Future potential of endovascular techniques for vascular surgeons.

In his presidential address to the American Association for Vascular Surgery in 2000, the late Dr. John Porter announced that there was insufficient time in the vascular training program to entertain endovascular technology because of the volume of vascular surgery techniques that must be learned. His philosophy accurately depicted the prevailing attitude of vascular surgical academia until very recently, and this restrictive stance has caused gradual but profound diminution in the caseload of vascular surgeons who are not trained in endovascular surgery techniques. Ultimately, the reluctance of vascular surgeons to expand their skill sets to include expertise in percutaneous interventions has enhanced the two competing disciplines of cardiology and radiology. As an early proponent of exploring endovascular therapy and its attendant tools and devices, my personal experience--both favorable and unfavorable--has provided me with a degree of perspective about the current status of endovascular surgery and enough background to speculate about the future role of the vascular surgeon in the treatment of arterial and venous disease. Parenthetically, it is encouraging that over the last few years, many educators in the field of vascular surgery have adopted a much more enlightened viewpoint regarding endovascular procedures. Hopefully, the pendulum has not already swung too far out of balance, and vascular surgeons will still have the opportunity to participate fully in the future of this exciting endovascular field. The following observations, ideas, and suggestions may pertain more to young trainees about to enter practice than to seasoned vascular surgeons.