Dr. Thomas Wakefield has been committed to the treatment of venous disease since completing his fellowship at the University of Michigan in 1986. He has always incorporated phlebology into his practice, and since 2004 he has devoted his practice entirely to the treatment of venous disease. Board-certified in vascular surgery and general surgery, Dr. Wakefield has been the head of the vascular surgery service at the University of Michigan since 2004, and is the former president of the American Venous Forum, Michigan Vascular Society and the Frederick A. Coller Surgical Society.
Treating veins has been a passion of Dr. Wakefield’s since he started out as a physician, and his research has always dovetailed into venous and coagulation issues, both of which blend his passion in care with his research. As he aptly states, “I’ve seen over the years most faculty be successful when what they are passionate about in taking care of patients is also their passion in research, because you can better see what needs to be done and what questions need to be answered, and apply the knowledge to your patients.”
Dr. Wakefield, please tell us about why you chose to practice medicine and how you came to choose vascular surgery as your specialty.
I chose to practice medicine due to my desire to do something that would be of help to others. I had a Jesuit education and the motto of the all-male Jesuit school I attended in Toledo, Ohio, was “men for others.” I believe that this motto stuck with me, and I still try to live my life that way. In high school and in college at the University of Toledo, I was fortunate to be able to work at the Medical College of Ohio under the chair of anatomy (Dr. Liberato Didio) in a project involving the atrial arteries of human hearts. Because of this experience, I thought I wanted to be a heart surgeon. However, in medical school, I had a mentor who was a wonderful vascular surgeon (Dr. Robert Navarre). Initially, I wanted to be like him and, eventually, I wanted to do what he did. This is how I came to choose vascular surgery as my specialty. I see this very frequently, that someone ends up in a particular specialty due to the importance of a mentor. This highlights the importance of being a good mentor to our young trainees.
Please tell us about your practice.
I have a very significant practice involving both superficial and deep venous disease. A good part of our practice is involved in the clinic, and I interact with an interventional radiologist and cardiovascular medicine specialist. We often see patients together because, basically, two heads are better than one. Also, patients can see two providers with one appointment, which is in the model of keeping the patient at the focal point of care. We all have the same goal in mind: outstanding patient care and service excellence. We all bring unique aspects to the table, and we can all add value to the ideal patient care experience.
I have been working with TRIVEX™ transilluminated powered phlebectomy. I am one of the few people in the country currently working with powered phlebectomy, and we presented some data at the AVF this year with the largest sample of TRIVEX™ patients in the world. Clinically, my areas of research focus include DVT and problems related to that syndrome.
As a past president of the AVF, Michigan Vascular Society and Frederick A. Collier Surgical Society, what are some of the lessons you have learned serving in this capacity with respect to creating collaboration and working toward consensus on issues within the specialty?
Any leader needs to realize that he is only as effective as those around him or her. I have learned that the best way to get things done is to give the overall direction of where you believe the organization should go, and then empower those individuals doing the work to really have the freedom and support to get the work done and move the organization forward. In every presidential role (including my current role as president of the University of Toledo Alumni Association), I have been incredibly fortunate to have outstanding people in the organization who have gotten things done and helped to move the organization forward. A leader should never micromanage, but should empower those around him or her to make contributions and achieve high goals. A good leader sets the tone, and then gets out of the way of those who are carrying out the mission.
Another very important role for a leader is to listen to his or her constituents, and then act when appropriate and give credit where credit is due – make sure those around you feel valued and receive the recognition for their accomplishments.
You have been at the University of Michigan for some time now. What led you to the university and what has kept you there?
