Ortigas Avenue, Pasig – First
President of the PSVES Dr. Ricardo Jose DT. Quintos II delivers his inaugural
address at the occasion of the turnover ceremonies last November 11, 2017.
“I am privileged to be giving the
closing remarks on this night, filled with awe at the company of distinguished
personages, all of you who have given life to and significantly shaped the
growth and development of the discipline of Vascular surgery in the country.
For this homecoming of Titans, I must express my deepest gratitude to the
organizers and to our partners who have generously given of themselves so that
this historical occasion can come to fruition. Dr. Purugganan and your staff,
Marky and Amie, Jurlit, Catherine, kindly rise to acknowledge our humble
thanks. Mr. Joel Mallari, represented by Ms. Love Villacorta, of Getz Bros,
Philippines, thank you for your continuing support towards our shared vision.
Everywhere in the world the
discipline and practice of Vascular surgery is in a state of flux. As science
continues to unearth tons of new information on physiologic and
pathophysiologic processes related to vascular health and disease, the
technology for vascular management continues to move forward at a dizzying pace
which brings forward exciting new modalities in imaging and treatment resulting
in radical paradigm shifts that challenge time honored traditions and
techniques. Suddenly, clinical acumen is under attack by big data and
artificial intelligence; the scalpel yields ground to laser, radio frequency or
even ultrasonic energy; the suture and the classic principles of vascular
anastomoses laid down by Alexis Carrel find themselves besieged by balloons and
stents, clips, percutaneous closure devices, and biological adhesives. Even the warm, fine motor movement and
control of the hand lumbrical muscles are challenged by the onslaught of the
cold precise micro-movements of robotic systems.
These evolutions in vascular management call
for revolutionary changes in the person uniquely positioned to manage vascular
disease. If the technologies are to be left embraced by specific specialties
wedded to a single approach, and who lay claim to the traditional turfs of the
technologies, ie., imaging to the radiologist, medicine to the internist,
surgery to the surgeon, and endo-luminal intervention to the interventionists,
the management of the patient with vascular disease will always be fragmented, inefficient
and costly. This loss of value for vascular repair was bewailed by Dr. G.
Patrick Clagett in his presidential address to the Society of Vascular Surgery
(SVS) entitled "Does Vascular Surgery Cost Too Much" (JVS 2009); and
was also demonstrated by an AHA document showing that in 2009, on the average,
a 2-vessel CABG is less costly than an open repair for an infra-renal abdominal
aneurysm. It certainly lends credence to the oft told joke that it may cost an
arm and a leg to save a leg.
Subsequent outcomes and process
flow studies by the SVS show how effective, efficient vascular management may
be achieved by a holistic approach carried out by a specialist uniquely trained
and positioned to be able to conduct diagnostics, give medical management, perform
catheter endo-interventions using different modalities of balloons, lasers,
radiofrequency and other energy devices, as well as wield the scalpel and the
needle.
The beginnings of this concept of
the vascular specialist as a vascular generalist, one who knows the strategies
and indications of when to operate, when to dilate, when to medicate, all the
while being the gate-keeper of patients requiring services for their vascular
conditions, I was very fortunate to personally witness while undergoing fellowship
training under Drs. Frank Veith and Takao Ohki in Montefiore, New York in 1996,
in a discussion that started one late fall afternoon during our weekly research
hour which carried on until endorsement rounds the following day. The
discussion eventually crystallized into the establishment of the International
Society of Vascular Surgery (ISVS), and may have laid the groundwork for the
formation of a specialty board for Vascular Surgery in 1998 in the US, and an
eventual primary certificate for Vascular Surgery in 2005.
As this was happening stateside,
on this side of the ocean, the Philippine Society for Vascular Surgery (PSVS)
independently and in parallel created the first multitrack training program in
Vascular surgery, with the 5+2 and the 0+5 iterations. The program aimed to put
flesh on the concept of the vascular generalist, uniquely incorporated training
experience in the complete holistic management of the vascular patient, from
non - invasive diagnostics to endovascular and open surgical treatment, and we
offered the program in 2002, some time before similar programs were opened in
the United States. One brave soul was the first to try the fledgling program in
2009 and the first 0+5 in 2011.
Because of the establishment of
the training program, the Philippine Board of Vascular Surgery, which was
previously a mere committee of the Philippine Society for Vascular Surgery
tasked to verify and evaluate credentials of vascular surgeons trained abroad,
reorganized in 2012 in order to be able to objectively evaluate qualifications
of graduates of the existing sole and future vascular surgery training
programs.
Following the formal
re-institutionalization of the Philippine Board of Vascular Surgery, the
Philippine College of Surgeons in 2015 accepted into its august rolls the
initial instances of fellows in the discipline of vascular surgery, thus
unequivocally giving due recognition to Vascular Surgery as a distinct surgical
specialty, and the vascular surgeon as a distinct surgical specialist.
Tonight, we chart history as we recall these remarkable milestones in Philippine Vascular Surgery.
We close a chapter in the book
that is continually being written. Like any classic book that withstands the
test of time though, a chapter’s end leaves the reader eager to go on to the
next pages.
As the selected caretaker of this
bold new venture, I am challenged at the prospects and opportunities before us.
It is truly an auspicious beginning to have all of you here tonight, all of you
who have left parts of yourselves indelibly marked upon the landscape of
Philippine Vascular surgery. I fully
intend to keep you in the picture, and to build upon what you have laid down,
for it is on standing on the shoulders of giants that we are able to see
further, and go further. My first
proclamation is the establishment of the Senior Advisory Council to be composed
of this august group of persons, who we will call upon for their sage advice,
for inspiration, and the continuity of what has been a successful run.
This leadership will be known for
its commitment to improving quality and value vascular services delivery to
patients and the public, by establishing the standards of vascular care,
raising the level of vascular knowledge and skills homogenously among the
vascular surgeons, ensuring the sustainability of the practice, all for the
provision of the best outcomes, high value vascular services accessible to the
public.
I have no doubt that tonight we
have planted the seeds of the revolution to keep ourselves relevant and on top
of the continuing evolution in vascular surgery.
Once again, I thank you all and
for gracing this session, and propose a toast: To the PSVES, may you be the
beacon of light, the refuge in storms, the wellspring of knowledge, and partner
in practice, by vascular surgeons, for vascular surgeons, in the delivery of
relief from suffering to humanity."
Ricardo Jose T. Quintos II, MD
First President, PSVES
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