By Steve Lewis
HOUSTON – Carlos Bechara, MD, a staff vascular surgeon at the Michael E. DeBakey VA Medical Center (MEDVAMC) says his recent development of a new endovascular technique that offers an attractive alternative to the more traditional approach with minimal complications was something he felt he “owed” to his patients.
“These patients are so challenging and so sick with advanced vascular disease that they make you try to think of all the alternatives; they make me think outside the box,” he explains. His technique addresses flush iliac artery occlusion, which is most often treated with open bypass surgery.
Flush iliac artery occlusion often is difficult to treat with minimally invasive surgery because there is no room for a wire and catheter to go through the blockage in order to place the stent.
Bechara overcame the obstacle by placing a balloon at the fork of the artery to allow passage of the wire through the blockage, avoiding open surgery and related morbidities.
“This blockage is very challenging,” Bechara acknowledges. “But I thought this approach could help. We started with one patient and it worked. We avoided a big operation and sometimes you can do it on a local, so you avoid the potential danger of general anesthetic as well.”
His technique will be featured during the VIETH 39th Annual Symposium on Vascular and Endovascular Issues in New York later this year. The VEITH Symposium is one of the world’s-largest gatherings of vascular surgeons and vascular specialists to discuss groundbreaking research, updates on clinical trials, and advances to treat vascular disease.
Bechara trained and did his fellowship at MEDVAMC.
“I realized several things,” he says, explaining his decision to remain with VA. “I realized how complex the procedures we do are, because the patients all have advanced vascular disease, which is a challenge. On the other hand, they need good people to help them through these complex procedures, and I have had great training and can offer good surgeries – providing a valuable service to the veterans.”
In addition, according to Bechara, who also has experience treating patients in a civilian facility, “Veterans, compared with other patients I encountered as a resident, are very appreciative of what we do.”
He said he has received a number of emails and letters from patients and their families.
“Maybe they’re not used to getting stuff for free,” he suggests. “Being in the military, they always are expected to give unconditionally. But now they’re getting something back in return. They paid their dues, and now they receive top-notch surgery – especially at this VA.”
The VA work environment is another plus, he adds.
“Here, you do not have to fight over patients where [specialty] services overlap. We are salary-based, so we do what’s best for the patients.”
A number of leading institutions like the Cleveland Clinic use the same model, he notes.
“They move away from having reimbursement as the incentive,” he continues. “When there is an overlap, specialists do not have to fight, and, in fact, we sometimes even do the case together.”
Giving and Receiving
Bechara is serving the patients not only as a surgeon but also as program director of Vascular Surgery Fellowship at Baylor College of Medicine (BCM) and working with surgeons-in-training at the VA.
“I have this great position where trainees are exposed to something I cherish, and I want to make sure we train people who will be leaders and be the best in vascular surgery — and this is the best place for them to get exposed to these challenges,” he notes.
But Bechara is first to admit: He gets back as much as he gives.
“This is very rewarding; we are here to help people who paid their dues,” he says. “These guys risked their lives, so it’s time to give back and give them the best care we can.”
Bechara says he is often asked by friends why he works at VA.
“People think VA is not a great place to work, but I disagree. It is,” he asserts. “If money is what you’re looking for, you can go somewhere else. But this is a package — if you look at a job you have to look at the package. I have friends who used to be patients. We exchange Christmas cards. That is very rewarding.”
Bechara also says the research environment at VA is rewarding.
“I did not really need approval [to do the research], because we were not really deviating from the standard of care,” he says, referring to his new technique, “But VA does encourage us to do research like this. At the end of the day, they want to benefit more veterans.”
In the future, he says, he’d like to move forward with his research and clinical work, as well as training future surgeons.
“I’m very interested in outcomes research – identifying best practices,” he says.
He’s well on the way with development of the new surgery technique for flush iliac artery occlusion.
“I am proud the technique that I developed will be featured at one of the most prominent vascular meetings in the world. Something like this is a dream come true for a young surgeon like myself,” Bechara says.
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