Giancarlo Biamino

When did you decide you wanted a career in medicine? Why cardiology and angiology?

If I remember correctly, I was 16 or 17 years old when I read a book about an English doctor working in London. I was so attracted by all the professional and ethical problems of his activity, that I was already making the decision to follow this career. For me, it was a complex and long way, starting in a small city like Bolzano.

Why cardiology? It was the fascination with this complex system – described by H Harvey only 100 years after the discovery of America – that stimulated my imagination and interest. My interest in angiology came a bit later. After many years of work in the cardiology field and searching for new ways in the interventional world, I realised around 1985–1986 that the possibilities offered by endovascular treatment of peripheral obstructive arterial disease were underestimated and not very well valued.

Who has inspired you in your career and what advice of theirs do you remember today?

To answer this question I would have to mention a long list of teachers. I will limit my list to two people. OH Gauer, my professor and mentor in physiology, motivated me to understand the pathophysiology of the blood circulation in detail. He insisted on intensive research work and admonished me continuously: “Remember that unpublished data are data that do not exist.”

The second inspiration was G Hartzler with B Rutherford in Kansas City who taught me in 1983 the really (at the time) rudimentary percutaneous coronary intervention and he showed me that the only way to improve is to work “harder, longer, better”. This is the definitive motto of my career.

What have your proudest moments been?

It is difficult to answer this question without giving the impression of being a poser or a big mouth. Probably the proudest moments are connected to the global development of LINC (Leipzig Interventional Course). In fact, the success of this event is the result of a fruitful interaction of work with all my friends in Leipzig, and in particular, with Dierk Scheinert, who had the energy and support to transform our ideas into reality, maintaining a very high scientific and ethical level.

How has angiology evolved since you began your career?

Personally I can make only some remarks in relation to interventional angiology. The evolution in this field, particularly in the last 10 years, has been simply dramatic. If you just compare the TASC recommendations of 2000 with those of 2007 you can immediately recognise what has happened.

I suppose that we had never observed such impressive technological changes as happened in the last two decades. However, we have to remain critical. We must demonstrate the real validity of all the new technologies on the basis of scientific data. Enthusiasm is as essential as scepticism.

What have your most memorable clinical cases been?

I would like to mention two cases. One is my first recanalisation of an occluded popliteal artery (6cm long) with a multifibre Excimer Laser catheter in January 1989 (Ted Diethrich was present in the cath lab). The second case was a successfully treated external iliac perforation after stent implantation in a non-operable patient because of an antecedent replacement of the bladder; a horror trip of 20 minutes. It was my first implantation of a covered stent!

How do you see the endovascular field developing in the future?

This is one of the most interesting and delicate questions today. My answer is relatively simple: the field of endovascular therapy is more than huge with a perspective of growth in the number of patients for decades to come. The need for endovascular specialists should be clear for everybody. Therefore it is mandatory to train young people, overcoming all the obstacles of the past between the different disciplines. In my opinion the CX Symposium and LINC are excellent examples applying the motto “education, education, education”.

You developed your career in Germany and Italy. Do you see differences in terms of approach in these two countries?

The two countries are of course not equal. However, the enthusiasm of young people is present in both systems. Personally I have to stress that it was a great change at the end of my career to have the opportunity to move to Italy and contribute successfully to build peripheral programmes in different centres from Turin to Palermo, having a limited experience.

It was also great to have the opportunity to work with and to motivate such a large number of young colleagues to start the peripheral journey. I am now proud to observe that they were able reach an international level of quality with a good scientific activity. I hope that I can maintain this connection for some more time.

Economical and structural differences may have an impact for the future.