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Twentieth anniversary of American Vascular Association/Lifeline Foundation: A celebration

2008; Elsevier BV; Volume: 47; Issue: 6 Linguagem: Inglês

10.1016/j.jvs.2008.03.026

1097-6809

William H. Pearce, John A. Mannick, Alexander W. Clowes, James S.T. Yao,

Cardiac, Anesthesia and Surgical Outcomes

The American Vascular Association/Lifeline Foundation is celebrating its 20th anniversary this year. This remarkable two-decade journey represents a cumulative effort by the leaders and members of the Society for Vascular Surgery (SVS). For the historical record, we would like to chart the sequence of events leading to various programs. In 1986, the Executive Council of SVS approved the formation of an Education/Research Foundation, from which the Lifeline Foundation evolved, with the mission to support the career development of young research-oriented vascular surgeons. Since that time, Lifeline has awarded 141 Student Fellowships, 21 Wylie Traveling Fellowships, 17 Mentored Clinical Scientist Development (K08) Awards, and three Mentored Patient-Oriented Research Career Development (K23) Awards. In 2001, the American Vascular Association (AVA) was established under the aegis of American Association for Vascular Surgery (formerly International Society for Cardiovascular Surgery-North American Chapter). In 2004, with the merger of the SVS and the American Association of Vascular Surgery into a single entity (SVS), Lifeline and the AVA merged into a single foundation, the AVA. As AVA/Lifeline is poised to launch a campaign for an endowment fund, we hope this report will let the members of the SVS know what has been accomplished, what we plan to do, and, most importantly, what we need to do in the future. The American Vascular Association/Lifeline Foundation is celebrating its 20th anniversary this year. This remarkable two-decade journey represents a cumulative effort by the leaders and members of the Society for Vascular Surgery (SVS). For the historical record, we would like to chart the sequence of events leading to various programs. In 1986, the Executive Council of SVS approved the formation of an Education/Research Foundation, from which the Lifeline Foundation evolved, with the mission to support the career development of young research-oriented vascular surgeons. Since that time, Lifeline has awarded 141 Student Fellowships, 21 Wylie Traveling Fellowships, 17 Mentored Clinical Scientist Development (K08) Awards, and three Mentored Patient-Oriented Research Career Development (K23) Awards. In 2001, the American Vascular Association (AVA) was established under the aegis of American Association for Vascular Surgery (formerly International Society for Cardiovascular Surgery-North American Chapter). In 2004, with the merger of the SVS and the American Association of Vascular Surgery into a single entity (SVS), Lifeline and the AVA merged into a single foundation, the AVA. As AVA/Lifeline is poised to launch a campaign for an endowment fund, we hope this report will let the members of the SVS know what has been accomplished, what we plan to do, and, most importantly, what we need to do in the future. Which of the operations we are doing today will be the discards of the next decade? What is needed is knowledge and such knowledge will be provided by the young amongst us and those yet to come.Allan Callow, 1987 The American Vascular Association (AVA)/Lifeline Foundation is celebrating its 20th anniversary this year. This remarkable two-decade journey represents a cumulative effort by the leaders and members of the Society for Vascular Surgery (SVS). For the historical record, we would like to chart the sequence of events leading to various programs. As AVA/Lifeline is poised to launch a campaign for an endowment fund, we hope this report will let the members of the SVS know what has been accomplished, what we plan to do, and, most importantly, what we need to do in the future. In the early 1980s, vascular surgeons had become experts in the surgical treatment of atherosclerosis obliterans. However, fundamental knowledge about atherosclerosis and basic insights into the pathogenesis of neointimal hyperplasia were lacking at the time. Vascular surgical research generally consisted of implanting prosthetic devices in the arterial system and studying patency. Vascular surgeons were only beginning to investigate the molecular biologic mechanisms of vascular disease. Unfortunately, funding for research at the time was difficult and discouraged many young investigators. Furthermore, reduction in reimbursement forced many young