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The science and art of vascular surgery has no country

2008; Elsevier BV; Volume: 48; Issue: 6 Linguagem: Inglês

10.1016/j.jvs.2008.09.048

1097-6809

Péter Gloviczki,

Aortic Disease and Treatment Approaches

It is an honor and privilege for me to stand here as the second president of the World Federation of Vascular Societies (WFVS). Presidency of a society is always a sign of the highest appreciation by your peers, and I am humbled by the opportunity to serve as both president and founding member of this distinguished world organization. I am particularly indebted to my eminent colleagues Renald Barry, Ian Brunkwall, John Harris, Hiroshi Shigematsu, Henrik Sillesen, Kumud Rai, and Martin Veller, all leaders of the federation, who elected me to this post at the inaugural meeting of the society last year in Madrid. For nominating me as representative of the Society for Vascular Surgery (SVS) to the Council of the Federation, my gratitude goes to past president Craig Kent, current president Wayne Johnston, and Greg Sicard, chair of the International Relations Committee of the SVS. The WFVS is a new and ambitious organization with the mission of uniting vascular societies around the world to share information, solve common problems, and ensure the future of our specialty worldwide. The foundation of this federation is international collaboration, an ideal that I have always cherished and promoted, and a principle that has tremendously enriched both my professional and my private life. My primary goal today is to convey to you the importance and benefits of an international spirit we all should embrace—a spirit this organization was created with. I want to remind you that our history and heritage are international and that our clinical practice, education, and research are also universal for very simple reasons: this profession has no boundaries, and the science and art of vascular surgery has no country. My second, and equally important, goal is to enhance your interest in the WFVS, to introduce you to the society, and to tell you why the concept and structure of this federation is so different from all currently existing international vascular societies. In his recent presidential address, "Without Prejudice," Keith Calligaro pointed out that many of the past presidents of the Society for Clinical Vascular Surgery were not born in the United States, and all were descendents of people who came to this country recently or a few generations ago to find a better life.1Calligaro K.D. Without prejudice.J Vasc Surg. 2008; 48: 237-243Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar More so in the United States than in other countries, vascular surgeons have an international background, and I am no exception. I was born and raised in Hungary in a multiethnic family. My physician father, Dr Zoltán Gloviczki, had a Polish family background, and my mother, Eva Erhardt, was a descendent of Austrian immigrants (Fig 1). It is most appropriate in this address to thank both of them and my entire family for their love and lifelong support. My mother tongue is Hungarian; I learned German as my second language and studied Russian for 10 years during the Communist rule in Hungary. As a physician, I trained in Hungary, France, Belgium, and the United States. I married a wonderful woman, Dr Monika Lecomte, a French citizen of Polish origin. My two children, Peter Jr and Julia, were born in Minnesota, but both are fluent in Hungarian. My stepson, Michael, was born in Paris and fluently speaks French, English, and Polish. I may say that I live and breathe the multiethnic and multicultural life of millions of people around the world. My international activities have enriched my professional life and contributed to great experiences during my professional career. During the past 3 decades I have spent at Mayo Clinic, I have maintained and cherished the international connections I brought with me from Europe and added many new acquaintances. I have benefited greatly from international activities in several societies, most importantly in the Society for Vascular Surgery, the Society for Clinical Vascular Surgery, the American Venous Forum, the International Union of Angiology, and, most recently, in the World Federation of Vascular Societies. Attending international meetings, collaborating on international consensus documents, working on the editorial board of international journals, interacting with colleagues and trainees from around the