Up Close with Dr. Frank J. Veith

This extensive interview which appears in the Spring/Summer 2020 issue of Vein Magazine appears here in two parts:

Part 1: Veith on VEITHsymposium (see below)

Part 2: Embracing the New in an Imperfect World -- Steve Elias and Frank Veith discuss current themes in their beliefs and explore the topics of education, quality of care, and what's next for the field of vascular surgery.

by Dr. Steve Elias

When you cross over the George Washington Bridge from New Jersey, you either turn south to NYC or north to the Bronx. I turned north. This interview with Dr. Frank Veith took place in early February at his condominium building overlooking the Hudson River, where he has lived for many years. We spoke in the common room of that building, both of us wearing down jackets. It was cold. The interview lasted about 90 minutes.

We have since edited this discussion but kept most of it and all of what we deem essential. The essential facts, but more importantly, the essential feelings.

It was one of the most pleasant and engaging interviews I have done. A pleasure speaking with the man. Most of us know the acronym of his meeting: VEITH, which stands for Vascular and Endovascular Issues Techniques and Horizons. We hope this interview helps you to know the man: (Frank) Veith.

Veith on VEITHsymposium

Steve Elias: The VEITH meeting lasts almost a week, involves hundreds of faculty and industry members, more than 750 talks, and thousands of attendees. What was the origin of the VEITH meeting?

Frank Veith: Henry Haimovici, who was the Chief of Vascular at Montefiore when I went there as a transplant, vascular and general surgeon in 1967, held a meeting in the late 70s at one of the old fleabag hotels in New York City. He attracted about 15 faculty members and less than 100 attendees. The meetings continued for two to three years. He got me involved in it when he had to leave for Mexico. I played a little role in it, but not much. Then when I replaced him as the Chief of Vascular, I took over the meeting.

Over the years, it gradually grew for a couple of reasons. One is it was in New York, which is in many ways the epicenter of the world, relatively easy to get to from all over the world, and attractive. Besides that, we did a couple of things that really made a big difference. I think it was largely good luck. But before anybody else, we embraced industry, which used to be regarded as a poor step-sister, a somewhat corrupt poor-step-sister. We regarded our industry partners as equals in educating all sorts of vascular specialists.

That was a unique thing that attracted their support, which of course is necessary to hold a meeting in New York City. The other thing that was fortunate was we had people who wanted to speak in abundance. I wanted to get them all in and in order to do that, we couldn’t have 10- or 15- minute talks, which were the tradition.

We reduced the time for the talks so that speakers only presented the essence of what was new, exciting, and different about their topic. We ended up with five- and six-minute talks, sometimes even four-and-a-half-minute talks.

I got the idea from watching television where you’d have a Henry Kissinger on a new show. He would talk for maybe two or three minutes. Then they’d say, Well, that’s very interesting, come back. We borrowed that idea in a way so that we could get in a larger faculty and a diversity of views. We didn’t present one biased view from one speaker. We presented his biased view counteracted by a somewhat conflicting view and that made for tension, what I call ‘electricity,’ that attracted interest and a larger audience. We phrased some of these things in the form of a mini-debate, where two or more conflicting views could be expressed about a controversial subject and the audience could then make up their minds.

SE: Was it a steady rise in growth or were there one or two years when you had a tipping point due to an abundance of new technology that pushed you to your next level?

FV: It was a steady growth. We went through all the hotels in New York City to our current hotel, which is the largest, because of how the meeting grew in size and industry support. Clearly the endovascular revolution, which I embraced and promoted very early on because of our work with Parodi and EVAR going back to 1992, was a factor.

Part of this embrace was due to my relationship with Barry Katzen. I had the good fortune when I was young and president of the New York Cardiovascular Society to invite Barry Katzen to speak on thrombolysis when he was just out of a fellowship. He gave a really stimulating talk that helped his career in a way, and we became very good friends. After that, he started inviting me to his ISET meetings in Florida. I saw what interventional radiologists were doing, and very early on, even though I wasn’t doing endovascular procedures, I embraced them with our very sick limb-salvage patients. I recognized that contrary to what other surgeons thought, these endovascular treatments worked.

