Introduction
Rantner: Welcome to the very first episode of “Focus on Vessels – Advances in Vascular Surgery and Vascular Medicine”.
My name is Barbara Rantner; I am a vascular surgeon and senior consultant at the LMU Medical Centre in Munich.
Adili: And my name is Farzin Adili, a vascular surgeon and consultant at Darmstadt University Hospital. We are the hosts of “Focus on Vessels”, the new podcast from the German Society for Vascular Surgery and Vascular Medicine. In future, we will take turns to guide you, together with our guests, through the fascinating world of our speciality. We’ll be highlighting the latest developments in surgical, endovascular and preventive vascular medicine and discussing topics within our field with leading experts from academia, teaching, clinical practice and the healthcare sector.
Rantner: True to our motto: “We take vascular thinking further”.
Adili: In future, this podcast aims to provide you, dear listeners, with a platform where we delve deeply into the topics that shape and advance our field. In this first episode, however, we’ll start by introducing the Society to you, its values and goals, and why we’re here today. We hope this gives you a good introduction and that you’ll appreciate the upcoming specialist discussions and insights even more.
Middle section
Rantner: The year 2024 was a very special year for our professional society. We celebrated our 40th anniversary. Some of you may have been at the annual congress in Karlsruhe and can still recall the lavish party that was held to mark the occasion. So we’d like to take this as an opportunity to discuss developments in vascular surgery to date – and, of course, the challenges ahead – in this episode with the President for the years 2023–2024, Professor Jörg Heckenkamp, and the current President for the years 2025 and 2026, which is you, dear Farzin. We’re meeting here now for the first podcast, but we’ve known each other for a while through our work on the executive committee, so I’m very pleased that we can now kick off this session. Dear Jörg, a warm welcome. We’re delighted you’ve joined us.
Heckenkamp: Yes, thank you very much for the kind invitation.
Rantner: Jörg, looking back over the past 40 years – as we mentioned during our initial discussion in preparation for this podcast – none of us has been involved the whole time; we aren’t founding members. But what do you think: how has the DGG developed as a professional society over the past years, and what have been the key milestones since 1984?
Heckenkamp: Back then, medicine was completely different, surgery was completely different, and of course, in the early 1980s, vascular surgeons were part of the wider surgical family, within general visceral surgery. And naturally, the establishment of a separate professional society for vascular surgery was viewed with great suspicion and, of course, not welcomed by many other surgical societies. Nevertheless, a few intrepid colleagues realised that vascular surgery needed to be taken to the next level, and decided at the time to found the German Society for Vascular Surgery. A great deal has happened over these 40 years, of course. Today, we can say that it was the right thing to do, because our speciality has developed considerably, and we at the DGG are now the largest European vascular society. And this shows that it was a success story and that the visionaries of the time had the right idea in founding precisely this society.
Rantner: This very distinction from other surgical disciplines was certainly, as you’ve already said, necessary and sensible, especially when you look back at the technological advancements in vascular medicine that have taken place over the last 40 years. What do you think has primarily helped us the most in our development of vascular medicine?
Heckenkamp: Well, I believe a very important decision was that taken by the German Medical Association in 1978 to establish vascular surgery as a sub-speciality, thereby granting us autonomy in terms of further training and continuing professional development. I believe that was a crucial cornerstone of our success. And, of course, our speciality – vascular surgery – has developed tremendously over the last 40 years. If you look back to the 1980s, open vascular surgery was often the main focus of our work. But now there are so many endovascular, minimally invasive methods that we have also adopted and use. And I believe we can treat our patients very differently today than we could back then, and the DGG, as a scientific society, has accompanied this entire process.
Rantner: That’s a good point, Jörg. That was actually going to be my next question. The DGG was, of course, founded as a scientific professional society. There has always been an incredible amount of professional policy-making taking place within the society as well. How do you view the balance between these aspects, and how has the DGG supported these developments for its members over the past 40 years?
