Vascular surgery in Turkey

This year the ESVS was held in Istanbul, Turkey. “This was a great opportunity for Turkish surgeons interested in vascular surgery,” commented Dr Cuneyt Koksoy, the General Secretary of the Turkish Society for Vascular Surgery. He went on to describe the current situation for vascular surgery in Turkey for this 16th edition of Vascular News.

The population of Turkey is around 67 million, with the number of people who are older than 60 only totaling about 5 million. Turkey’s population is therefore relatively young compared to the rest of Europe. Approximately 10,000 vascular procedures are performed per year in 25 centres across Turkey. However, the majority of all vascular and endovascular procedures are performed in Turkey’s five major vascular centres. There are two in Ankara; the Yuksek Ihtisas Hospital of Turkey and the Ankara University Ibn-I Sina Hospital and a further three in Istanbul; Dr Siyami Ersek Cardiovascular Centre, the Kosuyolu Cardiovascular Centre and the Istanbul University Medical School Hospital.

The founders of modern vascular surgery in Turkey are considered to be Dr Ahmet Yaycioglu, Dr Osman Akata, Dr Alaattin Vardar, Dr Metin Ozgur and Dr Ibrahim Ceylan. There are two Turkish pioneers in the field of vascular diseases who particularly stand out; Dr Hulusi Behcet who described Behcet’s disease, and Dr Cemil Topuzlu Pacha, who was the first surgeon to perform vascular anastomosis. Cemil Topuzlu Pacha presented his vascular suture techniques over a century ago at the International Medical Congress in Moscow in 1897 and at the annual Congress of the Société de Chirurgie de Paris in July 1904. He reported two cases of arterial tear during breast carcinoma resection and repair within the same session.

The major clinical research areas into vascular disease in Turkey are vascular complications of Behcet’s disease and trials on the management of deep vein thrombosis and aortic surgery. Basic scientific research is focused on vascular biology, vascular complications of diabetes and reperfusion injury. Endovascular procedures are performed in close collaboration with interventional radiologists and every year approximately 1,000 to 1,500 of these procedures are accomplished. These include endovascular aortic aneurysm repair, balloon angioplasty and stenting, caval filter placement for venous thrombosis and embolization.

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National Society
The Turkish Society for Vascular Surgery (TSVS) is the only organisation that represents the entire vascular surgery community in Turkey. The society was founded in 1978 and currently has 258 members, including vascular surgeons, general surgeons, cardiovascular surgeons, interventional radiologists and vascular scientists. The primary concern of the society is to establish vascular surgery as an independent subspecialty in the near future. The society also develops educational and training programmes for vascular surgery trainees, medical students and other public health professionals. Several screening programmes for major vascular diseases are being carried under the sponsorship of the society and the TSVS is also the major sponsor of research into vascular disease. The society holds twice yearly vascular surgery meetings with international collaborators, with the current president of the society being Dr Murat Beyazit. The Turkish Journal of Vascular Surgery is the official journal of the TSVS.

Training
Vascular surgery is not an independent speciality in Turkey and there is no accredited training programme. However, both cardiovascular and general surgery residency programmes have vascular surgery rotations. Vascular surgery is performed mostly by cardiovascular and general surgeons who are dedicated to vascular surgery, with the majority of vascular surgeons being trained abroad. Recently guidelines for a vascular surgery training programme were developed by the TSVS. With the aid of this, as well as the recognition of vascular surgery as an independent specialty by the Turkish Ministry of Health in the near future, training for vascular surgery will soon be established in Turkish surgical clinics. A national vascular registry will be established by the TSVS in January 2003.