Dr. Wande Pratt speaks to Kym McNicholas about the fundamental training of vascular surgeons. He is a vascular surgeon at Modern Vascular in St. Louis (Creve Coeur, MO). The conference is called the “Making the Impossible, Possible” 3rd Annual PAD Warrior Conference and is hosted by The Way To My Heart. It is a conference dedicated to educating those living with PAD, or “PAD Warriors”, about peripheral artery disease. Kym’s first question for Dr. Pratt is about the training that a vascular surgeon must go through. He answers by saying that the traditional training for a vascular surgeon typically starts with a 5-year general surgery residency.
After that is a 2-year fellowship. The fellowships are typically focused on vascular and endovascular procedures. In the past 10 – 15 years there has been a transition where after medical school physicians can spend approximately 5 years in a dedicated residency and fellowship program. After those 5 years, you are ready to take your board for vascular surgery. That’s a typical training route for most vascular surgeons coming out of medical school.
Dr. Pratt did 2 years of a general surgery residency, did a research fellowship in vascular surgery, returned to complete the last 3 years of residency, and then went to Houston to finish his 2-year fellowship. Kym asks Dr. Pratt when he decided to focus on less invasive endovascular procedures. He mentions that he still performs open operations. However, with the advancement in technology our ability to do these procedures in a safe environment and an outpatient setting, most can be minimally-invasive endovascular procedures.
The benefits to these endovascular procedures are that you do not need to make an incision and a hospital stay is not required. The profile of the devices being used is much smaller. Now the closure devices are much safer and patients don’t have complications like bleeding or pseudoaneurysms. The image quality has also improved. The amount of contrast that is necessary for a good image has been reduced.
Advancements in intravascular ultrasound technology allow for the more precise deployment of stents and balloons. The advancement in technology allows vascular surgeons to do more from an endovascular standpoint and less open operations.
Dr. Pratt concludes the discussion by highlighting the importance of tailoring the treatment options to the patient. Putting stents in and performing endovascular procedures may not be as durable and long-lasting for a young, healthy patient as a simple bypass. However, sometimes patients don’t want a bypass because they don’t want to be in a hospital or they don’t want to have the scars. It’s a decision that providers need to make in consultation with the patient. He says that the good thing about being a vascular surgeon is that he can present different options to the patient and have a discussion about what is best for them.