Heckenkamp: Yes, good question. I can’t contribute much personally regarding the early years, but it has always been the case, ever since I became a member of the DGG and have been following its history, that it wasn’t just about scientific topics, even though these were very important – and I believe it remains absolutely essential that we promote scientific rigour and that we act as an important and constructive dialogue partner in this regard. But of course there are many other matters that we as the DGG have supported and continue to support, and I actually believe that professional policy is also a very important task for our professional association during these highly volatile times. Whether that involves discussions with political decision-makers or with fellow professional societies, all of this concerns the vital interests of our members, and so I think this is a very important area of activity; and we can also see in the work of the Executive Board – and I have seen this during my presidency – that it has taken up more and more space and time.
Rantner: Farzin, perhaps I can pass the next question on to you straight away. Jörg has already mentioned it; professional policy has also been a major focus for us on the Executive Board recently. We are currently in very turbulent, perhaps even politically turbulent times, and there is a great deal of change taking place in the healthcare sector. What specific challenges do you see for vascular surgery in Germany at the moment?
Adili: Well, one of the most significant challenges over the next two or three years will certainly be dealing with hospital reform in Germany. Vascular surgery is, after all, a speciality that takes place primarily in an inpatient setting, i.e. in hospitals, and this reform will naturally turn things quite upside down there. Some departments may be excluded from patient care altogether, whilst others will have to change the scope of their services. You might say, ‘OK, we can adapt to that somehow’, but of course this has knock-on effects for staff on the ground, particularly with regard to training, further education and professional development. On the other hand, we naturally face exactly the same problems as many other sectors, and particularly within the healthcare sector: a shortage of young talent and a shortage of skilled workers. This is certainly something that concerns us greatly, and we need to mitigate all of these effects. As you’ve already mentioned, we started out as a scientific professional society, and science is indeed now part of our work, but above all we also fulfil the duties of a professional association. These are precisely the professional policy issues, and so we are working at various levels within the political sphere to ensure that future working conditions – on the one hand under the changed framework conditions in hospitals, but also with regard to the skilled workforce issue – can be shaped as effectively and practically as possible for us.
Rantner: Jörg, we’ve been discussing very frequently in the board meetings what my personal keyword for 2024 is: ‘visibility’. We’ve made a great effort to increase our presence in the public eye, so to speak. We’ve become politically active. That has already proved challenging, because we first had to identify the key influencers within the various committees. You and Farzin were very active in this regard; you travelled to Berlin on our behalf. Could you give our listeners a brief insight into what was actually necessary to raise political awareness of our issues and to make our concerns visible again during this period of restructuring and resource constraints?
Heckenkamp: Yes, that’s a good question, and I can start with something quite basic. The problem is that a great many people – including those in positions of responsibility in Berlin – have no idea what vascular surgery actually is. And you have to start with this very small domino, because many people are familiar with cardiology and heart medicine, and cancer has a large lobby that many are aware of, but issues relating to vascular surgery and vascular medicine are actually largely unknown in Berlin. And we have ventured into uncharted territory here. I’ve gained a bit of an insight into how health policy works, and it really does proceed in very, very small steps. And in the end, the idea of re-election is always hanging over everything that is discussed, and often the content that is then to be conveyed is only somewhat incidental, and hopefully it fits perfectly with the idea of re-election. Nevertheless, I believe we have gained access to opinion leaders in the Federal Ministry of Health. We have also spoken to various MPs. We have spoken to various parties. And I believe that, little by little, at least some understanding is emerging as to why vascular surgeons are so important in this country and what kinds of conditions we actually treat. That has taken us a long way forward. And in other areas, such as the Joint Federal Committee, we have actually managed to achieve quite a bit, particularly with regard to the BAA quality guideline. So it’s an exciting field. But it’s also a field where you need a bit of patience and staying power. And it’s a field of very small successes. But I believe we’re on the right track.
Adili: What struck me most, Jörg – you’ll remember – was when we had the pleasure of welcoming the deputy leader of the CDU-CSU parliamentary group to your office, and you handed him a delivery system for an EVA, for an endovascular aortic graft. Do you remember?
