Longer life span means more room for both vascular diseases and the development of vasular surgery. Even though procedures today are mostly non-invasive and even though their benefit outweighs the risks, there are things we can do to reduce their frequency. For starters – to try to relax and enjoy ourselves
MD Đorđe Radak has had a fruitful life before becoming chief of surgery in Euromedik hospital based in New Belgrade in July this year. Not only was he chosen as a member of Academy of the Medical Sciences (AMS), part of Serbian Academy of Sciences and Arts (SANU), not only was he a university professor and an esteemed vascular surgeon, not only was he the head of Vascular Surgery Clinic in Cardiovascular Institue ”Dedinje“, not only did he also occasionally work in Switzerland and Germany – he also has a knack for painting! Patient and well-spoken, he proves to be an interesting interlocutor on many subjects. For obvious reasons, he talks about vascular surgery with a noticable passion.
As a young doctor, how did you decide to specialize in vascular surgery?
When we do the comparison of risks, misfortunes and problems that operations entail and when we comprehend possible benefits of therapy, this field of medicine has the most to offer and that’s what was appealing to me.
Vascular surgery has unfathomably big room for future progress. Developments in general medicine, diagnostics and prevention led to a situation in which people live between 70 and 80 years on average, significantly longer than even some thirty years ago. For example, life expectancy in the Ancient times was between 30 and 40 years. Jesus was crucified when he was 33 and at that time it was understood that the death would be approaching in the fourth decade of life. The development of civilization and medicine made life span longer for 30 to 50 years.
The fact that life expectancy today is longer than ever means that there is more time for vascular diseases to develop, since they are mainly degenerative and progressive in nature. Treatment of those diseases had at least three revolutions (by that, I don’t mean like the ones in the films about Partisans), paradigm shifts. The first one came with the introduction of non-invasive diagnostics like magnetic resonance, ultrasound and scanner. Artery punctions, angiographies and complications are no more. The second one came with the standardization of the procedures which previously carried a certain ammount of risk. Vascular surgeons come into play when the general surgeons get scared of coming into contact with a blood vessel. You see, general surgery has been performed for centuries, while vascular surgery came to be in the middle of the last century. The third revolution came some twenty years ago, along with minimally invasive therapy solutions (stents, stent grafts, etc.). Today, we can usually avoid the traditional notion of surgery and perform an endovascular procedure – we enter an artery, make a dilatation and place a stent in a blood vessel that is clotted or strictured. Or, in a case of aneurysm, we coat it with a stent graft. The first time that procedure was performed was in 2004, so the clinical practice is pretty vast. I’m very happy that Euromedik has provided us with the conditions to reap the benefits of all of the three revolutions I mentioned.
What sort of professional challenge did you find in becoming the chief of surgery in Euromedik?
Our idea was to give our patients everything they need in one place – from diagnostics to surgery and then to final treatment and post-operative care. Furthermore, we wanted to assemble a team of scientifically and professionally individuals who would also have the necessary conditions to show and implement their qulities in one place. The purpose is twofold – patients get planned security, surgeons get ideal work conditions. It’s a concept that’s been alive for a long time in wealthier Western countries.
What makes a good surgeon in your opinion, given your vast experience?
People imagine that surgeons are supposed to have strong backs so that they can stand for long periods of time and that they can be persistent and perhaps a bit rough. But that’s an image from the last century and even then it wasn’t accurate. A surgen needs to understand the disease, the patient, what he or she can provide and what shouldn’t even be on the table. Surgery goals were never big and beautiful procedures, but the procedures that can bring the most benefit to the patient. When those three visions collide, you have a good starting point to have a good surgeon.
Serbia nurtures a good school of vascular surgery, but we keep finishing high on lists of disease-and death frequency. How do you explain this discrepancy and the most common delusions about vascular diseases?
We create good, talented, educated surgeons that are sought after in Europe and the rest of the world. However, that’s not enough to brigde the systemic and structural flaws of our public health care. From diagnostic unavailability to waiting lists and uncomfortable conditions in some institutions to methodic inaccessibility and work overload. The scope of associated problems is very wide. That’s where centres like Euromedik step in. Thirdly, high mortality rate of vascular diseases is caused by everyday problems and epidemiologic causes of the diseases. Our country has survived several armed conflicts and collective traumas in these turbulent times. Richer and more organized countries wouldn’t be able to process and deal with them in thirty years. All of that reflects on the quality of life.
The list of potential silent killers is getting longer every day – some say it’s the stress, some say it’s cholesterol, some say it’s nicotine and alcohol… what should we be wary of?
Answers to these questions often come down to boring morals. I don’t want to be the man in white who goes around and hands out warnings. But I do think that it’s very important to change the approach to important questions in life like family, career and friendship. Less dwelling on the past, more hope and looking to the future. Dwelling on the past can only multiply negative things. People should engage in appealing, attractive things and they should try not to burden young people with uniformed demands. We should all bow down in front of youth and talent, and then the creativity that’s in our blood will show itself. I also think that there’s not enough awareness about what vascular surgery can provide, because it’s not publicly debated. One small intervention on a carotid artery that entails no more than three days of hospital treatment prevents brain stroke, vascular dementia and it rejuvenates the brain for 10 to 20 years. One operation and consequent seven-day hospital stay prevents aneurysm burst, while renal artery stenosis which leads to kidney failure can now be prevented by non-invasive endovascular dilatation. Patients go home the next day. All of these procedures carry minimal risk, but they do carry big direct and even bigger distant benefit. Isn’t this an anti-ageing concept in its most productive sense? Organ function rejuvenation, and that means rejuvenation of both the body and the soul.
Let’s not get preachy, then – how do you relax?
I loved making aquarelle paintings. I like to read. I had two exhibitions of aquarelle paintings, but now I don’t really have time for that. I’m actually living like a convict, almost literally – I spend my life in a green suit, in an operating theater, so I get weirded out when I see that someone is wearing colorful clothes in the streets. The more enclosed a man gets, the less he needs to feel pleasure.
By: Slavko Stefanović