world, and traveling internationally have been sources of tremendous professional and personal satisfaction that I would not want any of our younger colleagues to miss. When I arrived in Rochester, Minnesota, 27 years ago, even with my multiethnic background, I was awed by the international spirit I found at Mayo Clinic. Doctor William Worrall Mayo (Fig 2, A) —father of William James and Charles Horace Mayo (Fig 2, B), founders of Mayo Clinic—remarked as early as 1872 that the duty of the physician "knows neither color nor race when humanity is suffering." Both William J. and Charles H. Mayo held international exchange in great esteem, and both traveled extensively to all parts of the world to meet foreign surgeons and to bring home new ideas and techniques. These travels attracted many physicians and students who in turn came to Rochester to watch Drs Will and Charlie operate (Fig 3). In those days, international travel took weeks on trains and boats, so the brothers usually traveled separately. While one traveled the other stayed in Rochester to take care of daily activities at the clinic. William James Mayo detailed his experiences from one of his travels to Italy in a beautiful article published in the Journal of the Minnesota State Medical Association in 1910.2Mayo W.J. Notes on Italian surgery.J Minn State Med Assoc and the Northwestern Lancet. 1910; (30 New Series): 373-380Google Scholar Dr Mayo wrote, "The science and art of surgery has no country, and while the practice of art varies in some particulars with different nations, it may be truthfully said that the best surgery is much alike in all civilized countries. Italian surgery is no exception to this statement." Then, in a message that reflected both his international spirit and his good humor, he added, "If one goes abroad to criticize there are plenty of opportunities, but why go abroad for that purpose? There are plenty of opportunities at home."Fig 3William James Mayo operates in front of visiting physicians in 1913 at Mayo Clinic. Copyright Mayo Foundation for Medical Education and Research.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Because we have been inspired by our heritage, international education has been important in our activities in the Vascular Surgery Division at Mayo Clinic during the past 3 decades. Trainees from all corners of the world have traveled to Rochester, Minnesota, to spend time at the Gonda Vascular Center, named after Leslie and Susan Gonda, visionary philanthropists and Hungarian immigrants to the United States, to study vascular disease and vascular and endovascular surgery. Mayo Clinic has been blessed by the many international patients who choose to come to Rochester for their care, and vascular patients have been no exception. One of our grateful patients and benefactors, Canadian Edward S. Rogers, Jr, President and CEO of Rogers Communications, has established the Edward S. Rogers Clinical Research Fellowship in Vascular Surgery, thus ensuring that the flame of international spirit in vascular surgery at Mayo Clinic will stay alive for generations to come. So far, physicians from Portugal, Italy, China, and Brazil (Fig 4) have benefited from this year-long training program. In addition to traveling to international meetings and participating in international societies, one goal of our international program is to take education abroad, so physicians and patients worldwide can benefit from experiences gained at Mayo Clinic. With attendees from 31 countries, a successful international symposium of the Gonda Vascular Center was organized in 2007 in Reykjavik, Iceland. The second Mayo Clinic International Vascular Symposium will take place in Budapest, Hungary, on June 27-30, 2009 (Fig 5). The history and heritage of vascular surgery is international. Modern vascular surgery has multiple roots and was developed by the early efforts of surgeons from all corners of the globe. To illustrate this, let me give a few examples. In England, John Hunter first successfully treated a popliteal aneurysm in 1785,3Home E. An account of Mr Hunter's method of performing the operation for the popliteal aneurism Communicated in a letter to Simmons by Mr Eduard Home, Surgeon.London Med Journal. 