Heckenkamp: Yes, Farzin, I can also remember the meeting with MP Mittelberg very well. And for me, it was also extraordinary to see how he suddenly developed a certain fascination for our field very quickly after we showed him support systems and stent systems and he actually held them in his hands. And you could really tell that his interest in our field was suddenly quite different from when he first walked in. And I believe that it is only through all these achievements we have made and all these exciting things we do that we can succeed in getting even closer to the political sphere. And that is why I think these relaxed, off-the-record meetings are particularly important. And I’m glad that we were able to open a few doors there.
Rantner: And Farzin, as Jörg has already said, other disciplines have significantly greater visibility. Everyone knows what a cardiologist does. Many people also know what radiologists do. And in that context, it was of course important for us to engage in both collaboration and differentiation from other specialist disciplines – so that, on the one hand, we could broadly position shared interests within the Federal Committee at government level, whilst on the other hand also emphasising the role of vascular surgery as a distinct discipline. How do you see it? Is it more about working together or going it alone?
Adili: Well, I am firmly convinced that we can only succeed together. I have always viewed medicine – and surgery in particular – as teamwork. And it is also a given that, with our different skills and expertise, we can be most effective when working together for the patient. That is why I am absolutely convinced that, professionally speaking, we can only succeed together. And in many hospitals, I’ve seen that, in practice, there’s absolutely no need to deal with problems, reservations or conflicts at the patient’s bedside when it comes to finding the best solution for patients. Here and there, as we’re well aware, there’s naturally friction at the professional policy level, but in my view, that really must take a back seat to our goal of actually providing good medicine. And something I’ve also taken away from discussions with health policymakers is that they aren’t familiar with these niche fields or subspecialisations. They know, of course, what a surgeon is; they know what an internist, a paediatrician or a gynaecologist is. But they are not really familiar with the difference between a vascular surgeon and an angiologist, or a thoracic surgeon and a plastic surgeon. Not even our licensing regulations – that is, our training regulations for doctors – recognise these distinctions. They simply only recognise surgery and internal medicine. And only if we work together – if politicians recognise that doctors from different specialities, but with similar clinical focuses and the same concerns, come forward and pull in the same direction – will we be heard and seen, and only then can we make a difference. But if they perceive that we don’t see eye to eye with one another, that weakens our position. And that’s why I think, at the professional policy level, we really can only succeed together. But reaching that consensus is, of course, hard work in some respects.
Rantner: We’ve already talked quite a lot about professional policy, yet we’ve also mentioned how fast-paced vascular medicine has been, and how rapidly developments and technologies in vascular surgery have advanced in recent years. We are living in the age of artificial intelligence and robotics. Farzin, now that you have taken over the presidency of the German Society for Vascular Surgery at the turn of the year, what are your thoughts? Which technologies will be particularly prominent in the coming years? What is only of limited relevance to vascular surgery? Where do you see opportunities and limitations?
Adili: As far as the technical side is concerned – that is, our clinical work with patients – I believe that the greatest innovative momentum currently lies primarily in endovascular technologies. Key terms here are miniaturisation and vessel preparation: endovascular methods to restore patency to vessels, to maintain their patency, and to do so as minimally invasively as possible. On the other hand, treating the thorax, the aortic arch and right up to the aortic valve increasingly with minimally invasive techniques. A great deal is happening in this area at the moment, it has to be said. And basically, at every meeting we attend, we come across something new. Also the innovative strength of our colleagues, who time and again manage to combine these new technologies with conventional vascular surgery – in the sense of hybrid operations – and to refine them further and further. It’s truly impressive to witness. So that’s where I see some of the most impressive changes in practice, right at the patient’s bedside. You mentioned it yourself just now: artificial intelligence, augmented reality – that is, of course, the second major topic. We have made great strides in vascular medicine with fusion imaging. The trend is clearly also moving towards navigation within the vascular system, avoiding ionising radiation wherever possible – in other words, moving further and further away from X-rays. In my view, the use of artificial intelligence and simulation for further training and continuing professional development is the future of training. I consider it practically unthinkable that, in a few years’ time, we will allow colleagues to operate on patients for the first time without first demonstrating, through high-fidelity simulation, that they not only know how to do it but are also capable of performing the procedure manually. All of this can now be learnt outside the operating theatre thanks to modern technologies, just as pilots fly on a simulator before stepping into the cockpit for the first time. And I think this will make up a large part of training and further education. And that is where I see the greatest potential. And we needn’t even mention AI-assisted diagnostics. That already plays a major role in many other specialist fields. And I believe this will also be of great help to us in carrying out our day-to-day medical work. Keywords: writing medical reports, medication, avoiding polypharmacy, and so on.
