LEGACY OF PHILIPPINE SOCIETY FOR VASCULAR SURGERY (PSVS)

THE PHILIPPINE SOCIETY FOR VASCULAR SURGERY:  SHAPING THE LANDSCAPE FOR VASCULAR SURGERY IN THE PHILIPPINES 

By:   JOSE LUIS J. DANGUILAN, MD; JOY M. GALI, M.D. 

The story of the Philippine Society for Vascular Surgery (PSVS) depicts the growth of vascular surgery as a distinct specialty in the country.  Many, if not all of the local standards and practice came about directly or indirectly by the activities of the PSVS and its members. The PSVS continues to shape the landscape of vascular surgery in the country through the foresight of its leaders and the inherent innovativeness that characterize the very nature of every vascular surgeon. 

BIRTH OF PSVS 

E. Ona, A, Aventua Sr, C. Millar, M. Chua Chiaco, A. Ramirez

In the late 70’s, seven young proactive surgeons who were already prominent personages in their respective fields of vascular surgery, thoracic surgery, cardiac surgery and general surgery began to meet regularly over dinner to exchange views and shared their experience and expertise in the management of vascular conditions.  Headed by Dr. Enrique T. Ona, who was then the Chief of the Section of Thoracic and Cardiovascular Surgery at University of the Philippines – Philippine General Hospital (UP – PGH), along with Dr. Avenilo Aventura, Sr., the then Director of the Philippine Heart Center, Dr. Aniano Vicente, Dr. Cesar Millar, Dr. Manuel Chua Chiaco, Jr., Dr. Francisco Pascual and Dr. Ruben Valenzuela, they decided to formalize their group and incorporated it in 1981 to become the Philippine Society for Vascular Surgery (PSVS).   Dr. Ona was elected and inducted as the first president of the Society.  Subsequently, the Philippine College of Surgeons (PCS) recognized the PSVS as its affiliate society, and PCS President Dr. Alfredo T. Ramirez formally inaugurated it into the PCS. 

THE PIONEERING PERIOD 

These pioneers were all trained in performing vascular procedures from different medical centers abroad. They all brought with them individually unique skills and expertise in different aspects of vascular surgery.  During the early part of the 1980’s, regular meetings were conducted with the goal of collaborating and communicating their experience to each other and to other surgeons interested in learning about vascular procedures. From the initial seven members, the number of participants gradually increased as more surgeons sought to gain knowledge in vascular procedures and the management of vascular diseases. Out of these regular meetings, the standards of management began to fall into place as the members took home and applied the collective experience and wisdom into their respective practices.  The local vista for the practice of vascular surgery slowly came into focus. 

Among the early trailblazing practices initiated by the Society was the establishment of the first non-invasive vascular laboratories and the standards of non-invasive vascular diagnostics in three key institutions in Manila, namely The Medical City, St. Luke’s Medical Center and Philippine Heart Center.  The vascular laboratories in these hospitals were headed respectively by vascular surgeons namely: Dr. Enrique T. Ona, Dr. Francisco Pascual and Dr. Florimond Garcia, who performed and interpreted non-invasive vascular diagnostics using Doppler and Plethysmography, and eventually Duplex Ultrasound. The establishment of these laboratories eventually became a means for partnership with other vascular specialists, paving the way for the birth of other subspecialties in the country such as vascular medicine. 

THE NURTURING PERIOD 

 Dr. Borromeo, Dr.  Ona, Dr. Bauer Sumpio,Dr. Montemayor, Dr.  Quintos

 Dr. Romulo Barrameda, Dr. Leo Carlo Baloloy

Many other subspecialties in the Philippines were born out of the activities of the PSVS. In the early to mid- 1980’s, the beginnings of the epidemic of kidney diseases were being felt in the country along with the already exponentially rising numbers of patients with heart and vascular diseases.  Upon the establishment of the Philippine Heart Center (PHC) and the National Kidney Foundation of the Philippines (NKFP), which the latter eventually became the National Kidney and Transplant Institute (NKTI), the PSVS and its members were called upon to create programs and algorithms of management and to perform the vascular procedures required in those centers.  From the PHC, NKTI and the university hospitals such as the UP - PGH and the University of Santo Tomas (UST) came the first locally trained vascular surgeons, albeit not as a distinct entity but rather as a part of either a program in thoracic and cardiovascular and vascular surgery or in organ transplantation and vascular surgery. 