1786; 7: 391-406Google Scholar and his student, Sir Astley Cooper, used proximal ligations in a patient with an iliac aneurysm in 1817.4Cooper A. Case of ligature of the aorta Surgical Essays by Astley Cooper and Benjamin Travers, Pt. 1, 101-30, 2 pl. Cox, London1818Google Scholar In Russia, Eck performed vascular anastomoses as early as 1879.5Eck N. Trav Soc Natur St Petersbourgh, 1879, p x, cited by Guthrie CC: blood vessel surgery and its applications.in: Harbison S.P. Fisher B. the contributions of Dr C.C. Guthrie to Vascular Surgery. University of Pittsburgh Press, 1959Google Scholar In the United States, John Murphy in 1896 reconstructed a femoral artery after excision of a traumatic aneurysm,6Murphy J.B. Resection of arteries and veins injured in continuity – end to end suture – experimental and clinical research.Med Record (NY). 1897; 51: 73-88Google Scholar and in France, Alexis Carrel described his technique of suturing blood vessels in 1902.7Carrel A. La technique operatoire des anastomoses vascularies et la transplantation des visceres.Lyon Med. 1902; 98: 859-864Google Scholar In the United States, Rudolph Matas introduced endoaneurysmorrhaphy for treatment of aneurysms in 1903,8Matas R. An operation for radical cure of aneurism based upon arteriorrhaphy.Ann Surg. 1903; 37: 161-169PubMed Google Scholar and in Spain, Jose Goyanes first replaced a popliteal aneurysm with a vein graft in 1906.9Goyanes J. Nuevos trabajos de cirurgia vascular Substitucion plastica de las arterias por las venas, o arterioplastia venosa, applicada, como nuevo metodo, al tratamiento de los aneurismas.El Siglo Med. 1906; 364: 561-564Google Scholar In Germany, Erich Lexer used vein grafts as early as 1907.10Lexer E. Die ideale operation des arteriellen und des arteriell-venõsen Aneurysma.Arch Klin Chir. 1907; 83: 458-477Google Scholar The list of early and recent pioneers in vascular surgery is endless, and these giants came from all continents of the world. From North America: Michael E. DeBakey, Denton A. Cooley, D. Emerick Szilagyi, Edwin J. Wylie, Jesse E. Thompson, and E. Stanley Crawford. From South America: Juan Parodi and E.C. Palma. From Europe: Joao Cid Dos Santos, Jean Kunlin, Charles Dubost, Renee Leriche, H.H.G. Eastcott, and Clarence Crafoord, among dozens of others. Surgeons from India contributed to our knowledge on arteritis and lymphedema,11Jamal S. Lymphovenous anastomosis in filarial lymphedema.Lymphology. 1981; 14: 64-68PubMed Google Scholar from China, on venous reconstructions,12Wang Z.G. Zhu Y. Wang S.H. Pu L.P. Du Y.H. Zhang H. et al.Recognition and management of Budd-Chiari syndrome: report of one hundred cases.J Vasc Surg. 1989; 10: 149-156PubMed Scopus (76) Google Scholar and from South Korea, on vascular malformations.13Lee B.B. Do Y.S. Yakes W. Kim D.I. Mattassi R. Hyon W.S. Management of arteriovenous malformations: a multidisciplinary approach.J Vasc Surg. 2004; 39: 590-600Abstract Full Text Full Text PDF PubMed Scopus (190) Google Scholar From South Africa came Christian Barnard in cardiovascular surgery and a vast experience in the management of vascular injuries.14Du Toit D.F. Strauss D.C. Blaszczyk M. de Villier R. Warren B.L. Endovascular treatment of penetrating thoracic outlet arterial injuries.Eur J Vasc Endovasc Surg. 2000; 19: 489-495Abstract Full Text PDF PubMed Scopus (81) Google Scholar How could we practice today without the pioneering works of Takayasu of Japan,15Takayasu M. A case with unusual changes of the central vessel in the retina.Acta Soc Ophth Jap. 1908; 12: 554-555Google Scholar or the discoveries of Sven-Ivar Seldinger of Sweden,16Seldinger S.I. Replacement of the needle in percutaneous arteriography.Acta Radiol. 1953; 39: 855-860Google Scholar Charles Dotter of the United States,17Dotter Ch Udkins M.P. Transluminal treatment of arteriosclerotic obstruction Description of a new technique and a preliminary report of its application.Circulation. 1964; 30: 654-670Crossref PubMed Scopus (1224) Google Scholar Andreas Gruntzig of Germany,18Gruntzig A. Kumpe D.A. Technique of percutaneous transluminal angioplasty with the Gruntzig balloon catheter.AJR. 1979; 132: 547-552Crossref PubMed Scopus (204) Google Scholar or Argentinian-born Julio Palmaz, of San Antonio, Texas?19Palmaz J.C. Garcia O.J. Schatz R.A. et al.Placement of balloon-expandable intraluminal stents in iliac arteries: first 171 procedures.Radiology. 1990; 174: 969-975PubMed Google Scholar In an interesting monograph, Raphael Suy from Belgium recalls the fascinating international history of endovascular aortic reconstructions,20Suy RMS. Arterial aneurysms (a historical review) Fonteyn Medical, Sint-Genesius-Rode, Belgium, 2004.Google Scholar from the experiments of Cragg21Cragg A. Lund G. Rysavy J. Casataneda F. Castaneda-Zuniga W. Amplatz K. Nonsurgical placement of arterial endoprosthesis : a new technique using nitinol wire.Radiology. 