Peter Gloviczki, professor of Surgery, College of Medicine, Mayo Clinic, Rochester, USA, is the president of the Society for Vascular Surgery (SVS) 2012–2013. Gloviczki, who started his career in Hungary, moved to the United States in 1981 to work in Mayo Clinic. With a special interest in magic, he won a TV contest in Hungary when he was 14. One of his shows, “Chicago Balls”, performed at the World Championship of Magic in Paris, in 1973, can be found on YouTube.
When did you decide you wanted a career in medicine?
I was six years old when someone asked me what I wanted to be when I grew up. I said “professor of Surgery”. My decision was easy. I come from a family of doctors; my father, grandfather, brother and uncle were all physicians.
Why did you decide to specialise in vascular surgery?
I developed an interest in vascular diseases during medical school in Budapest where I worked with Professors Harry Jellinek and Anna Kadar, two famous vascular pathologists at Semmelweis University. When I finished medical school I started my residency at the Cardiovascular Clinic and it took me only two weeks to fall in love with this amazing specialty.
Who have your greatest influences been and what advice of them you still remember?
The list will be long if I am to mention everyone. The first people on it, by all means, are my parents. They taught their five children all the values we have followed: love, hard work, honesty and integrity. In communist Hungary my brothers and I were all educated at the Benedictine high school of the Abbey of Pannonhalma. My father was the best and most compassionate physician I have ever known.
Later, I was mentored by a pioneer Hungarian vascular surgeon, Professor Lajos Soltesz. He was a great humanist and an inspiring teacher who taught me that vascular surgeons should take care of the full spectrum of vascular diseases (arterial, venous and lymphatic). In France, Professors Servelle and Cormier also had great influence on me. The advice I remember most was from Servelle: “Monsieur Peter, the best place in the world for medicine is Mayo Clinic”. It took me six more years but in June 1981, I finally arrived to Rochester, Minnesota, USA. Drs Hollier and Pairolero were my teachers, mentors and later, my friends. There was no returning to Hungary. In the past three decades my professional life has been fully dedicated to the Mayo Clinic.
What have your proudest moments been?
I have been very fortunate to have a loving family at home and a fantastic group of colleagues at Mayo Clinic. My proudest moments in my private life have been the births of my children, Peter and Julia, and my marriage to an extraordinary woman, Monika. My proudest moment in my professional carrier has been, without doubt, becoming president of the largest and most respected vascular surgery society of the world, the Society for Vascular Surgery.
How has vascular surgery evolved since you began your career?
Amazing changes have taken place in terms of technique and technology. Endovascular treatment is now widespread and effective, and patients leave hospital in a day or two even after ruptured aneurysm repair. But open surgery is still needed, and for the latest generation of vascular surgeons this may be a challenge. Soon we will have to start special fellowships for complex (or even simple) open aortic surgery.
One of your biggest interests is in phlebology. What topic attracts you most in venous disease management and why?
I dealt with most areas of venous diseases, both acute and chronic. A testimony of this is the Handbook of Venous Disorders, published now in its 3rd Edition. I love challenges and my favourite operations are large vein reconstructions for both benign and for malignant occlusive disease. I edited an atlas with John Bergan on endoscopic perforator vein surgery, where I described the technique we developed at Mayo and our results.
Finally, I am very proud of the latest Society for Vascular Surgery/American Venous Forum Guidelines, which we published in the Journal of Vascular Surgery under my chairmanship, in 2011.
At the next Charing Cross Symposium, you will talk about advanced imaging for evaluation and follow-up after large vein reconstruction. What will the main message of your presentation be?
The main message is that both CT and MR venography have progressed tremendously and that we should use these minimally invasive three dimensional imaging technologies for evaluation and patient selection before venous reconstructions.
Having treated varicose veins successfully with surgery for many years, which endovenous method – laser, radiofrequency, foam, etc – you consider most promising?
We progressed by leaps and bounds but we do not have a fully effective, safe, painless outpatient procedure just yet. We use both radiofrequency and laser at Mayo Clinic for venous ablation and there is no major difference between these two techniques – for me these are still the best current techniques. But we have to solve the problem of pain, bruising, needing tumescent anaesthesia and of the rare but definite problem of thrombotic complications.
Apart from vein disease, what are your other areas of research?
I have been involved in several areas of research in aortic and arterial diseases. In the past few years we have established the Mayo Clinic aortic registry and we have analysed 25 years of experience with open repair and 15 years of experience with endovascular repair of aortic aneurysms. We have also recently published our clinical research with popliteal and iliac aneurysms. Other areas that have been very close to my heart include vascular malformations and Klippel-Trenaunay syndrome as well as management of lymphoedema and chylous disorders.
What are your objectives as president of the SVS?
We established several objectives this year to support our mission and advance excellence and innovation in vascular health. Quality in patient care and education, and excellence and integrity in research have been the cornerstones of our society which will celebrate its 67th anniversary in San Francisco in the Vascular Annual Meeting (30 May–1 June 2013).