We also had Dotter to our meeting in New York. He was regarded as Crazy Charlie. But I realized that maybe he had something. I, therefore, sent our radiologist out to spend a week with him and to come back and start doing Dotter dilatation tapered catheter angioplasty—before balloon angioplasty.

Our sick limb-salvage patients were thereby spared big operations—aortobifemoral bypasses. The endovascular procedures worked. They didn’t work perfectly, but they worked. I was always an endo enthusiast. I involved radiologists and cardiologists in our meeting, again, as equals, very early on. They are innovative enough and contributing enough that, aside from the turf issues which all of us have, our meeting’s educational experience was made better by including them.

As I got older, I was more in a leadership role with vascular surgery. Right out of the box, I made that the theme—that if vascular surgeons didn’t embrace endovascular techniques, they were going to become dinosaurs. Our meeting reflected that.

SE: Have you thought about not always having five- or seven- minute talks, but instead, having 15 or 20 minutes dedicated to a huge topic in vascular procedures and disease?

FV: Sure. I have. So many people advise me, make your talks eight minutes. Make your talks 10 minutes. The only talks that I give a lot of time to are the military talks because I believe supporting our military is vital. So, I do give more time to the talks in that session.

The problem is as soon as you increase the time for one or two talks, you cut down on the number of speakers. And there’s tremendous pressure on us both from industry and from the speakers to include everybody and everything. The reality is we only have so much time and so much space. The other thing is everybody wants to talk from 10 o’clock to 12 o’clock on a Tuesday or Wednesday morning. The reality is, we do the best we can.

It’s more important to get it out there and if something may be important like Parodi and his water drinking thing that will cure arteriosclerosis (I think that’s important), I’ll just let him have his five minutes or five-and-a-half minutes to get the message out, and then other vehicles will have to take over and describe all the details.

Every year I say we’re going to have fewer speakers. Why? Because there’s some redundancy. Yet, every year, talks come in at the end and I struggle to find a spot. The making up of the program is clearly a challenge. And I agree with you, a five-minute talk is nothing. And yet, you go back and watch the television anchors; they have some prestigious guy on and he talks for two minutes.

SE: You envision your meeting as a way of letting people see what’s out there. And if they want more information about a particular topic they heard, then they go and get it in some other way.

FV: Pursue it. Talk to the speaker when he or she is there. If it’s an industry-related talk, they can attend a non-CME session if there is one where they give 10-minute talks or panels. The other thing is, our talks are indexed. So, speakers can give literature citations with more information.

SE: Tell me about the name of the meeting. The name must have changed. When Haimovici was running it, he didn't call it the VEITH meeting.

FV: The name has nothing to do with my name. It’s an acronym.

SE: Oh, it had nothing to do with your name? Come on Frank.

FV: It was not my idea. It was one of my associate’s ideas, which I was against because it would elicit hostility and jealousy. I vetoed it, but the reason we did it was to get ownership of the meeting, and that was the reason we changed the name.

SE: You seem to be a relatively humble kind of person in general and I know you don’t want a meeting named after yourself, so to speak. But whether you like it or not it’s associated with you.

FV: Well, it’s not a coincidence but…

SE: If you had to change anything and could magically make things a little different, what would be one or two changes you might make to your meeting?

FV: I’d like to have more interventional cardiologists and more interventional radiologists come to the meeting, as attendees. When TCT [the Transcatheter Cardiovascular Therapeutics conference] solicited our relationship they felt that we did as good a job or even a better job than they were able to do in educating about non-cardiac vascular disease. And so, I would like more cardiologists to come. They view us as a vascular surgery meeting. And we’re really not. If we could get 500 interventional cardiologists then that would be great. It would increase our attendance and make our meeting better. That would be a major change we would like to make work. Otherwise, I think making our meeting a little smaller in terms of talks would be better. The problem is you would have to dissatisfy industry and faculty because they like to come to New York and present what they have that’s new.

The other thing I would like to see happen is for the content of our meeting to be made available at a very nominal price. There are 30,000 vascular specialists in the world and more than half of them don’t come to our meeting. So, we would like the content to be made available more widely. We’ve tried to do that in a number of ways, but so far it hasn’t worked. We are trying some new approaches which we hope will work.

SE: That’s one thing for the future. The other thing for the future is where are you going? You’re not going anywhere but...