1983; 147: 261-263Crossref PubMed Scopus (154) Google Scholar and Balko22Balko A. Piasecki G.J. Shah D.M. Carney W.J. Hopkins R.W. Jackson B.T. Transfemoral placement of intraluminally polyurethane prosthesis for abdominal aortic aneurysm.J Surg Res. 1986; 40: 305-309Abstract Full Text PDF PubMed Scopus (176) Google Scholar in the United States, to the revolutionary work of Juan Parodi in Argentina23Parodi J.C. Palmaz J.C. Barone H.D. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms.Ann Vasc Surg. 1991; 5: 491-499Abstract Full Text PDF PubMed Scopus (2797) Google Scholar and the nearly forgotten pioneer Nicholas Volodos in Russia.24Volodos N. Shekhanin V.E. Karpovich I.P. Troyan V.I. Guriev Y.A. Synthetic self-fixing prosthesis for the endoprosthetics of vessels (in Russian).Vestnik Khirurgii. 1986; 11: 123-124Google Scholar International collaboration between Parodi, Palmaz, and Barone resulted in the first successful clinical series of endovascular abdominal aortic aneurysm repair.23Parodi J.C. Palmaz J.C. Barone H.D. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms.Ann Vasc Surg. 1991; 5: 491-499Abstract Full Text PDF PubMed Scopus (2797) Google Scholar No progress would have been possible, however, without visionary contributions by Thomas Fogarty,25Fogarty T.J. Vision of relevant technologic progress for the next two decades.J Vasc Surg. 1996; 24: 291-296Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Frank Veith,26Veith F.J. Presidential address: transluminally placed endovascular stented graft and their impact on vascular surgery.J Vasc Surg. 1994; 20: 855-860Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar Michael Dake,27Dake M.D. Miller D.C. Semba C.P. Mitchell R.S. Walker P.J. Liddell R.P. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms.N Engl J Med. 1994; 331: 1729-1734Crossref PubMed Scopus (1303) Google Scholar Timothy Chuter,28Chuter T.A.M. Green R.M. Ouriel K. Fiore W.M. DeWeese J.A. Transfemoral endovascular aortic graft placement.J Vasc Surg. 1993; 18: 185-187Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar Michael Marin,29Marin M.L. Parsons R.L. Hollier L.H. Mitty H.A. Ahn J. Parsons R.E. et al.Impact of transrenal aortic endograft placement on endovascular graft repair of abdominal aortic aneurysms.J Vasc Surg. 1998; 28: 638-646Abstract Full Text Full Text PDF PubMed Scopus (120) Google Scholar Wesley Moore,30Moore W.S. Brewster D.C. Bernhard V.M. EVT/Guidant InvestigatorsAorto-uni-iliac endograft for complex aortoiliac aneurysms compared with tube/bifurcation endograft: results of the EVT/Guidant trials.J Vasc Surg. 2001; 33: 11-20Abstract Full Text PDF Scopus (93) Google Scholar Edward Diethrich,31Diethrich E.B. Endovascular interventions into the 21st century: what can we anticipate?.Eur J Vasc Endovasc Surg. 1998; 15: 93-95Abstract Full Text PDF PubMed Scopus (1) Google Scholar and Roy Greenberg,32Greenberg R.K. 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Myhre from Norway, Lars Norgren from Sweden, and Christoph von Duber from Germany. Stimulated in great part by the unique international alliance in EUROSTAR, endovascular centers of excellence rapidly developed in several cities in Europe, including Antwerp, Athens, Barcelona, Bern, Cologne, Copenhagen, Dendermonde, Dusseldorf, Groningen, Leicester, London, Malmo, Marseille, Milan, Nottingham, Nuremberg, Perugia, Rostock, Utrecht, and Vienna, among many others. During this time, activities in Asia intensified accordingly, and Japan provided a major impetus to endovascular aortic interventions with seminal contributions from M. Kato,38Kato M. Ohnishi K. Kaneko M. Ueda T. Kishi D. Mizushima T. Matsuda H. New graft-implanting method for thoracic aortic aneurysms or dissection with a stented graft.Circulation. 1996; 94: 188-193Google Scholar Usui,39Usui A. Ueda Y. Akita T. Takagi Y. Tajima K. Nishikii N. Ishiguchi T. Mid-term results of an endovascular stent-graft by means of median sternotomy for distal aortic arch aneurysm.Artif Organs. 2002; 26: 1044-1049Crossref PubMed Scopus (4) Google Scholar Inoue,40Inoue K. Hosokawa H. Iwase T. Sato M. Yoshida Y. Ueno K. Tsubokawa A. Tanaka T. Tamaki S. Suzuki T. Aortic arch reconstruction by transluminally placed endovascular branched stent grafts.Circulation. 