Sebastian Debus is taking over as secretary general of the European Society for Vascular Surgery (ESVS) for a five-year term this September. Professor and chairman, Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany, Debus is also an accomplished musician. In this interview he speaks about his career in medicine and music and his proudest moments and describes his plans for the future of the ESVS.
When did you first decide you wanted a career in medicine and why did you decide to enter into vascular surgery?
I had my first thoughts about going into medicine during secondary school when I had the opportunity to watch a gynaecological operation. I was fascinated by it and decided to go into surgery. Initially vascular surgery was not in my plans, and the reason for that was that during medical school I had contact with a surgeon who needed hours to perform every femoropopliteal and varicose vein operation—obviously he was not the most dedicated vascular surgeon. Then, during my surgical education, I rotated into vascular surgery and planned to spend six months experience this specialty. It was my third surgical year, and besides some minor work such as abscess drainage and toe amputations, I had not fully operated yet. On a call at a weekend, a ruptured abdominal aortic aneurysm came in. I informed my chief on call, and he advised me to operate this patient by myself, without assistance of a senior surgeon. Luckily this operation was successful; the patient survived and stayed healthy for many years, and we kept in touch. From that day on, I was allowed to operate on all patients from the vascular ward. That was how the decision to go into vascular surgery happened.
Who have been your greatest influences and what advices from them you still remember?
I had two main surgical teachers: Prof Turina, a heart surgeon in Zurich, Switzerland, and Prof Franke, my vascular teacher in Würzburg, Germany. I admired both of them for their outstanding surgical skills. Besides this, I had teachers who educated me in ethical issues: Prof Kelly from the Mayo Clinic in Rochester, USA, Prof Hamelmann in Kiel, Germany, and Prof Kern in Würzburg—all of them general surgeons. Kern, who was an artist in many ways (pianist, painter and poet), influenced me beyond pure surgery.
On a professional level, what have been your proudest moments?
My first ruptured abdominal aortic aneurysm as described previously, my PhD examination, my first appointment as head of Surgery at the community hospital in Harburg, Hamburg, at age 39, my appointment as full professor and director of the Department for Vascular Medicine at University Heart Center Hamburg-Eppendorf, and, more recently, a lecture as visiting guest professor at the Mayo Clinic in Rochester.
Vascular surgery has undergone many changes over the years—what do you think the most fundamental changes have been?
In my opinion, the most important changes were the evolvement towards an independent surgical speciality, the introduction of endovascular and percutaneous technologies, and the evolution from pure vascular surgery towards a vascular specialist (“non-operative surgery”).
Can you please tell us about the first endovascular procedure you performed?
I did an EVAR in 1997 as consultant at the University Hospital of Würzburg, together with a radiological consultant. The procedure was uneventful and successful.
This September, you are taking over as secretary general of the ESVS. What do you intend to achieve during your five-year term?
My vision for vascular surgery within the society is not with the traditional vascular surgeon, who exclusively operates in his/her theatre. Vascular surgery is evolving and today it is in fact one of the fastest changing of all medical disciplines. This makes our profession highly desirable, especially for young physicians.
Modern vascular surgery consists of managing the vascular patient (gate keeping), treating his/her cardiovascular comorbidities, and choosing from a wide range of treatment options including the many techniques, endovascular and open, as a vascular specialist. We as vascular surgeons have the general responsibility for the well-being of the vascular patient and, therefore, we need more specialists than ever. The increasing incidence of cardiovascular diseases drives us in this direction. In addition, cardiovascular diseases are still the leading cause of premature death in Europe. My efforts for the ESVS will be directed at widening our focus from a solely operating vascular surgeon to a vascular specialist who is proficient in many other treatment options. We want to look for cooperative work with other cardiovascular societies.
We need to increase our membership: The current renewal process of individual membership is complicated and cumbersome. I suggest easier renewal modalities every year unless the member actively cancels ahead of the expiration date. This will not only prevent loss of members but also facilitate long-term budgeting for the society.
We should promote dual memberships for the ESVS and national societies. Up to now only a few national societies (Austria, France, Ireland, The Netherlands and Switzerland) offer dual membership of their national society and the ESVS. Some national societies offer to pay for their trainees’ membership only (Denmark, Portugal and Turkey). Dual memberships would greatly increase the number of members of the ESVS. Since the ESVS membership is associated with obtainment of the journal, its circulation and readership would rise significantly.
Another important step is to focus on young vascular surgeons, physicians in training and students, who can be attracted to the ESVS through special programmes such as students’ seminars during the annual meeting, industry courses, EU rotation and fellowship programme, e-learning and virtual learning concepts amongst others. The European Vascular Surgeons in Training (ESVT) needs support to offer academic and leadership courses.
How can we gain industry support? Since the ESVS is the leading scientific vascular society in Europe, we should be the first destination for the medical-technical industry to support our efforts to introduce and optimise new vascular technologies. Additionally, support by the pharmaceutical industry should be within our reach as the vascular patient is increasingly important to them. The ESVS may provide infrastructure to administrate industry funds and support clinical research by their members. Advantage for sponsors would be a competent review process.
