I spent a lot of my time on the university faculty in trouble for something. In the early 1990s I started worrying about the morbidity and mortality rates of my patients who were going for peripheral bypass surgery. We used to say, “Fem-pop, chop-chop, hop-hop.” The vascular surgeons weren’t doing endovascular work at my institution but the cardiologists were. So I started sending all my elderly patients to the invasive cardiologists. In fact in 1993 we showed that after endovascular revascularization, if their TCOMs went up 30 mmHg, they healed their wounds so we could use TCOM as a predictor of success.
I stopped sending any patients to the surgeons unless cardiology told me they couldn’t help them. The surgeons told me that I wasn’t doing the right thing because those stents would only stay open 3 to 5 years. But that’s about how long those patients expected to live. And now endovascular revascularization is considered the standard of care. And nowadays, all the vascular surgeons are trained in endovascular work.