1999; 100: 316-321Google Scholar and Ohki,41Ohki T. Ouriel K. Silveira P.G. Katzen B. White R. Criado F. Diethrich E. Initial results of wireless pressure sensing for endovascular aneurysm repair: the APEX Trial–acute pressure measurement to confirm aneurysm sac exclusion.J Vasc Surg. 2007; 45: 236-242Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar among others. Endovascular surgery has advanced by leaps and bounds in the past decade as a result of remarkable combined efforts by vascular specialists all over the world; this has strengthened our profession enormously and benefited millions of patients with vascular disease worldwide. International meetings are forums in which to exchange ideas, learn about new advances, review current management of vascular diseases, including those more prevalent in some countries than in others, and learn the latest results of multicenter and international clinical trials. They are also showcases of international industry and a chance to get acquainted with local culture, history, art, music, food, and geography. Most important, meeting colleagues from other countries will ultimately open the door for scientific collaborations, educational experiences, new ideas and projects, and lifelong friendships. As a young surgeon from Hungary, I enjoyed tremendously the stimulating atmosphere of international meetings organized by Professor P. Balas from Athens, Greece. His world congress of the International Union of Angiology in 1980 gave me a chance to listen, for the first time, to the inspiring presentation of Michael DeBakey and to meet two Mayo Clinic physicians, Larry Hollier and Alexander Schirger—a meeting that paved my way to Rochester, Minnesota, and changed my life forever. International meetings provide tremendous scientific opportunities for vascular surgeons both young and old. Who would not be overwhelmed by 400 rapid-fire presentations of world experts at the VEITH symposium in New York, organized for the 35th year in 2008 by Frank Veith, or by the Great Debates or Consensus Updates of the Charing Cross International Symposium in London, as presented by Professor Roger M. Greenhalgh? For those who primarily enjoy endovascular interventions, the International Congress of the International Society of Endovascular Specialists is the one to attend. With numerous world-renowned speakers and chaired by Edward B. Diethrich, this congress in beautiful Arizona provides a unique experience, with many live procedures and a virtual showcase of the latest technology. For those who favor South America, the meeting not to miss is the PanAmerican Congress on Vascular and Endovascular Surgery in Rio de Janeiro, organized by Enrico Ascher, José Luís C. do Nascimento Silva, and Sergio Leal de Meirelles. The Asian Society for Vascular Surgery meetings and Vascular 2008, organized by the Australian and New Zealand Society for Vascular Surgery, are other high-level annual international conferences to welcome those who wish to travel to more exotic parts of the world. Annual meetings of the World Federation of Vascular Societies will not compete with nor wants to replace any of the current international meetings. The half-day or full-day congress of the WFVS will be held together with the annual meeting of one of the regional vascular societies, like this second annual meeting organized in San Diego as part of the annual meeting of the Society for Vascular Surgery. International exchange has always been important, and vascular surgeons have been establishing and leading international organizations for decades. Until the recent turn of the century, the International Society of Cardiovascular Surgery with its active international chapters, played a major role in advancing our specialty. The structure and program of this society became outdated, however, and even changing the name to the International Society of Vascular Specialists could not save the society, at least not in North America. The task of going international was taken over by the International Society of Vascular Surgery under the leadership of Frank Veith from the United States, Sir Peter Bell from the United Kingdom, Giorgio Biasi from Italy, Vicente Riambau from Spain, Ernesto Molina from Sweden, and Rajiv Parakh from India, among others. The need to unite endovascular specialists into one organization was recognized more than 20 years ago by Edward B. Dietrich, who established a most successful International Society of Endovascular Specialists. Vascular surgeons also played a key role in the success of the International Union of Angiology, a multidisciplinary world organization, currently under the presidency of Elias Bastounis from Athens. Past surgical