Rantner: Farzin, perhaps building on that – and because I know what an inspiring and dedicated teacher you are – what do you think will be particularly important now during your presidency? Where do you want to place your focus? I can imagine it will be heavily focused on the sector of training, further education and continuing professional development. But what have you set out to achieve over the next two years?
Adili: Well, before I briefly outline my agenda, so to speak, I’d like to start by saying that, naturally, like everyone before me – Jörg, you’ll be able to relate to this very well – I’ll be continuing along the path that others have set out on. That means one of our tasks on the Executive Board will be – and I see myself here practically only as first among equals – to manage day-to-day business. That means dealing with the daily challenges that await us in professional policy – everything we’ve discussed over the past few minutes – or that may arise unexpectedly, and implementing them as effectively as possible in the interests of our members and vascular surgeons in Germany. As for my own agenda, I naturally have some ideas of my own. As you mentioned earlier, the word ‘visibility’ plays a very significant role, and I see it as a task for our professional association to help vascular surgery – or rather, vascular surgeons – achieve greater visibility. How can we do that? On the one hand, of course, by emphasising the scientific nature of our discipline. That means drawing up meaningful, high-quality, easily readable and practical guidelines, improving existing guidelines, and promoting healthcare research. We have our own institute, the DIGG, the German Institute for Vascular Medical Health Research, which is primarily dedicated to healthcare research. And healthcare research data, which runs into the tens of thousands, is playing an increasingly important role in understanding how medicine works. To further this, we need to network more effectively. In other words, I would like to dedicate myself to bringing our scientific beacons at universities and research institutes closer together, thereby steering them more strongly towards basic research and translational research, and also to connecting vascular surgeons even more effectively with one another in the spirit of scientific professionalisation and faculty development. And last but not least, I believe it is extremely important to collaborate even more closely and intensively with industry. Industry is indispensable, particularly when it comes to developing innovations. But they also need our input. We can learn a great deal from one another and benefit from each other in this regard. But we also need industry to raise the profile of our research findings and our achievements. That means, for example, that they support our annual conference. And the final area is actually education, training and continuing professional development. Over the next two years, I would like to develop standards for vascular surgery teaching. Of course, standards already exist, but I am referring to standards in teaching. How can we actually provide even better training, further education and professional development within the framework conditions under which we work? The whole thing has a didactic, methodological pillar. That means we must pass on the necessary didactic knowledge. And it has a certain technological pillar. That means that if we want to learn through simulations, we must also help develop these tools. Then we will be tasked with further developing the model training regulations. That will be a major issue. The German Medical Association is already in the starting blocks. Because the training regulations will also have to adapt to the new realities in the healthcare sector. And a great deal is happening in that area at the moment. And if we then manage to network our trainers more effectively, so that we work more closely together and actually guide young vascular surgeons precisely to where they can best learn specific operations and techniques – and do so in as integrated a way as possible – then I’d be pretty happy. As you can see, I’ve set myself a great many goals. But only those with many visions can perhaps turn one or two of them into reality.