VascuNet collaboration and Quality improvement: The VascuNet collaboration is one of the most important strategic achievements of the ESVS. VascuNet generates invaluable data of vascular maintenance and quality control. It reveals differences between countries and leads to quality improvement. The ESVS needs to strengthen these activities, including financially. Data obtained by VascuNet can also be interesting to the industry and form a basis for industry-funded projects. When analysed properly, these data may help define quality standards in vascular medicine. Setting up standards of quality in vascular care, these could be used to introduce an ESVS accreditation programme for vascular centres.
Guidelines committee: There is a dire need to strengthen our guidelines committee as it is our key instrument to document vision and leadership in the field of vascular medicine. Also, intersociety and transatlantic collaboration of guidelines activities should be strengthened.
Assistant medical professionals: Nurses, technicians and physician assistants working in invasive vascular medicine should be given the opportunity to specialise in one area of their field by signing up to specific training programmes. These programmes may be certified with an exam accredited by the ESVS. In addition, we should have programmes for endovascular assistants who want to be trained in catheter procedures. Other areas of specialisation could include wound care, vascular diagnostics and management of the vascular patient.
Cooperation with national societies: One of the responsibilities of the secretary general will be to create a platform for a vascular maintenance survey programme. This programme will provide important information to our society with regards to vascular supply, treatment and other issues in our member countries. As these data will be of high relevance and should be made available to the public.
Strategic partner: An important decision of the ESVS was to collaborate with MCI (Brussels, Belgium) as a professional partner to support the society with marketing strategies, administration, member management, website development, industry relationship and management of our training programmes, courses and meetings. This partner should have a longstanding commitment to working with the ESVS. This partnership will be first visible at our conference in Porto.
The ESVS goal for 2020 should be to improve its professional and financial situation through membership growth and focusing on research, training and education. ESVS is our mother society and has to be the leading vascular society in Europe. I want to achieve this by consolidating our finances, increasing activities outside the annual meeting to make the society attractive for all European nations as well as nations outside of Europe.
In your centre you work closely with colleagues from heart surgery to perform high-end intervention in the ascending aorta and arch. How has this collaboration helped develop new approaches to challenging procedures?
By collaborating closely with our colleagues from cardiology and heart surgery within our University Heart Center, we were able to build a comprehensive aortic programme, which led to the opening of the German Aortic Center Hamburg in 2012. New technologies were introduced such as alternate transcardial access techniques (transseptal and transapical), as well as first experiences with antegrade stent graft deployment “right through the heart”. We were one of the first institutions to introduce endovascular repair of the ascending aorta as well as arch repair. Regular weekly aortic rounds, with vascular surgeons, heart surgeons and cardiologists are the cornerstone for an interdisciplinary approach to extended aortic disease intervention. Due to a large connective tissue disease programme, new hybrid approaches to these patients have been developed.
You are an accomplished pianist. When did this passion start and how have you managed to conciliate music and medicine?
Although I started out when I was six years old, I only became passionate after the age of 15. Numerous concerts in various ensembles have led to a professional career as a pianist. However, following the preparation for a Schumann’s piano concerto, which took me eight hours per day for several weeks, I finally decided to go into medicine and keep music as a non-professional but serious and continuing activity. With others I founded a programme for patients at our hospital, containing five concerts per year as well as an academic training programme for music therapists with the Hamburg High School of Music and Theatre, and a research programme to evaluate the influence of music on pain and walking distance in claudicants.
What are your current areas of research?
Our research includes the development of novel devices for endovascular and hybrid treatment of aortic pathologies, tissue perfusion imaging following revascularisation, vascular maintenance and quality improvement research.
Outside of medicine and music, what other interests do you have?
I am into sailing, my family, cultural activities, belles-lettres and sports.
Professor and chairman, Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
1968–1969 Grundschule Groningen, The Netherlands
1969–1972 Grundschulen Dautphetal, Schierensee and Mielkendorf, Germany
1972–1981 High School (Kieler-Gelehrten-Schule), Kiel, Germany
1981 High School Diploma
1981–1987 Christian-Albrechts-University Kiel (Germany), Zurich (Switzerland) and Rochester, USA
1988 Medical Licensure (MD)
1989 Doctorate thesis (magna cum laude)
Professional career (selected)
1989–1990 Institute of Pathology, University of Würzburg, Germany
1990–1991 Dept of Surgery, University of Marburg, Germany
1991– Dept of Surgery, University of Würzburg, Germany
1997 German Board Certification, general surgeon
1998 European Board of Surgery Qualification (EBSQ), Vienna, Austria
1999– Consultant, Dept of Surgery, University of Würzburg, Germany
1999 Faculty appointment as university lecturer in General Surgery
2000– Senior consultant, Vascular Unit, Dept of Surgery, University of Würzburg
2003– Chief, Department of General and Vascular Surgery, Asklepios Clinic, Hamburg-Harburg, Germany
2009– Professor and chairman, Department of Vascular Medicine,University of Hamburg-Eppendorf, Germany
2013–2014 President, German Vascular Society
2014– Guest professorship Huazhong, University of Science and Technology, Wuhan, China
2014 Certification Phlebology
2008–2013 2nd Secretary Northwestern German Society of Surgery
2015 Secretary general-elect, ESVS (2015–2020)
June 2015 Visiting professor, Mayo Clinic, Rochester, USA