Our first objective this year was to continue to strengthen our society so we can speak with a common voice and represent all vascular surgeons. As a result of our efforts in 2012 the Society for Vascular Surgery has reached a milestone. For the first time we now represent more than 4,000 specialty-trained vascular surgeons and other medical professionals dedicated to the prevention and cure of vascular disease. We are proud of the large number of young vascular surgeons and trainees who have joined our ranks. We are also very proud of our increasing international membership: the SVS has 266 international members from 39 countries; there are five international chapters – Brazil, Colombia, Egypt, Hungary and India – with several more in the making.
Our second objective is to increase national and international participation in the SVS Vascular Quality Initiative (VQI). With over 200 participating centres in the United States and Canada and outcome data of more than 65,000 procedures, we have demonstrated our commitment to quality vascular healthcare. VQI offers a comprehensive method for vascular professionals to record treatment and results and to improve the care of vascular patients.
Another objective is the expansion of practice and research of vascular surgeons to venous disease, and a major achievement on this is the new Journal of Vascular Surgery, Venous and Lymphatic Disorders, an official publication of the Society for Vascular Surgery and the American Venous Forum, with the first issue published in January 2013.
In your opinion, how will the healthcare reform affect vascular surgery in the United States?
We are learning about all the changes we are going to have since now we know for sure that they will be implemented. Expanding insurance to the uninsured and covering those with pre-existing conditions will be good to a segment of the population, no question. But decreasing reimbursement will affect vascular surgery to a great extent, since most of our arterial and aortic cases are Medicare patients aged over 65. We have to decrease further our expenses and practise cost effective medicine. I am not only concerned about decreasing quality of care but also concerned that increasing taxes to device manufacturers will adversely affect innovation.
You started your career in Hungary and worked also in France before moving to the USA. How have these different experiences contributed to the way you practise vascular surgery?
As mentioned before, I learned a lot in Europe about venous and lymphatic diseases. That experience helped me to build my practice at Mayo Clinic and make these subspecialties more popular in the United States. Also, I speak Hungarian, English, German and French and have learned a few other languages as well and that has always been helpful to meet with colleagues, and learn about international experiences and new techniques.
Tell us about one of your most memorable clinical cases.
Just as any vascular surgeon of my age, I have had many. At Mayo Clinic, I treated celebrities, government officials and their family members, business leaders, foreign dignitaries and television personalities. Still, one of the most memorable cases I had was the one of a young and courageous but very sick little girl who had superior vena cava syndrome and required several operations and a difficult open surgical reconstruction of the superior vena cava. She recovered completely and became an avid long distance runner. Several years later I received an article describing her disease, recovery and success in life together with a picture which showed her crossing the finish line at the San Francisco marathon. I will never forget her and her famous picture.
Outside of medicine, what other interests do you have?
My hobby is magic. When I was 14 I was a winner of the “Hungarian Idol” (Ki Mit Tud? National TV Star Search). My magic awards include First Prize of the Society of American Magicians, the Grand Prix of the Pacific Coast Association of Magicians Convention and first place at the Grand Prix of World Magic in Tokyo, Japan, in 1978. When you YouTube my name, you will see a brief portion of my show in Paris at the World Championship of Magic in 1973, where I received silver medal. I am a member of the Academy of Magical Arts of the Magic Castle in Hollywood, California.
1989–present Consultant, Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, USA
1994–present Professor of Surgery, College of Medicine, Mayo Clinic
1999–present Teaching/Examining Privileges in Biomedical Engineering, Mayo Graduate School, College of Medicine, Mayo Clinic
1966–1972 MD, Semmelweis Medical University
1970–1972 Internship, Department of Pathology, Semmelweis Medical University
1972–1975 Residency, Surgical Clinic, Semmelweis Medical University
1975–1976 Residency, Cardiac and Vascular Surgery, Hospital St Joseph, Paris
1975–1976 Residency, Cardiovascular Surgery, Hospital St Michel, Paris
1976–1977 Residency, Institute of Vascular Surgery, Semmelweis Medical University
1977 Visitor and Student, Department of Vascular Surgery, Vrije (Free) Universiteit Brussel
1977–1979 Fellowship, Vascular Surgery, Institute of Vascular Surgery, Semmelweis Medical University
1981–1982 Fellowship, Peripheral Vascular Surgery, Division of Vascular Surgery, Department of Surgery, Mayo Graduate School of Medicine
1982 Research Fellowship, Division of Cardiovascular Surgery, Department of Surgery, Mayo Graduate School of Medicine
1983 Fellowship, Vascular Surgery, Division of Vascular Surgery, Department of Surgery, Mayo Graduate School of Medicine
1984–1987 Residency, General Surgery, Mayo Clinic, Rochester
1979–1981 Staff member, Institute of Vascular Surgery, Semmelweis Medical University, Budapest, Hungary
1987–2000 Research director, Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester
1987– 1989 Senior associate consultant, Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester
1987–1991 Assistant professor of Surgery, College of Medicine, Mayo Clinic
1991–1994 Associate professor of Surgery, College of Medicine, Mayo Clinic
1993–1999 Associate Faculty Privileges in Physiology, Mayo Graduate School, College of Medicine, Mayo Clinic
1995–2000 Vice chair, Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic
2000–2010 Chair, Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic
2002–2010 Director, Gonda Vascular Center, Mayo Clinic Rochester Centers