surgeons to take up heavy clinical loads to generate incomes for their academic departments. In 1982, departments of surgery received only 5.1% of the total National Institutes of Health (NIH) awards, and this amount was declining. It also became apparent to the leaders of the SVS that with the rapid expansion of biologic investigations, dabbling in basic science research was no longer possible. Basic laboratory research required a substantial time commitment by young investigative clinician–scientists to compete with nonsurgical colleagues. The SVS recognized the need to protect time for career development and the financial resources required in the establishment of a charitable foundation. In 1984, Dr Allan Callow asked the leadership of the SVS for the “utilization of certain assets of the Society to further the interests of young surgeons.” The Executive Council of SVS approved the request and the formation of a Foundation for Research and Education at the June meeting in 1986.1Callow A.D. Research and emergence of the Lifeline Foundation.J Vasc Surg. 1996; 23: 1054-1057Abstract Full Text Full Text PDF Scopus (2) Google Scholar The Board of Directors of the new foundation met in New Orleans on October 22, 1986. The first board members included Drs Victor Bernhard, Allan Callow, Calvin Ernst, Wesley Moore, and Malcolm Perry. At this first meeting, officers were elected: Dr Calvin Ernst, president; Dr Victor Bernhard, vice president; and Dr Malcolm Perry, secretary/treasurer. The foundation's financial support came from a grant of $50,000 from the SVS, a grant of $10,000 from W. L. Gore & Associates, and $4000 in contributions from members of the Board of Directors. In 1988, Dr Michael DeBakey became president of the foundation, and it was registered in Illinois as a 501C(3) nonprofit charitable foundation. In 1989, the Foundation for Research and Education adopted a new name—the Lifeline Foundation—as suggested by Dr DeBakey. The SVS Council provided $100,000 per year for 5 years to establish funding for the first award. The leaders of the Lifeline Foundation then included Drs Michael DeBakey, Thomas Fogarty, Robert Leather, John Mannick, John Ochsner, Ronald Stoney, Victor Bernhard, Malcolm Perry, Allen Callow, Wesley Moore, and Stanley Crawford.1Callow A.D. Research and emergence of the Lifeline Foundation.J Vasc Surg. 1996; 23: 1054-1057Abstract Full Text Full Text PDF Scopus (2) Google Scholar Dr Calvin Ernst served as executive director of the Lifeline Foundation for 5 years (1987-1991), creating programs such as the Industrial Advisory Committee and the Resident Research Award. The first Resident Research Award in the amount of $40,000 was given to Dr Brian Rubin, Washington University, to study the effects of the duration of thrombosis on vessel wall thrombogenicity. Acting on the recommendation of Dr Ronald Stoney, the foundation established an Industrial Advisory Committee (IAC) to allow participation by industry in the foundation and to provide a closer liaison between the two groups. In the 1980s, the landscape of surgical research had changed significantly and, in many surgical departments, large animal study had gradually been replaced by molecular biology or gene-based research. Surgical research requires a close mentorship and exchange between surgeons and basic scientists. Dr Eugene Strandness first conceived the idea of a closer liaison of the SVS and International Society for Cardiovascular Surgery (ISCVS) with the National Heart, Lung and Blood Institutes/National Institutes of Health (NHLBI/NIH). He thought that, if an interchange of ideas could evolve, it could be important to those involved in research devoted to vascular disease. With the help of John Watson, chief of Device and Technology Brand, and Robert Barnes of the Cardiology Advisory Committee of NHLBI, a Workshop on Vascular Disease was established. The success of the workshop resulted in a publication of the proceedings, Vascular Disease: Current Research and Clinical Application in 1987.2Strandness Jr, D.E. Didisheim P. Clowes A.W. Watson J.T. Vascular disease: current research and clinical application. Grune & Stratton, Orlando, FL1987Google Scholar Because of the success, a dialogue began with Dr Claude Lenfant, the director of NHLBI, to plan future meetings, which became known as the Research Initiatives Conference. The first joint meeting was held February 19 and 20, 1988, in Bethesda, Maryland. In 1993, the Research Initiatives Conference was incorporated into the Lifeline Foundation. From 1993 to present, the Research Initiatives has functioned under the leadership of the Lifeline