Having initially been geared towards a career in engineering, Vincent Rowe was ultimately drawn to medicine’s dual offering of intellectual stimulation and interpersonal engagement. He overcame a fear of the sight of blood to pursue what has so far been a “deeply rewarding” career in vascular surgery, culminating in his current role as professor of surgery and division chief of vascular and endovascular surgery at the University of California, Los Angeles (UCLA; Los Angeles, USA). Speaking to Vascular News, Rowe reflects on his career to date and shares his thoughts on the state of surgical education, multidisciplinary care, and vascular surgery’s identity.
Why did you choose to pursue a career in medicine and what drew you to vascular surgery?
Medicine has always been an inspiring and fulfilling field, and if I had the chance to start over in college, I would unequivocally choose the same path. My early passion for science initially directed me toward a career in engineering, where I explored the intricacies of problem-solving and innovation. However, I soon realised that while engineering stimulated my intellectual curiosity, it lacked the human connection and interpersonal engagement that I found deeply meaningful. This revelation prompted me to pivot toward medicine, a discipline that seamlessly integrates scientific inquiry with compassionate care.
Before committing to this path, I had to confront a significant obstacle—my fear of the sight of blood. Determined to overcome this challenge, I immersed myself in a trauma centre emergency room, embracing a form of ‘shock therapy’ that ultimately desensitised me to this fear. With the added strength drawn from my faith and reliance on divine support, I was able to transcend this limitation and fully dedicate myself to a career in medicine. This journey not only solidified my resolve, but also deepened my appreciation for the profound impact of this vocation.
Vascular surgery captivated me with its unique combination of specialisation and breadth. I was drawn to the opportunity to work across multiple regions of the body and collaborate with diverse specialists, including nephrologists, neurologists, cardiologists, and podiatrists. Spanning from the neck to the toes, the field offers a dynamic and interdisciplinary approach to patient care.
What continues to fuel my passion for vascular surgery is the constant innovation and technological advancements that keep redefining the specialty. These inspiring developments have made vascular surgery both challenging and deeply rewarding.
Who were your career mentors and what was the best advice that they gave you?
I’ve been asked this question many times, and my answer always comes back to the fact that I had very few mentors early in my career—largely because I was not the best mentee. I’ve worked hard to change that over the years, striving to be the best mentor I can for others now. Upon reflection, I recognise that not reaching out to more people for guidance, early on, was a mistake.
That said, I was fortunate to work closely with Fred Weaver for over two decades. His guidance played a pivotal role in shaping my development as an academic surgeon, and I am deeply grateful for his unwavering support. One of his many pieces of wisdom that has stayed with me is the simple yet profound reminder that “persistence is a virtue”. I’ve carried those words with me throughout my career and have tried to embody that mindset in all aspects of my work and life.
What have been some of the most important developments in vascular surgery over the course of your career so far?
By far, the most transformative development in vascular surgery has been the advent and evolution of endovascular techniques. I’m old enough to remember a time when endovascular options were entirely absent from our toolkit. Today, they are integral to patient care, seamlessly incorporated into nearly every treatment plan. This paradigm shift has not only expanded our capabilities but also redefined the standard of care for countless conditions.
Another equally impactful advancement has been the growing spirit of collaboration among specialties. The establishment of aortic centres, limb salvage programmes, stroke teams, and similar initiatives reflects our field’s commitment to working together to optimise patient outcomes.
What are the biggest challenges currently facing vascular surgery?
One of the greatest challenges facing our specialty is the issue of identity and branding, which has not yet reached a level that reflects our critical role in patient care. This lack of recognition has, at times, led to vascular surgeons being undervalued, both within the surgical community and by the broader healthcare system. Many complex operations simply wouldn’t happen without the assurance of vascular surgery expertise, whether for direct involvement or for providing essential support. I hope the indispensable role of vascular surgeons in achieving better patient outcomes is fully recognised and appreciated in the future.