 Dr. Amado Enriquez, Dr. Ricardo Quintos , Dr. Leo Baloloy, Dr. Jose Luis Danguilan, Dr. Paul Montemayor,

Dr. Rose Marie Liquete, Dr. Florimond Garcia

However, after the pioneers in Dr. Ona and Dr. Pascual there was a shortage of trained surgeons focusing solely on peripheral vascular surgery. Only a few Filipino peripheral vascular surgeons who trained abroad in the decades of the 80’s and 90’s made it back to Philippine shores, among them were Dr. Victor Gisbert, from Hennepin County Hospital in Minnesota, specially trained in vascular access surgery; Dr. Paul Montemayor, from Yale University in Connecticut, specially trained in endovenous ablation; Dr. Ricardo Jose Quintos II, from Montefiore Medical City in New York, specially trained in limb salvage and endovascular surgery; and Dr. Esteban Lacson, from Washington Hospital in Washington, specially trained in endoscopic vascular surgery.  After verification of their credentials, the PSVS welcomed them into the Society. 

DR. BAUER SUMPIO’S CONFERMENT
Dr. Montemayor, Dr. Ona, Dr. Bauer Sumpio, Dr. Aventura Sr.

In 2000, the PSVS encouraged the establishment of a training program focused on peripheral vascular surgery.  The following year, the Society accredited the first Peripheral Vascular Surgery training program at the NKTI, with Dr. Quintos as its first Program Director. Soon after, in 2005, the PSVS board evaluated, certified and inducted Dr. Leo Carlo Baloloy as the first home-grown peripheral vascular surgery graduate. 

Dr. Ricardo Jose T. Quintos, Dr. Christopher Zarins,    
Dr. Francisco Pascual (†)

The PSVS continued to look overseas for global trends in order to augment the learning obtained in the local programs.  Foreign faculty were invited to share their experience to PSVS members and other practitioners of the art. One of the early foreign faculties was Prof. Sariel G. Ablaza of the Medical College of Pennsylvania and Hospital who shared his experience in novel procedures for the repair of thoracic aortic dissections and aneurysms.  Prof. G. Douglas Tracy also flew in to mentor workshops in vascular surgery techniques.  In 1994 and 1996, Dr. Christopher Zarins of Stanford University was the main faculty in the Stanford - Asia Cardiovascular Symposium held in Manila sponsored by the Society. 

Dr. John Riccota, Dr. Takao Ohki

In 2000, the PSVS co-sponsored the International Conference of the Asian Vascular Society with a workshop on Endovascular Surgery taught by Dr. Takao Ohki of the Montefiore Medical Center of New York. Another distinguished figure who was sponsored by the Society to come to Manila was Dr. Bauer Sumpio of Yale University who arrived in 2002 to talk about the role of endovascular surgery in the management of vascular trauma.  Through the endorsement of the PSVS, Dr. Sumpio was conferred as honorary member of the PCS in the same year. Joint symposia of PSVS and Philippine Association of Thoracic and Cardiovascular Surgeons, Incorporated (PATACSI) took place in 2009 where invited speaker Dr. Nelson Bernardo of Washington Hospital Center lectured on the endovascular treatment of abdominal aortic aneurysms while Dr. John Ricotta also of Washington Hospital Center discussed combined coronary and carotid disease, and disease management.  In 2001, another combined symposium with the PATACSI was held, featuring Dr. Nathaniel John Castro of the University of Minnesota speaking on thoracic aortic aneurysms. 

