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EDITORIAL
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 1-2

Has vascular surgery evolved enough to cut the umbilical cord from other related specialties? The Indian perspective


Department of Vascular Surgery, Institute of Vascular and Endovascular Sciences, Sir Ganga Ram Hospital, New Delhi, India

Date of Submission11-Mar-2022
Date of Acceptance11-Mar-2022
Date of Web Publication23-Mar-2022

Correspondence Address:
Varinder Sing Bedi
Department of Vascular Surgery, Institute of Vascular and Endovascular Sciences, Sir Ganga Ram Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_17_22

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How to cite this article:
Bedi VS. Has vascular surgery evolved enough to cut the umbilical cord from other related specialties? The Indian perspective. Indian J Vasc Endovasc Surg 2022;9:1-2

How to cite this URL:
Bedi VS. Has vascular surgery evolved enough to cut the umbilical cord from other related specialties? The Indian perspective. Indian J Vasc Endovasc Surg [serial online] 2022 [cited 2022 May 28];9:1-2. Available from: https://www.indjvascsurg.org/text.asp?2022/9/1/1/340502



Vascular surgery was one of the newest superspecialties in early 1990's when the subject after being delisted from CTVS Surgery was considered for MCh. Vascular Surgery at Madras Medical College. Prof. Veera Reddy was one of the pioneers in the specialty at a time when Vascular Surgery was an appendage of CTVS Surgery. Most of the vascular work which involved lumbar sympathectomies, debridements, and amputations were performed by general surgeons and the acute limb ischemia, aortic aneurysms were managed by CTVS surgeons. All the patients with gangrene and critical limb ischemia were condemned to undergo amputations with minimal effort at limb salvage.

A meeting was first held in 1994 at Chennai, where a group of Vascular Surgeons, CTVS Surgeons, and General Surgeons interested in Vascular Surgery got together, and the Vascular Society of India was formed in 1994.

This was possibly the incentive which kicked off the vascular revolution in the country. The degree course in Vascular Surgery started in Chennai got recognition by MCI, and in the millennium years, Sir Ganga Ram Hospital, New Delhi, was granted permission to start a 1-year fellowship course. During this period, vascular surgery was confined to open surgery only and the first of the endovascular procedure such as Iliac stenting was started at some centers with the cooperation of friendly interventional cardiologists and rarely some interventional radiologists.

A few cases of endovascular aneurysm repair were performed in late nineties with involvement of proctors from overseas but this was the first of the baby steps taken in the direction of vascular surgery becoming vascular and endovascular surgery. The next bundle in starting endovascular practice was getting access to the Cath laboratories as most cardiologists resisted the idea of letting vascular surgeons performing endovascular procedures independently as they considered it to be their domain.

The Vascular Society held a meeting in New Delhi where these issues were discussed, and using leverage of the industry, almost all 25 participants who attended the meeting in Delhi (2009) started getting access to the Cath laboratories.

During this period, DNB Vascular Surgery had become a 3-year course and other institutions in Bangalore, Vellore, and Thiruvananthapuram also started the MCh courses.

However, the endovascular experience was sorely lacking at various centers, and therefore, most of the Vascular Surgeons went overseas for short/long duration courses to get hands-on experience at centers in Germany, Holland, and other centers in Europe and USA.

Today, the specialty boasts of training programs at almost all big cities such as Delhi NCR, Chennai, Hyderabad, Bangalore, Vellore, Pune, and Madurai with more than 35–40 seat intake of superspecialty seats [Figure 1].
Figure 1: Map of india depicting vascular surgery training centers and vascular surgeons location in the country

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However, this growth has been a bit unbalanced as various large states such as UP, Uttarakhand, Punjab, Haryana (except Gurgaon), Rajasthan, J and K, Gujarat, West Bengal, MP, and North East are still dependent for advanced training facilities on Tier “A” cities rather than starting their own training program [Figure 1]. Due to this, one part of the country is still dependent upon General Surgeons, Interventional Radiologists, and Interventional Cardiologists to provide some kind of salvage services as a large number of people are either unable to visit advanced centers due to logistic issues or various other considerations.

At present, these patients are mostly undergoing amputations because of such compulsions. A large number of the young vascular surgeons feel that the IC's or IR's are eating into their work and either not managing patients properly or depriving vascular surgeons of their work.

The logic is perfectly acceptable in places where there is a surfeit of choices for patient to decide as to whom to approach for the treatment.

However, the same logic cannot apply to the patients in Tier 2/3 cities where neither the government set up nor the private institutions are able to deliver treatment to the eligible patients. Therefore, till there is some kind of balance throughout the country, one would rather join hands with other colleagues to deliver some form of care to salvage limbs/lives of patients who by virtue of fate are unfortunately not able to get the best of treatment for their critical disease.

“So, what is the way forward”: In the last 3–4 years, many of colleagues have applied for starting DNB/MCh course in their cities but still one does not find these centers coming up in Tier 2/3 cities. It is therefore imperative that a group of vascular surgeons get together at smaller cities and make an attempt to start training programs in their respective cities.

The second thing to do for gaining more experience is to join hands with friendly interventionists so as to increase their “hands-on experience” and gain independence gradually after they gain confidence in handling complex peripheral interventions.

The third aspect would be attending workshops/meetings such as endovascular live/overseas to update their hardware and soft skills.

Therefore, to conclude, I feel that perhaps it is still not the time to cut our umbilical cord from these specialties. However, looking at the way, there is growth in starting new training centers, I am quite sanguine that in the next decade, the growth of vascular surgeons will be more balanced, and they will be able to provide adequate facilities in Tier 2 and Tier 3 centers. I will be delighted to be proved wrong about this growth happening earlier, but one sees a very bright future of the specialty in the years to come.




    Figures

  [Figure 1]



 

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