presidents of the union included P. Balas, A. Nicolaides, P. Gloviczki, and J. Fernandes y Fernandes, among others. Many other international organizations, small and large, also provide opportunities for international exchange and a pleasant atmosphere to meet international colleagues; these include, among others, the Mediterranean League of Angiology and Vascular Surgery, the Central European Vascular Forum, the International Union of Phlebology, and the European Venous Forum. The World Federation of Vascular Societies is the latest addition to the list of international organizations, and the need to establish the federation was recognized by several major vascular societies of the world, including the Society for Vascular Surgery. Efforts of the Society for Vascular Surgery to improve international connections have intensified greatly in recent years. The International Relations Committee, with members Enrico Ascher, Jack Cronenwett, Peter Gloviczki, Craig Kent, Heron Rodriguez, Anton Sidawy, and Anthony Whittemore, has been rejuvenated under the leadership of Gregory Sicard, past president and international ambassador of the society. The committee introduced important initiatives to strengthen our relations with other countries in the world. To follow the international structure of the American College of Surgeons, the concept of international chapters of the Society for Vascular Surgery was introduced. With the leadership of Kumud Rai, Natarajan Sekar, KR Suresh, and Sudhir Rai, the Indian chapter was inaugurated as the first international chapter of the SVS, with several others to follow. The committee also invited several young international scholars to visit centers of excellence in the United States and to attend the annual meeting of the SVS. We increased international membership and organized highly successful joint sessions with the European Society for Vascular Surgery (ESVS) in Prague, Baltimore, Madrid, and San Diego. Finally, we agreed to be charter members of the World Federation of Vascular Societies and organized, with the expert help of Susan Burkhardt and Rebecca Maron from the SVS administrative office, and Linda Nielsen, administrative secretary of the ESVS, the second annual meeting in San Diego in 2008. I don't know much about other federations, but the birth of this one was not easy. To save the short-lived International Society of Vascular Specialists, a society formed to replace the International Society of Cardiovascular Surgery, president Lazar Greenfield and secretary Anthony Whittemore suggested the idea of an International Federation of Vascular Societies. Although the proposed federation never materialized, the need for an international federation to unite leading vascular societies of the world became evident to several international leaders. In Europe, supporters of the concept were Michael Horrocks from the United Kingdom and Henrik Sillesen, general secretary of the ESVS from Denmark. They were followed enthusiastically in the United States by then–SVS president Enrico Ascher. The plan to set up a loose federation of vascular societies was discussed at multiple meetings in Europe and the United States. For the concept of a federation to be accepted by participating societies, it was essential to agree that no single nation can dominate, that presidency of the federation will rotate each year, that there will be no membership fee, and that main issues discussed at annual meetings include education and politics in vascular surgery in the world. With joint support of ESVS presidents Jesper Swedenborg and Jan Brunkwall, Hiroshi Shigematsu of Japan, Martin Veller and Renald Barry of South Africa, John Harris and Peter Woodruff of Australia, Col Kumud Rai of India, and SVS president Craig Kent, together with Greg Sicard, chair of the International Relations Committee of the SVS, the federation was established in Madrid in 2007. Councilors of six major regional or national societies (Fig 6) signed the constitution on September 21, 2007, and a new international vascular organization was created—the World Federation of Vascular Societies (Fig 7).Fig 7Member societies of the World Federation of Vascular Societies.