THE PARTNERSHIP PERIOD 

SOUNDPACT: Dr. Aquino,  Dr. Quintos, Dr. Ignacio Dr. Vea 

Early in its history, the PSVS encouraged and developed partnerships and multidisciplinary endeavors. The first such multidisciplinary activities wer the Venous Forum, which began annual meetings in 1993, bringing together practitioners from various disciplines such as dermatology, plastic surgery, cardiology, general and vascular surgery to discuss management of venous disease. A few years later, the millennial decade of the 2000’s was marked by the rapid increase in lifestyle related diseases such as hypertension, diabetes and their sequelae including vascular disease. Recognizing the epidemic of vascular disease in the country, the PSVS partnered with other specialties concerned for managing overlapping conditions in order to effectively bring forward the value of a holistic and integrated management of vascular diseases. 

Dr. Ricardo Jose DT. Quintos, II representing PSVS 

receiving the plaque of appreciation from the 

Asian Union for Microcirculation

In 2001, the PSVS partnered with the Philippine Lipid Society and the Philippine Society for Hypertension by participating in their annual convention. In 2003, the PSVS also participated in the international convention of the Asian Union for Microcirculation.  Also in 2003, the PSVS became an accredited member of the World Federation of Ultrasound and Biology, as a society member of the Philippine Society of Ultrasound in Clinical Medicine (PSUCMI).  The following year, PSVS became a co – signor for SOUNDPACT, a pledge for quality and ethical use of ultrasound in clinical practice.   In 2005, the PSVS was designated by the Philippine Society for Ultrasound in Surgery (PSUS) as the training arm for vascular ultrasound for surgeons. 

Dr. Jose Luis Danguilan

2nd PSVS President

In 2006, Dr. Jose Luis J. Danguilan was elected as the second president of the PSVS, and he further promoted partnerships by extending membership with colleagues in the thoracic and cardiovascular surgery sector as well as conducting exercises with the PATACSI. He initiated the exploratory talks for a unified board examination for Vascular Surgery and an accredited vascular surgery program with PATACSI. 

Dr. Rose Marie R. Liquete

 3rd PSVS President

In 2008, Dr. Rose Marie O. Rosete-Liquete was elected the third president of the Society, she continued the tradition of partnership and started the society’s spirit of service and social responsibility by instituting multidisciplinary outreach symposia on “Sugat sa Paa” (Foot Ulcers) which involved primary care physicians, diabetologists, infectious disease specialists, orthopaedics, rehabilitation medicine, plastic and reconstructive surgeons, and wound care nurses along with vascular surgeons as faculty.  

These were held in the community settings to reach out to local specialist at Tagaytay Medical Center, Tagaytay City, Angeles University Foundation Medical Center, Angeles City, Pampanga, Chong Hua Hospital, Cebu City and Baypoint Hospital and Medical Center, Subic, Olongapo.  This program was institutionalized through the coordination of Dr. Amado Enriquez as the Society’s Program Manager. 

Dr. Martin Anthony A. Villa with PWCS Officers

In 2010, the first of the annual Inter-Hospital Vascular Grand Rounds was organized which involved case presentations from the different programs at the NKTI, PGH, and PHC.   In 2011, another partnership was forged between the Philippine Wound Care Society (PWCS)   and PSVS, Dr. Martin Anthony Villa, a PSVS member, was elected as the first president of the PWCS.  Finally, under Dr. Liquete’s term, a landmark agreement between by the Board of Vascular Surgery the Philippine Board of Thoracic and Cardiovascular Surgery (PBTCVS) to unite the two entities into a joint board, and name the Philippine Board of Thoracic, Cardiac and Vascular Surgery (PBTCVS) was signed in August 5, 2012. 

THE RENAISSANCE PERIOD 

Certifying Workshop for Ultrasound, 2010

The global landscape of the practice of vascular surgery began to change in the millennial decade.  The rapid pace of technological developments began to offer many and new modalities in treating vascular diseases. The distinctions between specialties and even between surgical and nonsurgical disciplines began to blur as technological development begin to relegate classical surgical procedures into a smaller role in favor of minimally invasive endovascular strategies. Seeing the possibility that the practice of vascular surgery may be overtaken by other disciplines with the same access to technology, the PSVS proactively embarked on radical motions aimed at rearming and remodeling the vascular surgeon in order to assert and maintain primacy and relevance in the management of vascular disease.