I came to Michigan in 1977 as a visiting medical student and then, in 1978, as a general surgery trainee. It had the reputation of being a high-powered program, but with a good atmosphere and with excellent people—and that remains true today. I have never left. I have stayed at Michigan for all of these years because of two things: it remains a top program and there is a great deal of respect and camaraderie among the trainees and the attending faculty, as well as between the faculties themselves. Michigan is a unique place, and the Frankel Cardiovascular
Center at the University of Michigan Medical Center leads the way with our values of:
- Respect and compassion - We honor and care for one another as individuals
- Collaboration - We honor the synergy of team, built on trust
- Innovation - We honor individual and collective creativity
- Commitment to excellence - We honor the intrinsic desire to be “leaders and best"
I have some of the best partners in vascular surgery in the country, and we have a wonderful group and a great staff. We also have great support from the Department of Surgery at Michigan.
Congratulations on your appointment as the head of vascular surgery and as one of the directors at the Frankel Cardiovascular Center last July. An article that we found on your predecessor Dr. Stanley cites how he initiated a collaborative and integrated care model, and you are quoted citing the Frankel Center’s culture of collaboration and respect. Has Dr. Stanley served as a mentor in this regard?
Yes, I would credit Dr. Stanley with leading the way with our culture of collaboration and the integrated care model, and he has been a mentor to me and others in this regard. The Frankel Cardiovascular Center is a very different sort of place. We as vascular surgeons interact with interventional radiology, cardiac surgery, cardiology, cardiovascular medicine and have multi-disciplinary clinics. We all get along very well. One of the best ways to help build collaboration among faculty is to share in training experiences—this is good for the faculty involved and good for trainees. The basic tenant of treating your colleagues as you would want to be treated yourself is a good rule to live by and conduct yourself daily.
You have a long history with the AVF. Can you expand on this for our readers?
I had the great fortune to get involved in the AVF from its inception, and have been part of the AVF for nearly 25 years. I’ve been fortunate to serve on the council, as secretary and as president, and on the foundation. It has been a really important organization in my life, and I have made a great number of friends through the AVF. My home and heart has been with AVF, and it’s been great to see it evolve as an organization that has gone from having good meetings to a “doing” organization that now has education programs, a registry and facilitates the generation of practice guidelines. I had the great opportunity to help craft the new varicose vein registry as part of a committee of AVF and SVS members. This is a tool that will be very helpful for documenting results, meeting vein center accreditation metrics and elevating venous practices across the country.
The research that you are conducting at the Conrad Jobst Vascular Research Lab looks very promising. Studying the role of inflammation in thrombogenesis and of microparticles in thrombosis, and the development of oral compounds for use in place of anticoagulants for venous thrombosis prophylaxis/treatment seems groundbreaking. What can you share with us about this research?
For over 20 years now, the Jobst Vascular Research Laboratories at the University of Michigan has been working to define the role of inflammation in venous thrombogenesis and thrombus resolution. I am very pleased to say that through the efforts of dozens of people over the years, we are now, for the first time, conducting a study of a specific inhibitor to E-selectin in normal volunteers and patients with calf vein DVT. It is supported by NIH in a program called VITA.
Can you tell us more about the research being done with GMI-1271 biomarkers for the diagnosis of clinical DVT?
It’s not every day that you can take basic science discoveries and eventually apply them at the bedside, so I am very excited about this. GMI-1271 is an inhibitor to E-selectin from a company called Glycomimetics. In studies involving rodents, we have found that this compound significantly limits thrombosis and protects the vein from damaging effects of any thrombus that does form. This method is based on the knowledge that inflammation is a significant stimulus for thrombus to form and amplify. So, if you can limit the inflammatory response, you can stop the clot amplification from occurring. You might even stop the clot from forming at all and let the body dissolve the clot more readily on its own. It’s a way to have the anti-thrombotic effect without bleeding potential. When you inhibit inflammation, you inhibit the adverse effect on the vein wall that the clot engenders. Using an E-selector inhibitor can inhibit thrombosis without bleeding, but it also has the potential to limit any damage a clot that does form may have on the vein wall. As mentioned above, we are now working on a protocol to test this agent in calf vein DVT, and we have a pending NIH submission looking at this compound in more proximal significant DVT in a large animal model.
