Building a partnership between vascular medicine and vascular surgery: A coalition for the future of vascular care

W. R. Hiatt, M. A. Creager, J. P. Cooke, A. T. Hirsch

Research output: Contribution to journalArticlepeer-review

14 Scopus citations
Original languageEnglish (US)
Pages (from-to)918-925
Number of pages8
JournalJournal of vascular surgery
Issue number5
StatePublished - 1996
Externally publishedYes

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Advances in vascular biology in the past decade have shed new light on the mechanisms by which the vessel wall controls its tone, growth, and interaction with circulating blood elements. Insights have been gained regarding the disturbances of vascular homeostasis that cause vascular disease, and advances in vascular biology are likely to lead to novel therapies. 32,33 Research in vascular biology has been greatly facilitated by the NIH program project grants in vascular biology and medicine. Recent advances to treat vascular disease include gene therapy. This approach was derived from bench research, was initially applied in animal models of vascular disease, and has now reached preliminary human clinical trials. Catheter-directed administration of genes that encode angiogenic factors are currently being used to enhance the development of the collateral circulation in patients with PAD. 29 Other frontiers of gene therapy include the development of antisense oligonucleotides directed against nuclear proteins that are required for the cell cycle. In animal models, these oligonucleotides inhibit myointimal hyperplasia after balloon angioplasty or venous bypass grafting. 33,34 Gene transfer techniques have successfully restored elaboration of endogenous vasodilators after vascular injury in animal models of disease. 35 Many novel treatments will develop from new knowledge regarding the pathobiology of atherosclerosis and restenosis and an improved understanding of the factors that promote plaque rupture. Vascular biologists are generating new insights regarding the role of apoptosis in vascular remodeling, the principles of vascular adhesion biology, the transduction of humoral and hemodynamic stimuli, concepts regarding the elaboration and degradation of extracellular matrix, lipoproteins and their interaction with the vessel wall, and cellular and molecular mechanisms of thrombosis and fibrinolysis. Vascular medicine physicians and vascular surgeons are ideally positioned to translate advances in vascular biology into clinical practice. This has led to clinical trials of new pharmacologic agents in the treatment of claudication that will test the efficacy of drugs that promote regional vasodilation, lower viscosity, improve skeletal muscle metabolism, and promote angiogenesis. 27,29 Critical in the development of clinical trials has been a reevaluation of the guidelines for conducting such trials, including recommendations for graded treadmill testing and a battery of questionnaires to assess treatment effect in patients with claudication. 36

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