In the year 2000, the Academic Committee under Dr. Quintos revised the curriculum to include competencies in the new and coming technologies in noninvasive and invasive imaging as well as in endovascular techniques, with the aim of producing a wellrounded vascular specialist skilled in all diagnostic procedures as well as in the medical, surgical and endovascular modalities.   In 2002, the Constitution was amended and ratified by the members to outline the scope of practice of vascular surgery, and elevated the Committee on Membership into the Board of Vascular Surgery, and was tasked to evaluate individual vascular competencies and accreditation.

Certifying Workshop for Ultrasound, 2010

The PSVS also developed programs for training post-graduates in the new technology as addition to non-invasive diagnostics in the training curriculum.  In 2003, the PSVS began raising awareness in vascular ultrasound and started training vascular sonologists through the PSUCMI. In cooperation with the PSUS, the PSVS held several teaching symposia on performing and analyzing vascular ultrasound studies. The PSVS also organized several certifying workshops for ultrasound – guided central venous access insertions.   

The aim of the workshop was to promote the importance of patient safety through the use of ultrasound in the cannulation of the venous system as one creates vascular access for patients.  The first workshop was held at the National Kidney and Transplant Institute in October 2010.  During the same year, the PSVS issued policy statements in recommending mandatory ultrasound – guided vascular access cannulation.  It was followed by subsequent workshops at The Medical City in 2011, Victor R. Pontenciano Medical Center in 2012, and at the Batangas Regional Hospital in 2013. 

In 2010, the PSVS training program committee headed by Dr. Quintos approved the first 5 – year Straight Vascular Surgery Training Program.  This is the first program to exist  in the Philippines and Southeast Asia, aiming to produce a complete vascular specialist, who can perform own invasive and non – invasive vascular diagnostics, to perform surgical operations on the vascular tree anatomy,  endovascular procedures; and prescribe the appropriate pharmaceutical medications. The year 2011 saw the launching of an online database vascular registry for all vascular procedures done in different institutions in the country.  It is envisioned to be able to provide valuable information that can be used for future researches in vascular surgery. 

Dr. Ricardo Jose T. Quintos II

In the fourth quarter of 2014, Dr. Ricardo Jose DT. Quintos, II, assumed office as the fourth President of the Society. Under his guidance, the PSVS produced the recommendations for clinical practice guidelines on chronic leg ulcers, ultrasound - guided central venous access and the recommendations for relative value units for vascular procedures, thus further confirming the role of the PSVS at the forefront of innovation in training and clinical practice policies.

Dr. Benito Purugganan Jr.

Presently, the Society under headed by Dr. Benito VC. Purugganan Jr.   Under his leadership, Dr. Purugganan continues to stir the society towards establishing high quality standards based on effectiveness and appropriateness of vascular care while aiming for best outcomes for patients with vascular disease.  The society has worked closely with different societies and organizations to achieve this.  Its administration believes that it is not enough to contain the science and art of management of the disease of these special population of patients, instead, the theme of his leadership has always been collaboration and cooperation.   

Empowering doctors and even patients had been its advocacy, specifically in the field of vascular access surgery.  It held numerous workshops and lectures regarding the role of ultrasound in performing surgeries on vascular access, all over the Philippines.  The society has recognized the important role of nephrologist and vascular nurses in caring for vascular access, and the society geared towards  providing lectures and workshop that were meant to educate them, so they can be more proactive in management of patients.  Sharing knowledge in the management of vascular access allows the different societies and organizations  and its members to have full grasp of the challenges we face, in the Philippine landscape and allows everyone to come up with solutions that are applicable in our setting. 
 

Also under his leadership, the certification of Vascular surgeons, in collaboration with the Philippine Board of Cardiac, Thoracic and vascular Surgery has finally came into fruition.  The Society firmly recognizes the role of certification process in motivating its member to always to be on-top of their game.  Plans for further certification of the other fields of Vascular Surgery are currently penned by the members of the society.   Indeed, the Society, under Dr. Benito Purugganan Jr is in the epoch of coalescing its role as it continues to shape the practice of vascular surgery in the Philippines and faces the new challenges of globalization, managed care, patient safety and quality outcomes.

** This article was published as part of PCS Coffee Table Book