Foundation/AVA.3Strandness Jr, D.E. The research initiative meeting and the National Institutes of Health.J Vasc Surg. 1996; 23: 1058-1068Abstract Full Text Full Text PDF Scopus (4) Google Scholar The Research Initiatives Conference is the only annual research meeting sponsored jointly by the NIH and a surgical society. Both the NIH and the scientific community have benefited from this type of exchange. Many members of the SVS have helped to organize the meetings. Sponsorship of the meeting is expensive and draining on the financial resources of the Lifeline Foundation. We are very fortunate to have received a generous endowment of $500,000 from Dr and Mrs Julius Jacobson to support the Research Initiatives meeting. Dr Julius Jacobson, a well-known vascular surgeon from New York, has made great contributions in microsurgery and is also known for his philanthropic activities. On the recommendation of the Joint Council, the conference was renamed as the Joan and Julius Jacobson Research Initiatives Conference.4Yao J.S.T. Mannick J. Lifeline Foundation and National Institutes of Health.J Vasc Surg. 2001; 33: 1237-1238Google Scholar In 1992, the Council of the ISCVS-North American Chapter (NA) agreed to match the $50,000 support from SVS for 5 years for equal representation on the Lifeline Foundation Board. The inclusion of the ISCVS increased the number of the Board of Directors to include representation from the ISCVS. The inclusion of the ISCVS in the Lifeline Foundation also was associated with the transfer of the Student Fellowship Research Award to the foundation. The Student Fellowship Research Award is intended to stimulate the interest of students to choose vascular surgery as a career. The award consists of $3000 funding to allow the student to work in the laboratory or on a project under the mentorship of an SVS member. About 10 students receive the award every year, and 141 awards have been given since its inception. In 1992, the Lifeline Foundation also assumed administrative responsibility of the E. J. Wylie Traveling Fellowship. The idea was originated in the summer of 1984 by Drs John Bergan and James Yao. The fellowship allows young surgeons to visit centers of excellence in research or clinical surgery to broaden their horizons in surgery and also to provide them with personal contacts with leaders or researchers in vascular surgery at home or abroad. Dr Peter Gloviczki was the first E. J. Wylie Traveling Fellow and described the spirit of the Fellowship by saying, “I traveled on the shoulder of a giant.”5Yao J.S.T. Stoney R.J. The E. J. Wylie Traveling Fellowship.J Vasc Surg. 1996; 23: 1088-1091Abstract Full Text Full Text PDF Google Scholar We are grateful for the generous support from W. L. Gore & Associates (Jack Hoover and Donald Lass). Many of the E. J. Wylie Traveling Fellows went on to become leaders of national, regional, or local vascular societies (Table I).Table IE. J. Wylie Traveling Fellowship, 1987-1988 to 2007-2008Year of awardRecipient1987-1988Peter Gloviczki, MD1988-1989Torben Schroeder, MD1989-1990Alan M. Graham, MD1990-1991Bauer E. Sumpio, MD1991-1992Thomas F. Panetta, MD1992-1993Julie A. Freischlag, MD1993-1994Joseph L. Mills, MD1994-1995K. Craig Kent, MD1995-1996B. Timothy Baxter, MD1996-1997Elliot L. Chaikof, MD, PhD1997-1998Peter J. Pappas, MD1998-1999Richard J. Powell, MD1999-2000Steven M. Santilli, MD, PhD2000-2001Ronald L. Dalman, MD2001-2002C. Keith Ozaki, MD2002-2003Alan Dardik, MD, PhD2003-2004Jon S. Matsumura, MD2004-2005David C. Cassada, MD2005-2006Mark K. Eskandari, MD2006-2007Joseph J. Giglia, MD2007-2008Luis R. Leon Jr, MD, RVT Open table in a new tab In May 1993, the logo of the Lifeline Foundation, designed by Dr Ernst, was adopted under President Eugene Strandness. During the summer of 1993, the officers of the foundation requested support from the regional societies. The regional societies were supportive and provided funds ranging from $10,000 to $50,000. From 1991 to 1996, Dr Ronald Stoney was the executive director. In 1994, the mission of the Lifeline Foundation was formalized to support research and education in vascular disease by:1enhancing the development of young surgical scientists in the advancement of vascular science through its comprehensive research funding commitment, and2insuring that new knowledge concerning the cause, treatment, and prevention of vascular disease is disseminated to the medical profession and to the public. Dr John Mannick assumed the presidency of the Lifeline Foundation in 1996-1997. During the first year of his leadership, the foundation was restructured to make it more responsive to