FV: It’s a consideration. I’m trying to get one individual, Mark Adelman, who will know the way we make up the program because it’s a complicated intellectual process. We also have other parts to our succession plan with Enrico Ascher and Ken Ouriel. So, if something happens to me, the meeting will go on and thrive.

SE: You need somebody with your vision...

FV: Yes, and with the time to devote to the meeting. It is a full-time job. It’s not an intellectually unique process. It’s a time-requiring process because the topics are out there. I get access to them in one way or another; either I hear them, see them, read them, or somebody sends them to me. And then, they’ve got to be refined, re-refined and ultimately put into session packages that are so attractive to audiences that they want to come to the meeting. So, that process, which I’m currently involved in, is very labor-intensive. Unpleasant in some ways because it means sitting down and doing it. But gratifying in other ways.

Right now, Enrico Ascher is the next chairman of the meeting. That’s been out there for a long time. Ken Ouriel is the one after that. The making up of our meeting, which I used to do in a couple of weekends back in the eighties, is now a full-time job. It’s not magic. It’s just a labor-intensive process.

SE: I, myself, am a vascular surgeon, I haven’t done an arterial case in 20 years. Clearly, there’s the vein side of the vascular world. Twenty years ago, 25 years ago, you weren’t talking much about veins at the meeting. Now you have a couple of days regarding venous disease. What made you decide to cover more about veins?

FV: When I went to NYU after leaving Montefiore, I got to know Lowell Kabnick pretty well. I also got to know Jose Almeida well in 2001 when we were both stranded in Cancun, Mexico during 9/11. I realized that the treatment of venous disease was becoming a more important part of vascular surgery even though I was only peripherally engaged in it. New techniques were emerging such as radiofrequency and laser for varicose veins and the idea of treating venous occlusive disease with stents. I thought if our meeting was going to expand and appeal to more vascular surgeons and other vascular specialists that we should make venous disease more prominent because it’s everywhere.

Bo Eklof was another great person who was a friend. He also influenced me to stress the importance of venous disease. In many ways, it’s quite different from arterial disease.

SE: It’s not life or death. No. But that’s not a bad thing.

FV: It’s less life or death, but it’s important to the wellbeing of patients. In my practice, I treated venous disease equally with arterial disease. I guess I was a little more conservative because it wasn’t life or limb-threatening. I did some venous surgery, but minimally. Yet I felt that was going to be an emerging area and particularly I was influenced by Seshadri Raju. His work really made a difference and that also got me interested in adding more venous disease to our meeting.

SE: At the end of a VEITH meeting do you step back and say to yourself, Hey, this was a good one. This wasn’t a good one. Or are you just thinking about the next year?

FV: We definitely evaluate whether the meeting was good in terms of succeeding, and we do it as a group.

SE: I understand, but at some point, you’re sitting by yourself. Do you ever say to yourself, Hey, that was a really good one this year?

FV: No. What I start saying as the meeting is ending, I say, God, this was pretty good. I’m so very worried about next year. And I might go home because we get very little sleep during the meeting. I start worrying about the next year and my mantra is that you win the Super Bowl one year; you have got to win it again the next year. Every year is a new venture. And there’s no guarantee that just because it was pretty good in one year that it will be good the next year. I get one good night’s sleep and then I start thinking about the following year. And so, really there’s no great satisfaction from one good year. If we can make a little money and can reward the people that are working with us, that’s a good thing, but we don’t know about the financial aspect of it until it’s over.

SE: You’re not making an enormous amount of money. You’re looking to break even, help the people?

FV: I’m looking to do more than break even because if we don’t, if we lose money, we’re done. And we have some changes that are coming up in a couple of years where we’ve got to take more risks, and so it’s a concern. It’s like any small business; you don’t know if it’s going to be successful until the end of the year.

And we could have catastrophes. One year we had an American Airlines plane crash in New York City. Everyone thought it was a terrorist act and few Europeans came to our meeting. We still did manage to do OK, but it was a big worry. And now there is the Coronavirus pandemic. Hopefully, we will be OK.

See part two of this interview: Embracing the New in an Imperfect World -- Steve Elias and Frank Veith discuss current themes in their beliefs and explore the topics of education, quality of care, and what's next for the field of vascular surgery.