Rantner: Yes, absolutely. So the motto is clear: we’re aiming high. The Executive Board will do its utmost to help you implement these plans. And I’ve got one more question for Jörg. When we last met in November, you bid us farewell from this presidency with a very personal retrospective that you shared with us. Looking back now on the last two years, were there things you really wanted to achieve but didn’t have enough time for? Were there things you’d never even considered having to do? Perhaps you could give our listeners a brief summary of the past two years, so that Farzin might get an idea of whether everything he’s just said will actually be achievable.
Heckenkamp: No, but it’s always the case that things won’t be achievable. And yet you still have to set yourself plenty of goals. That’s what I did. And I actually feel quite content to have been relieved of my duties after these two years. Of course, you don’t manage to do everything you set out to do, particularly when it comes to political matters. I would have liked to have seen a bit more momentum and a more constructive approach to dialogue there. And I was brought back down to earth often enough in that regard. But there were also other things that, I believe, worked extremely well. That was that, building on the mission statement we developed and adopted – with the strong approval of our members – we continued the branding campaign with a new look and a new logo. We have thus shifted the focus to public relations, and consequently our visibility. As far as social media activities are concerned, we realised earlier than others that X was no longer the right platform for us, and so we shifted our focus to LinkedIn. And we now have a very large following there. And they are actually always very well informed about what is happening behind the scenes. And I feel that communication with our members has actually reached a whole new level, and we are in close dialogue with all those who are members of the DGG and, of course, want their interests to be represented. So I’m coming out of these admittedly very exhausting two years feeling very positive. But Farzin and I were always in dialogue and still are. And Farzin, you put it wonderfully: of course, it’s not just a two-year timeline; you take things from the previous president that continue to guide you. That was the case for me, and it will be the same for Farzin. And as long as we on the Executive Committee get on well, I believe, and want to focus on the same values and priorities, then it is excellent that this is a process which develops in the right and positive direction over many years, so that I would certainly like to draw a positive conclusion after my two years. And I’m glad that it’s now in Farzin’s hands, because we’ve known each other for many years, we have in-depth discussions, and I believe we share the same ideas – and not just the two of us, but the rest of the board as well.
Rantner: Yes, thank you very much for this first conversation. To be perfectly honest, I was very nervous about how things would go today. I’d like to thank you, Jörg, and of course you too, Farzin, for these wonderful insights into 40 years of vascular surgery, covering professional policy, science, innovation, and training and further education. I hope we’ve been able to give our listeners a little insight into our work on the Executive Board and the scope of the DGG’s activities. Is there any final message you’d like to pass on to young doctors? Perhaps to listeners who are currently deciding which surgical specialism to pursue? Farzin, what else would you like to add?
Adili: What else can I say, other than vascular surgery?
Rantner: Jörg, I wouldn’t expect anything else from you?
Heckenkamp: No, I chose it back in the day and have actually never regretted it; I find it a speciality that illuminates and examines fascinatingly diverse aspects of surgical practice, from conservative vascular medicine to outpatient vascular medicine, operative vascular surgery and interventional vascular surgery. You can do everything; you’re involved in so many different things, and I’ve been doing it for many years, but I still enjoy it.
Rantner: And without wanting to pry too much into your private life, Jörg, but you’ve already shown that you’re a great role model, because your daughter is definitely on the same path and has discussed it with you personally – whether she really should go down the vascular surgery route – and she says, “nothing else”.
Heckenkamp: Well, I have to say, she recently did an internship in neurosurgery and since then neurosurgery has been very high on her list, but I hope I can still change her mind.
End
Adili: Then let me just slip back into the presenter’s role for a moment. Barbara, I’d also like to thank you very much for the conversation and the wonderful, charming hosting. It was really fun. For me, this is also the first time I’ve done a podcast like this. I found it really fascinating and exciting, and I’m looking forward to the next ones. We hope, dear listeners, that we’ve offered you something of interest and sparked your curiosity about our new podcast, and we’d of course be delighted if you’d send us questions and feedback at podcasts(at)medizinkommunikation.org and tune in again for the next episode. So please feel free to leave us a review on your favourite podcast platform and follow us on the German Society for Vascular Surgery podcast. And on that note, until next time, all the best and bye for now!