the needs of its constituencies. Four new members from industry were added; all had voting privileges on the foundation. In addition, Dr James Yao was asked to serve as the vice president for Development, and liaisons from the NHLBI, David Robinson, and for clinical investigations, Dr Rodney White, were added. In the early 1990s, NIH developed the Mentored Clinical Scientist Development (K08) Award to help support career development in laboratory-based basic and translational research for clinically trained individuals. Dr Yao worked with Mr Robinson to develop a partnership support for a K08 grant. The meeting with Robinson led to a visit to NHLBI Director Dr Claude Lenfant at Bethesda in 1997 by Drs Alexander Clowes, James Yao, and John Mannick. The presence of Dr Clowes, a well-known researcher with NIH funding, impressed upon Dr Lenfant that vascular surgeons indeed are serious about pursuing basic science research. Dr Lenfant agreed to the partnership, making this a landmark event for the Lifeline Foundation and for vascular surgery. For the first time, the NIH partnered with a surgical society for sponsorship of a K08 grant. During this same interval, Dr Mannick proposed to the William J. von Liebig Foundation funding of these K08 grants. Working with Linda Hamilton of the von Liebig Foundation, a memorandum of understanding was completed and signed in November 1998. The award was renamed The William J. von Liebig Mentored Clinical Scientist Development Award and is given to two investigators per year with funding support of $150,000 per investigator per year for 5 years. Since 1999, the Lifeline Foundation has given 17 von Liebig awards to vascular surgeons. Table II lists the names of the recipients and titles of their research projects.Table IILifeline Foundation/National Heart, Lung and Blood Institute William J. von Liebig Mentored Clinical Scientist Development (K08) Awards, 1999 to 2007Year of awardRecipientResearch project1999Michael S. Conte, MDGenetic engineering of a failure resistant vein graft1999Larry W. Kraiss, MDControl of endothelial translation by fluid shear stress2000C. Keith Ozaki, MDInflammatory mechanisms of neointimal hyperplasia2000Rajabrata Sarkar, MD, PhDNitric oxide and smooth muscle cell proliferation2001Mark G. Davies, MD, PhDuPA receptor signaling and cell migration2001Gilbert R. Upchurch Jr, MDMMP-9-dependent vessel wall remodeling is NO dependent2002Raul J. Guzman, MDBone morphogenetic proteins in arterial remodeling2002Peter K. Henke, MDThrombus resolution is CXC chemokine dependent2003Peter L. Faries, MDMeasuring the efficacy of endovascular treatment of AAA2003Paul J. Gagne, MDCollagen-IV remodeling in ischemic leg revascularization2004Scott A. Berceli, MD, PhDMechanisms of shear-regulated vein graft remodeling2004Darren B. Schneider, MDRole of progenitor cells in hindlimb revascularization2005Paul J. DiMuzio, MDA tissue-engineered, small diameter vascular graft2005Iraklis I. Pipinos, MDMitochondriopathy of chronically ischemic muscle2006Alan Dardik, MDFlow responses to carotid angioplasty2006Melina R. Kibbe, MDNitric oxide eluting therapies for vascular surgery2007John A. Curci, MDVascular smooth muscle cells and elastolysis in abdominal aortic aneurysms Open table in a new tab Dr Robert Thompson recently reviewed the outcome of von Liebig award recipients and found six of seven (86%) vascular surgeons holding the K08 over 3 years had received academic promotion with tenure. All five who had completed the 5-year award had achieved independent investigator status with NIH support, showing that the von Liebig K08 program is an effective vehicle to stimulate research career development in the field of vascular surgery.6Thompson R.W. Schucker B. Kent K.C. Clowes A.W. Kraiss L.W. Mannick J.A. et al.Reviving the vascular surgeon-scientist: An interim assessment of the jointly sponsored Lifeline Foundation/National Heart, Lung, and Blood Institute William J. von Liebig Mentored Clinical Scientist development (K08) program.J Vasc Surg. 2007; 45: A2-A7Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar Multiple factors contribute to this success:1the combined funding from Lifeline and NHLBI is large enough that the award recipients do not need to have a heavy clinical load to generate income for salary;2the recipient is able to spend time with the mentor, a basic research scientist, to learn all the necessary molecular- or gene-based techniques to be an independent investigator; and,3the exposure to the basic science research environment helps to shape the careers of the recipients. To allow Canadian surgeons to have equal access to the