Every type of blood thinning medicine that is currently available involves inhibiting the coagulation system in one way or another. When you do that there is always a potential for bleeding. This is an unusual and unique approach that I think has great potential. We are about a year away from being able to use it in patients with DVT, and hope that at the end of the three-year study we can try to get a multi-center trial either as a standalone agent or as an adjunct to other therapies.
Please tell us about PAI-1 and its role in venous thrombosis.
We have found that PAI-1 is important in vein wall fibrosis after DVT. High levels of PAI-1 modulate vein wall fibrosis in a dose-dependent manner. Translationally, PAI-1 elevation may decrease vein wall damage after deep vein thrombosis, perhaps by decreasing macrophage mediated activities.
Can you please tell us how E-selectin therapy may play a role not only in the treatment of DVT, but also in battling cancer?
I believe that anti-selectin therapy has the real possibility of being a great agent for treatment or prophylaxis of DVT, and even PE, as it has the ability to inhibit thrombus amplification, thus allowing for more rapid natural thrombolysis and the prevention of vein wall fibrosis—all without bleeding potential. As you also mentioned, inhibiting selectins tend to restrain metastasis from cancers. In fact, the agent GMI-1271 that we are studying for DVT is being studied as a therapy in certain cancers at the same time.
I understand that the Jobst Vascular Research Lab collaborates with multiple labs in and out of surgery. How has this collaboration led to improvements in research?
We have significant collaborations inside and outside of surgery. These have included collaborations with hematologists, vascular medicine physicians, radiologists, cardiologists, veterinarians, etc. By collaborating with those inside and outside your field, one learns about new techniques, new ways of looking at data and the world, and one joins a much larger discussion of their work. I recommend this type of cross-fertilization; it makes one’s work more exciting and rewarding. In fact, the co-PI of the clinical project regarding GMI-1271, is from our Division of Hematology-Oncology.
What indicators do you see most represent the growth of the specialty?
The importance of venous awareness is shown by the growth in size and importance of the American Venous Forum over the years, and the emphasis on venous topics at the yearly VEITH meeting. In my opinion, VEITH is one of the premier vascular meetings in the country. Just a few years ago, there might be one, 2-3 hour session about veins for the entire VEITH meeting. Last year, we had three entire days of the five-day meeting devoted to venous topics, and we expect a similar emphasis this year. I am fortunate to share the duties of the VEITH program with Lowell Kabnick and Jose Almeida. As we move forward with the VEITH meeting year in and year out, venous topics will continue to make a big impact on this meeting.
What are your feelings about the growth of venous disease as a specialty?
It is a very exciting time for those who are focused on treating patients with venous disorders, and it is incredibly gratifying to be a part of the specialty. Today, there are many basic discoveries still to be made—technologies are rapidly expanding and improving, we have many more options today for diagnosis and treatment, and today therapies are based on physiological and functional data. The field of venous disease is rapidly becoming the next frontier in medicine. The fact that we have our own journal, the Venous and Lymphatic Journal, which is part of the Journal of Vascular Surgery, is a great advance. The journal is really coming into its own.
I like the fact that there is a lot of interaction now between different specialties and different practitioners. There is an effort being put forward now to have a common venous curriculum that would be part of venous fellowships going forward that involves a multidisciplinary approach, and I hope the University of Michigan will be a part of that. I think that will improve venous care in the country and provide extra training for people who want to treat venous disease. I invite all interested to immerse themselves in this wonderful field.
Is there anyone else you would like to acknowledge?
I want to acknowledge my wife Mary, who is an accomplished physical therapist, fantastic woman and someone who has made it possible for me to be successful. I also have two wonderful sons who I am very proud of—my eldest son Andrew is a seminarian in the Washington, D.C. Catholic diocese, and my younger son Victor is the head of the Nevada region for Teach for America.