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The mission of the federation is to provide a forum for the international exchange of educational, political, and scientific issues related to the diagnosis, treatment, and prevention of vascular diseases. The objectives of the federation reflect the need for international exchange, for unity in standards of education and politics in vascular and endovascular surgery, and for high standards in research, evaluation, and treatment of vascular disease (Table I). It was decided that member societies will be formally constituted major national or regional societies representing one of the major geographic regions of the world. Member societies of the federation have been in existence for a mean of 36 years and have a total membership of over 10,700 (Fig 8). Active members of contributing vascular societies automatically become members of the federation.Table IObjectives of the World Federation of Vascular Societies•To advance at an international level the knowledge and study of vascular surgery•To advance cooperation between vascular societies•To promote at an international level the best vascular surgical practices for treatment of vascular diseases•To promote and standardize education in vascular surgery•To promote and disseminate international vascular research•To hold symposia or congresses and to distribute information•To act as an international conduit for discussion between vascular surgeons and to be a spokesperson at an international level for vascular surgeons Open table in a new tab The WFVS in concept and structure is different from other international vascular societies in many aspects. The federation has no financial structure and has no assets. There is no formal office and, most importantly, there is no membership fee for individuals or societies. Costs incurred by the member societies will go to their own accounts. The federation has a busy website (www.wfvs.org) with links to all member societies in the world and features a new logo (Fig 9). The annual symposium is the major event, and this year's excellent program was built on the success of last year's lectures. To honor an individual who made major contributions to the art and science of vascular surgery and who enjoys exceptional international recognition for his academic achievements, the federation established the Robert B. Rutherford Lecture. It is a privilege to announce that in 2008 the lectureship was awarded to Jonathan Beard from the Sheffield Vascular Institute, United Kingdom. The highlight of this year's meeting is Jonathan Beard's lecture: "Which is the best revascularisation for critical limb ischemia: endovascular or open surgery?" Politics and relationships with other vascular specialties dominated the meeting last year in Madrid, and international education is the focus this year in San Diego. Program directors and educational leaders from all continents are here today to discuss the status of vascular surgery education in the world. As an introduction to this, however, we bring you a potpourri of great scientific presentations—a review of the best and latest in vascular and endovascular surgery from each continent in 2008. We are most thankful to editors Jack Cronenwett and James Seeger, who invited us to compile all lectures and discussions of this meeting for a special WFVS supplement published by the Journal of Vascular Surgery. To conclude, I would like to thank you again for the privilege of serving as your second president. I also thank you for attending this meeting in such high numbers and demonstrating your support for this society. This federation wants to embrace an international spirit, and I am asking you to keep this spirit with you. We are all proud of the country we belong to and the heritage we cherish. But we live in an era of international technological revolution, of rising health care costs around the world, of inequalities in delivering optimal or even minimal health care to those who need it most; we live at a time when multiple specialties compete for our territories and when major changes must take place in graduate and postgraduate education for our specialty to endure and to prosper. If you want to make an impact, it is no longer enough to be a good citizen of your country; we need and we must step up one level higher and become fellow citizens of the world. The objective of this federation is to unite our forces, and I am asking you to help us achieve this noble goal. The federation will always remind us of the greatness of international spirit and the importance of becoming international citizens. We can do this because vascular surgery is international; vascular patients, vascular disease, vascular interventions, and vascular surgeons have no boundaries. As William James Mayo said 98 years ago, "The science and art of surgery has no country."