award, a memorandum of understanding has been signed with the Canadian Medical Council. The Lifeline Foundation Board of Directors initiated the Technology Assessment Committee, which was designed to evaluate emerging technology. This, in conjunction with the Industrial Advisory Committee and the Endovascular Steering Committee, formed the nucleus of activities that led to the development of a registry to evaluate endovascular grafts. The Lifeline Endovascular Graft Registry project was begun in 1997 and was led by Dr Rodney White. The Endovascular Graft Registry recruited funding for a robust project to evaluate United States Food and Drug Administration (FDA)–approved endovascular devices. The registry was administered by the New England Research Institute under a contract to the Lifeline Foundation. The registry collected data on 2664 patients with endovascular grafts implanted and 334 open surgical patients. The report on long-term primary outcome measures of the Lifeline registry of endovascular aneurysm repair was recently published in the Journal of Vascular Surgery.7Lifeline registry of endovascular aneurysm repair: long-term primary outcome measures, Lifeline Registry of EVAR Publication Committee.J Vasc Surg. 2005; 42: 1-10Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar, 8Current topics in clinical and basic vascular research.J Vasc Surg. 2007; 45Google Scholar The registry data suggest endovascular graft repair using FDA-approved devices is safe, effective, and durable. Needless to say, endovascular graft repair has since changed the face of practice in vascular surgery—nearly 50% of cases are now done with endovascular technology. In 1999, an anonymous donor provided a $3 million challenge-matching grant to the Lifeline Foundation as an endowment for clinical research. The donor would give the first $1 million, and if the SVS matched the same amount, the donor would give an additional $1 million to make a corpus $3 million endowment. Dr James Yao began an aggressive campaign involving the members, regional and local societies, and industry partners to match the $1 million Challenge Grant. The campaign raised nearly $700,000 and, with the remaining funds from the foundation to make it $1 million, the $3 million endowment was achieved. The details of the endowment were that a corpus of $3 million was required before interest could be spent on funding awards. The endowment by the anonymous donor reinforces that the American spirit of philanthropy is still alive. We salute the generosity and foresight of this individual. As new technology emerges, there is a great need for competent clinical investigators to evaluate new devices, and this grant helps to make the training of these investigators a reality. In 2001, a separate foundation under the aegis of American Association for Vascular Surgery (formerly ISCVS-NA) was established with Dr Robert Hobson as the president. The name of the foundation was American Vascular Association (AVA), modeled after American Heart or Stroke Association. The primary mission of AVA is to promote public education and community outreach. Two early AVA initiatives included the Vascular Screening Program spearheaded by Dr William Flinn and the American Vascular Research Organization (AVRO) headed by Dr John Blebea. The idea behind AVRO was to provide a single source for industry to identify programs to conduct clinical research activities. A third initiative was an AVA component to provide public education on the Vascular Web. These programs were supported by industry partners and individuals. In 2003, Dr James Yao succeeded Dr John Mannick as president of the Lifeline Foundation. Shortly afterwards, he received a letter from Dr Claude Lenfant of NHLBI/NIH inviting Lifeline to form a joint partnership for a K23 grant similar to that of the K08, except that this grant would be designated for clinical investigators. The K23 award is intended to support the career development of investigators who have made a commitment to focus their research endeavors on patient-oriented research. Patient-oriented research is defined as research conducted with human subjects and includes (1) mechanisms of human disease, (2) therapeutic intervention, (3) clinical trials, and (4) the development of new technologies. With the approval of the SVS Council, a memorandum of understanding was completed with NHLBI. The first K23 award was given to Dr Gregory Landry in 2005 to study functional outcome of critical limb ischemia. Table III lists the award recipients and titles of K23 awards given by the Lifeline Foundation.Table IIIAmerican Vascular