5 Questions with Frank J. Veith, MD
A trailblazer in endovascular grafting, Dr. Frank Veith sees a bright future for the endovascular field overall.
How did you first become involved in performing endovascular procedures? For more than 25 years, I have tried to be innovative in developing techniques to salvage lower limbs threatened by advanced atherosclerosis. Because this condition involves elderly sick people, we were attracted to less-invasive endovascular techniques for treating arterial lesions. Our group was one of the first to use iliac stents to improve the results of angioplasty. In 1992, we performed the first endovascular aneurysm repair in the US in a patient who was too sick to undergo standard surgery. Success with this first case prompted us to begin an endovascular graft program to treat aneurysms and other arterial lesions using our own surgeon-made grafts. This gave me the insight that endovascular treatments would replace or improve many of the standard open procedures vascular surgeons were performing. That realization prompted me to advocate that vascular surgeons must become proficient in endovascular techniques and procedures if our specialty were to survive.
Did you have a role in the concept or execution of any devices? My partners Takao Ohki, MD, and Michael Marin, MD, and I played a major role in the development of the Montefiore Endovascular Grafting System (MEGS) for aortic aneurysm repair. This device, which is currently used in the aortofemoral configuration, represents an improved version of the original Parodi graft and is composed of a balloon-expandable stent affixed to a PTFE graft. The distal end of the graft is anastomosed or sutured within the arteriotomy site used for device introduction. The MEGS device enables endovascular repair of aneurysms that would otherwise be difficult or impossible to fix, and it facilitates endovascular repair of ruptured aneurysms. Drs. Parodi, Ohki, Beebe, Bell, and I are trying to make this device commercially available.
How were the early pitfalls of endovascular grafting resolved? Because the initial days of endovascular grafting were replete with pitfalls and disasters, early grafts were only used in patients who were not suitable for standard treatment. Every case was an adventure, and the problems that we encountered were too numerous to detail. The success of the procedure and survival of the patient depended more on our ingenuity in finding ways to get out of seemingly hopeless situations than on any other factor. As time and experience progressed, we learned how to avoid many of these setbacks.
What is the most positive/frustrating aspect of being an endovascular specialist? The most positive aspect is seeing a high-risk patient the day after a difficult endovascular aneurysm repair and knowing they are ready to leave the hospital with minimal discomfort. This contrasts sharply with an open procedure, which may have been impossible for that patient, or otherwise could have been associated with major morbidity, protracted ICU stay, and more than a week’s hospitalization. The most frustrating aspect of being an endovascular specialist is seeing the procedures applied excessively to patients who would best be treated conservatively with no intervention.
In what ways will endovascular therapies evolve in the near future? Clearly, the evolution of endovascular treatments in the last 10 to 15 years has surpassed expectations in a remarkable way. I believe this pace will continue. For example, in 1994, I estimated that 35% to 70% of our standard vascular surgeries would be replaced by endovascular treatments. I now believe that percentage will be somewhat higher—perhaps as high as 50% to 90%. Of course, because of their intrinsic appeal, the challenge will be to apply these endovascular treatments only when their results are as good or better than alternate methods.