have one doctor for the patient but we don’t manage that fully, we have working time rules and so on, so that the patient will be taken care of by a team of surgeons.
Who were your greatest influences in vascular surgery?
Charles Rob, he was the chief of vascular surgery at Rochester. He was initially at St Mary’s in London and then moved to the US. He would be the greatest influence. I’ve got fairly little practical influence in vascular surgery in Sweden but interactions with Swedish colleagues has influenced me a lot.
On a professional level what have been your proudest moments?
I was asked to start a division of vascular surgery within the Department of General Surgery at the Karolinska, I was asked to do that at a relatively young age, I was only 33 years’ of age. This unit has eventually developed into a independent department.
Why did you decide to become involved with vascular societies and the ESVS in particular?
I was at the first meeting at Charing Cross 20 years ago with Roger Greenhalgh and his colleagues, who had the idea to start a European society for vascular surgery. At that time I had absolutely no idea about the difficulties to start such a society. I also met these surgeons at the Association of International Vascular Surgeons who meet at different ski resorts in the winter and by chance I went to a meeting in Austria, so I got to know some of the British vascular surgeons.
What have you tried to achieve during your time as President of the ESVS?
I’ve tried to contribute to a change in the meetings, which doesn’t mean that the meetings were bad previously, but times are changing and we have to change with them. We have added two symposia sponsored by the Society itself, which will give the audience and the members robust rules how to handle some of the core elements in vascular surgery, and we’ve also added other things. We have incorporated the European Association for Vascular Surgeons in Training which was a separate unit, we’ve managed to negotiate with them and now they’re into the Society which I think is a good achievement because we can build from below and get our younger colleagues to work within the Society. I think they are the two most important things that that we have achieved during my time as president.
What are the greatest challenges facing vascular surgery over the next few years?
The evolution is going very rapidly with the introduction of endovascular methods and that’s a challenge. How we handle that is and will, be very important. it’s been exciting – nothing is the same as it was really and endovascular surgery can make a revolution. But we also have to be careful and watch for pitfalls. We need to be thoughtful to see where it’s good and how it should be refined and not forget experiences from open vascular surgery.
What are your current areas of research?
I started out in blood clotting, there’s a strong tradition in blood coagulation in Stockholm and I was very inspired by being the Secretary General of the International Society on Thrombosis and Haemostasis Congress of the International Society of Thrombosis and Haemostasis, which was in Stockholm in the early eighties. And so I went along with that. I have tried to combine my vascular surgical interest and my knowledge about coagulation and right now I am most heavily involved in aortic aneurysm research. Previously, I’ve also been involved in research on deep-venous thrombosis, particularly large vein thrombosis in iliac-veins and also blood surface interactions, both interactions with the normal or deceased blood vessel wall or with foreign surfaces. So many times it’s been a combination of vascular surgical subjects where I could use my knowledge in blood coagulation.
Outside medicine what other interests do you have?
Mostly related to nature. I am a bird watcher, I also go skiing or skating when I have the time. I like classical music and going to concerts. And reading. I also enjoy spending time with my family and three grandchildren, ages four months, one and three years.
Do you have any other comments or memories you would like to share with our readers?
If the reader happens to be member of the Society, I’d like more interaction with them. I’d like to hear what they want and what changes they’d like within the Society, and what they would like to have at the meetings.
As for memories, being at the Charing Cross first meeting is a memory that stands out, but I also have a lot of personal memories with many talented colleagues at the Department of Vascular Surgery at the Karolinska Hospital in Stockholm.
Fact File: Jesper Swedenborg
Born May 21, 1940.
Licentiate of medicine and surgery, Karolinska Institutet 1967 (M D).
1971 Ph D, Karolinska Institutet, on a dissertation entitled “On the role of vasoactive substances in hemodynamic changes induced by thrombin”.
1968-1969 Postgraduate research surgeon, University of California, Los Angeles.
1969-1973 various positions in clinical general surgery at Swedish hospitals including urologic surgery and thoracic surgery.
1973-1974 (14 months) Associate in Surgery at the University of Rochester, School of Medicine and Dentistry, Rochester, New York.
1975-2000 Head of the Divison of Vascular Surgery, Department of General Surgery, Karolinska Hospital.
1986-1997 Vice Chairman of the Department of Surgery, Karolinska Hospital.
1991-1993 Chairman of Ethics Committee, Karolinska Hospital .
2000-2004 Chairman Department of Vascular Surgery, Karolinska Hospital
Present Professor of Vascular Surgery Karolinska Institutet.
• Swedish Surgical Society, Swedish Society for Vascular Surgery, International Society of Cardiovascular Surgery, The International Society on Thrombosis and Haemostasis, European Society of Vascular Surgery, International Society for Applied Cardiovascular Biology.
• Fellow Royal College of Surgeons.
• President Swedish Society for Vascular Surgery 1996-2001
• President European Society for Vascular Surgery 2005-2006
1980-1982 Chef de Clinique / Assistant des H̫pitaux
1982 University Assistant in Anatomy
1986 Practicien Hospitalier
1986 Professor of Vascular Surgery
1980-1981 Board of Directors of the University Paris XII
1985-1990 Coordinateur CSCT
1987-now Medical Committee Hospital Henri Mondor
1994-2002 Commission of Medical Employees
1995-1999 President of the Commission for On Call
2002-now Vice president of the Medical Committee of H Mondor Hospital
2003-now Head of the Department of Vascular Surgery, Henri Mondor Hospital Creteil France
1995-now European Society of Vascular and Endovascular Surgery
1995-now Board Member of the European Journal of Vascular and Endovascular Surgery
2001-now Associate Editor of the European Journal of Vascular and Endovascular Surgery
1992-1999 Member Board International Society of Endovascular Therapy
1992-now Member Board The Journal of Endovascular Therapy
1989-now International Union of Angiology
1985-now Soci̩t̩ de Chirurgie Vasculaire de Langue Fran̤aise
1990-1992 G̩n̩ral Secretary of the French Vascular Society
2003 Royal College of Surgeons of England (Fellow)
2003 Corresponding member of the SVS/AAVS (USA)
2003 Founding member of the International Society of Vascular Surgery
2004 Honorary member of the Vascular Society of Great Britain and Ireland