Association/Lifeline/National Heart, Lung and Blood Institute Mentored Patient-Oriented Research Career Development Award (K23), 2005 to 2007Year of awardRecipientResearch project2005Gregory J. Landry, MDFunctional outcome of critical limb ischemia2006Matthew S. Edwards, MDEmbolic protection during renal artery stenting2007Vikram S. KashyapEndothelial function in human peripheral arteries Open table in a new tab During the tenure of Dr James Yao, the Lifeline Executive Committee took several actions. These included (1) a review of the Endovascular Registry by a special committee, (2) a review of the performance of the investment firm and its policies, and (3) a decision to provide joint funding of the von Liebig Resident Research Award to be presented at the Southern Vascular Society meeting. The review of the financial status of Lifeline led to a change of management firms to UBS instead of Neumann & Berger. We also made a portfolio change to ensure diversity of the investment. The Challenge Grant experienced a significant loss in 1999 as a result of the stock crash. Since the new investment firm and strategy have been in place, it has more than $3 million in assets. One of the major events in 2004 was the merger of the SVS and the American Association of Vascular Surgery into a single entity, the Society for Vascular Surgery (SVS). With the merger, it was not desirable to have two foundations, and on the advice of the SVS Executive Council, Lifeline and AVA merged into a single foundation, the American Vascular Association (AVA). All programs under the Lifeline Foundation will retain the name Lifeline. In 2004, Dr William Pearce became the new leader of AVA, and both Drs Hobson and Yao were named emeritus members on the board to ensure a smooth transition. Under the direction of Dr Pearce, several programs such as the screening program, ARVO, and the Endovascular Registry have been moved to SVS. One of the most disappointing things we have to report is the loss of support of the von Liebig Foundation for the K08 grant. We are grateful for the generous support of the von Liebig Foundation in the past. In the last two decades, the von Liebig Foundation has been the main support for research under the direction of the Lifeline Foundation, and we have received a total of $6 million for the K08 grant, an unprecedented amount of funds. The loss of von Liebig support means we needed to chart new ways to support the K08 and K23 grants. The AVA has forged relationships with the American College of Surgeons to help support research. The American College of Surgeons, with the input of Dr Clowes, established a scholarship program for all surgeons that will support $37,500 of a K08 award. This year, Dr John Curci received both the AVA award of $37,500 and the American College of Surgeons award of $37,500. As we look back over the last two decades, we should be proud of what the Lifeline Foundation has accomplished. We are not the only surgical society that has an annual meeting with NHLBI/NIH, but we are the first surgical society to have a partnership with NIH to develop surgeon-scientists and clinical investigators. Reading the recent supplemental issue of the Journal of Vascular Surgery, “Current Topics in Clinical and Basic Vascular Research,”8Current topics in clinical and basic vascular research.J Vasc Surg. 2007; 45Google Scholar one has to be impressed with the depth and the breadth of the research by young vascular surgeons. There are 19 studies covering a wide variety of vascular biology mechanisms in vascular problems, and all are written by recipients of K08 and K23 grants. In addition, the Lifeline Foundation supports student research fellowships, the E. J. Wylie Traveling Fellowship, and the Resident Research Award. We need to remind ourselves that the commitment of a foundation is the pursuit of research support. The success we have is a cumulative effort by many leaders and members too numerous to list in this report. Although we appear to be very successful, we must not stop, especially since we lost the funding support from the von Liebig Foundation. We need to continue to support basic science research to answer the question raised in the quotation by Dr Allan Callow at the beginning of this article. The next phase of the Lifeline Foundation efforts is to launch a fund-raising campaign for an endowment fund to support the K08 and K23 grants. Philanthropy is an American spirit, and to keep the spirit alive, we urge all members to continue to give to the AVA/Lifeline Foundation. As Winston Churchill said, “We make a living by what we get, but we make a life by what we give.”