Welcome to Vascular Disease Management

It is with a sense of pride and excitement that I set out to write the first Editor’s Letter for the inaugural issue of Vascular Disease Management (VDM). This is a truly unique publication that was designed with the multi-disciplinary nature of today’s vascular team in mind. It intends to become a readily available source of practically important information and a forum for the dissemination of current opinions and changing standards in this rapidly evolving field. Unlike many of the established peer-review journals, VDM incorporates a unique format which places great emphasis on readability and practical relevance. The articles, discussions, and other features will focus largely on issues surrounding clinical decision-making, new technologies, and current trends in the treatment of blood vessel disorders. The composition of the editorial board is an accurate reflection of VDM’s intent and spirit, with distinguished representation of the four major specialties involved in vascular care today (cardiology, radiology, vascular medicine, and vascular surgery) by renowned leaders in their field. They will undoubtedly provide more than the necessary ingredients to create a fully flavored scientific magazine that can be embraced with interest by all. The discussion on management of femoro-popliteal arterial disease is a good case in point. The reader will find that indeed most experts agree with the premise that percutaneous intervention is the “up-and-coming” wave of the future, at the expense of a gradually diminishing role for surgical bypass. At the same time, this is a territory where endoluminal technologies face some of the most formidable challenges when durable success is used as the defining yardstick. Many areas remain unclear or unknown, but much has been achieved in the recent past, including both the promise of better results with catheter-based therapy and the undeniable fact that surgical treatment continues to serve many patients well — especially those with extensive disease causing limb-threatening ischemia. And the often-forgotten growing role of medical and pharmacologic management is appropriately emphasized. The discussors — all on VDM’s editorial board — provided a fascinating and instructive update on the various complex issues related to femoro-popliteal revascularization. We would likely be — and rightly so — subject to criticism if we failed to mention in this letter that the FDA approved carotid stenting (for a high risk indication) on August 31, 2004. This was a seminal event whose significance cannot be over-emphasized. Carotid artery intervention for stroke prevention ranks amongst the most significant patient-benefit activities for vascular surgeons and all other vascular specialists. But I suspect the transition from the established standard of care (carotid endarterectomy, CEA) to carotid stenting (CAS) will not be easy or quick, as enormous challenges loom on the horizon. In the end, minimally-invasive therapies will ‘inevitably’ triumph, in this and all other vascular beds. Having accepted that, it is also important to establish that no single procedure or technology will ever be good enough to address adequately all patients, and there is and will continue to be enough room for various approaches for many years to come. CEA is not going away (in my opinion), but its role will surely be re-defined and likely diminished as we march forward in the very important field of carotid revascularization over the next 3–5 years. In addition to the clinical and scientific contributions, each issue of VDM will contain relevant information on new devices and technologies coming from the industrial side — vascular and endovascular. The “tool makers” are indeed our partners, as we all orbit in the same vascular universe where patient care and better treatments occupy (as they should) the undisputed center. They will receive the attention they deserve. Finally, none of this will do any good if VDM fails to attract significant interest and readership. I'm sure I speak for the whole editorial board and the publishers in making a plea for feedback — both positive and negative — so we can continually improve the product in content and format. Please keep in touch and, principally, let us know where we fail. It will be greatly appreciated!

Frank J. Criado, Editor-in-Chief

Director, Center for Vascular Intervention Chief, Division of Vascular Surgery Union Memorial Hospital/MedStar Health Baltimore, Maryland

frank.criado@medstar.net