Aneurysms don't have borders - Journal of Vascular Surgery

My first real conversation with Roy Greenberg was a telephone interview for the Aortic Fellowship at the Cleveland Clinic. That cold day in January is etched indelibly in my personal history, and as I sat at my desk looking out over a snowy field in Hamilton, Ontario, Canada, we discussed what seemed like the most important things in the world at the time: surgery for thoracoabdominal disease, the design of fenestrated devices, and the goals I had for the fellowship. I loved working in Canada, so when the opportunity to move to Cleveland for training presented itself, I was eager to ensure it was as short and efficient as possible—I couldn't bear the thought of leaving my beautiful country and the patients I felt responsible to treat. When I made this request, Dr Greenberg laughed out loud and immediately exclaimed “aneurysms don't have borders”—promising that, if I invested the time, he would teach me methods of investigation and treatment that would help change my outlook on aneurysm disease and share the enthusiasm he had, not just to treat patients but to address the global burden of disease. It is in the spirit of that first revelation, and my subsequent understanding of Roy's great dedication to changing the global course of aneurysm disease, that I dedicated this lecture. The world's population is simultaneously aging and becoming more democratized; the result of these concurrent phenomena is that a blanket of cardiovascular disease is being woven across epidemiologic maps at unprecedented speed.1x1GBD 2016 Mortality Collaborators. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390: 1084–1150 Abstract | Full Text | Full Text PDF | PubMed | Scopus (122) | Google ScholarSee all References As vascular surgeons—the corporal manifestation of cardiovascular specialists—it follows that our duty to consider strategies to address this has never been more urgent. Although in its most basic form, vascular surgery is an intimate and local transaction between a surgeon and her patient, as medical and community leaders, I believe we also have the duty to look beyond each individual therapeutic relationship to the impact that the aggregate of our clinical decision-making has on our community and the world. The goal of this lecture will be to provide a bookmark in time reviewing the current state of aortic surgery around the world, to outline some of the more likely challenges we face in pursuit of equal