What are some of your current research interests?
I have always been deeply interested in preserving limbs through surgical intervention. Early in my career, my focus centred on the technical aspects of limb salvage, including mastering advanced surgical techniques and understanding the intricacies of vascular interventions required to save limbs.
Over the past decade, however, my perspective has broadened to include the critical role patient and social factors play in determining outcomes. This includes addressing disparities in access to care, socioeconomic barriers, and the influence of comorbidities on treatment success.
More recently, I have been studying the growing importance of interdisciplinary collaboration, recognising that optimal limb salvage outcomes depend on a team-based approach involving specialists in wound care, infectious disease, endocrinology, and rehabilitation.
What is your experience of working in a multidisciplinary limb salvage team on a day-to-day basis and how has the approach impacted patient care in your centre?
At my previous institution, we developed a strong multidisciplinary team for limb salvage, with daily collaboration among most members of the team. At my current institution, the foundational elements for a highly effective limb salvage programme were already established before my arrival. We are now focused on refining and optimising our integration to enhance the impact and efficiency of the team in delivering the best possible patient outcomes.
You have received numerous teaching awards over the course of your career so far. Could you share some reflection on the state of vascular education and training in 2024? Is there anything that you think needs to change moving forward?
I believe surgical education has never been stronger. For much of my career, teaching was primarily confined to intraoperative instruction or didactic lectures. Today, however, surgical educators have a wealth of tools at their disposal, allowing trainees to engage with simulators, cadavers, and review relevant content or questions via mobile educational platforms.
For surgical training, I believe our integrated training pathway has been revolutionary in enhancing the depth of surgical training. Surgical education is in an excellent place.
You have been active in surgical societies for many years now, including in 2022 as president of the Western Vascular Society. What were your highlights of this presidency?
The presidency of the Western Vascular Society stands as one of the highlights of my career. The camaraderie among members at the meeting and our ‘black and white’-themed banquet, the beautiful venue of Victoria, Canada, and the Empress Hotel of Victoria, and the presence of my wife, close family and friends all contributed to making that meeting truly special for me. I was even able to share some dance moves with past presidents Ben Starnes and Mike Conte.
What do you think is the most important vascular research paper to have been published in 2024?
That’s a hard question. So much effort is put into each publication by the authors, I would hate to place one manuscript over another. I do think the BEST-CLI trial publication, shared in 2022 in the New England Journal of Medicine (NEJM), was one of the most impactful publications I’ve been a part of in my career. Whether the results change the practice patterns of practitioners can be debated but having the data to help determine the optimal strategy to save limbs is of great importance.
Could you outline one of your most memorable cases?
Last year there was a patient with a previously placed endovascular aneurysm repair (EVAR) who presented with a graft enteric fistula. We took out the graft and reconstructed the patient with homografts. He was lost to follow-up and surprisingly re-presented about six months later with a rupture of the aortic homograft portion of our reconstruction. With balloon control from above, we were able to rereconstruct him. Thanks to Drs Karen Woo, Megan Brenner, and Jesus Ulloa for their help.
What advice would you give to someone looking to start a career in medicine?
The field of medicine, and surgery in particular, is incredibly rewarding, but it is also exceptionally demanding and requires a significant commitment of your time and energy. It is essential to ensure that medicine is truly the right path for you before embarking on this career.
Despite my own resistance to reaching out to mentors early in my career, I would strongly recommend interacting and connecting with people in the field of medicine early in your careers for guidance.
What are your hobbies and interests outside of medicine?
My original love was always basketball. However, as my schedule became more challenging, I transitioned to cycling. Riding a bike was much easier to do alone or, if my schedule allowed, with a group. Even though my size didn’t make me the ideal cyclist, I still competed and was often just happy to finish with the faster riders. I always heard an important part of wellness was engaging in exercise that would take one to exhaustion. Cycling does that for me. The sport also reinforced the importance of a team, sacrifice, and resilience to me.
