Research 2017-01-19T12:38:59+00:00

Research and Scholarly Standing

My Research Portfolio displays a focused dedication to the management of vascular disease and an acute recognition of the dramatic changes that have occurred in vascular disease throughout my career.

Vascular Surgery, once considered within the remit of general surgeons, is now recognized globally as a distinct independent specialty.

Contemporary vascular disease management has undergone a shift away from open surgery towards minimally invasive endovascular intervention. These catheter skills and the enhanced emphasis on cardiovascular risk management means that we as vascular specialists now have more in common with interventional cardiologists and vascular medicine physicians.

This paradigm shift is visible throughout my research portfolio and is reflected in my desire to embrace future directions and engage allied research groups.

Medical Technology device innovation and bioengineering insights into imaging, tissue engineering and material properties combined with therapeutic genomic manipulation have a central role to play in the future of vascular disease management. This necessitates a multi-disciplinary approach to clinically focused vascular research and my recognition of the vital role of biotechnology in modern endovascular therapeutics has encouraged me to engage scientists, engineers, related-clinicians and industrial partners.

Furthermore, my establishment of the Western Vascular Institute, as a clinical research institute and professional training centre which actively engages industry and promotes public education, demonstrates my view that an all-inclusive approach is vital to the advancement of vascular disease management.

What is more, I have established a variety of dedicated research subgroups within the WVI which comprise a mixture of undergraduate and postgraduate students and professionals. This reflects my longstanding viewpoint that research and education are inextricably intertwined and are a powerful combined force when it comes to delivering clinical excellence and patient care.

President of the Independent Global Registry on the Use of the Multilayer Flow Modulator in Complex Thoracoabdominal Aortic Pathologies.

The Multi-layer Flow Modulator is a disruptive technology which represents a new concept in themanagement of Aortic disease.

The mode of action of this device is completely different from that of conventional aortic devices, which has caused much scepticism among the vascular community worldwide. However, positive clinical outcomes have forced a more thorough investigation of this new device and the team at the Western Vascular Institute have been commissioned to undertake this exploratory task.

I am heading the team at the Western Vascular Institute which has established an independent registry to collect data from the surgeons and interventionalists around the world who have used this stent to treat thoracoabdominal aortic pathologies. The experienced team at the Western Vascular Institute comprises clinicians, biomedical engineers, scientists and data managers who are objectively analysing the clinical outcomes in patients treated with this device as well as engaging in independent biomedical testing.

International Awards

My extensive experience in the clinical research field is widely published, with near monthly papers in international peer reviewed journals and I, or one of my team, present each year, at every major international vascular surgical meetings in the USA, Asia, Europe, Australia and South America.

In international recognition of these achievements the American Society of Angiology has bestowed me with the honorary presidency of its Irish chapter.

Over the last few years the Western Vascular Institute has received 32 international awards from the most prestigious vascular surgery and cardiovascular societies in the world.

Awards

June 2015, Barcelona Spain

Thoracic abdominal endovascular aneurysm repair (TEVAR) with chimney grafts, hybrid techniques and multi-layer stenting in the management of Thoracoabdominal Aortic Pathologies

June 2015, Barcelona Spain

Evaluation of the Multilayer Flow Modulator in the Management of Complex Thoracoabdominal Aortic Pathology: A systematic Review and Metanalysis

Illness Severity Scoring Systems and Risk Prediction in Vascular Intensive Care Admissions
Mid- to Long-term Experience of Clinical Efficacy and Cost Per Quality-Adjusted Life-Years With Pararenal Endovascular Aortic Repair (PEVAR) Without Fenestration for Pararenal AAA Compared With Open Surgical Repair.
Primary non-synthetic AVFs: Are proximal AVF access procedures superior to distal access interventions ? A 5 years experience
The Results of the Sequential Compression Biomechanical Device in Patients with Critical Limb Ischaemia and Non-Reconstructable Peripheral Vascular Disease
Technical Superiority and Clinical Excellence of Duplex Ultrasound Arterial Mapping (DUAM) vs Magnetic Resonance Angiogram (MRA), as the Sole Imaging Modality in Bypass Surgery (BS) and Endovascular Revascularisation (EvR)For Critical Lower Ischemia (CLI) Patients. 6 Years Comparative Study in a Tertiary Referral Vascular Centre
Five-Year Irish Trial of CLI Patients with TASC II Type C/D Lesions Undergoing Subintimal Angioplasty or Bypass Surgery Based on Plaque Echolucency
Technical and Clinical Excellence of Duplex Ultrasound Arterial Mapping (DUAM), as the sole imaging modality in Bypass Surgery (BS) and Endovascular Revascularisation (EvR)
Five-Year Irish Trial of CLI Patients With TASC II Type C/D Lesions Undergoing Subintimal Angioplasty (SIA) or Bypass Surgery(BG) Based on Plaque Echolucency
TEVAR Hybrid Repair for a Challenging Thoracoabdominal Aortic Aneurysm
Cardiovascular Burden is More Treacherous Than any Neoplastic Pathology; Prevalence of Malignancies Post AAA Repair: an Eight Years Observational Study of EVAR vs Open Repair
Preoperative Vascular Screening and its Clinical Implications in the Presence of Aortic, Carotid and Peripheral Pathology for the Strategic Certitude for Vascular Surgery Patient’s Outcome
Fast track Carotid Surgery is the Gold Standard for High-risk (HRP) Carotid Artery Intervention: Five year Cost-effectiveness and Quality Stroke Free Survival Comparison between Carotid Endarterectomy (CEA), Carotid Angioplasty and Stenting Technique (CAST) and Optimal Medical Therapy(OMT) In Symptomatic Patients at a University Vascular Centre with Appraisal of the Contemporary Prose.
A prospective comparative study of pre-operative Duplex Ultrasound Arterial Mapping (DUAM), Digital-Subtraction Angiography (DSA) and Magnetic Resonance Angiography (MRA) in Critical Lower Limb Ischaemia (CLI) prior to Bypass Surgery (BS) or Endovascular
A Mid to long term Experience of Clinical Efficacy and Cost per Quality-Adjusted -Life Years with Pararenal Endovascular Aortic Repair (PEVAR) without Fenestration for Para-renal AAA compared with Open Surgical Repair.
Contemporary Management of Critical Lower Limb Ischaemia (CLI) in the femoro-popliteal segment. Randomization of CLI Patients with TASC C and D lesions to Subintimal Angioplasty (SIA) or Bypass surgery (BS) in concurrence to plaque echolucency: 5-year Irish Trial.
A prospective comparative study of pre-operative Duplex Ultrasound Arterial Mapping (DUAM), Digital-Subtraction Angiography (DSA) and Magnetic Resonance Angiography (MRA) in Critical Lower Limb Ischaemia (CLI) prior to Endovascular Revascularization (EvR).Clinical, Technical and Economic outcome
Paradigm Shift In Management Of Critical Lower Limb Ischaemia (CLI) In The 21St Century. Randomization Of CLI Patients With TASC C And D Lesions To Subintimal Angioplasty (SIA) Or Bypass Surgery (BS) In Concurrence To Plaque Echolucency In The Femoro-popliteal Segment. The 5-year Irish Trial
Subintimal Angioplasty (SIA) vs Bypass for Critical Lower Limb Ischemia in Patients with TASC C and D Lesions: 5-Year Result.
The Role of Prostaglandin I2 Infusion in Elective Open Repair of Abdominal Aortic Aneurysm.
Management of Critical Lower Limb Ischaemia in the 21st century. Randomization of Patients with TASC D lesions to Subintimal Angioplasty or Bypass surgery depending on plaque echoloucency in the occluded femoro-popliteal segment. The 5-year Irish Trial.
A Prospective Clinical, Economic and Quality of Life Analysis of Open Repair (OR), Endovascular Repair (EVAR) and Best Medical Treatment (BMT) in High-Risk Patients with Abdominal Aortic Aneurysms (AAA) Suitable for EVAR: The Irish Patient Trial.
Duplex Ultrasound Arterial Mapping (DUAM) as Sole Pre-Operative Evaluation Tool for Endovascular Revacularisation (EVR) in Critical Lower Limb Ischaemia (CLI). A Prospective Study of DUAM, Conventional Angiography (CA) and Magnetic Resonance Angiography (MRA)
Abdominal Aortic Aneurysm (AAA) Repair in Octagenarians versus Younger Patients in a Tertiary Referral Centre: 5-year survival rate of non-operative AAA.
A Comparison Of Open And Endovascular Abdominal Aortic Aneurysm Repair With Best Medical Treatment: Has The Availability Of EVAR Expanded Our Indications For Intervention And Improved Survival?
Carotid artery intervention in High-Risk Patients; A Prospective parallel group Study of Carotid artery Stenting (CAST) under neuro-protection and Carotid Endarterectomy (CEA)
A parallel group observational study of duplex angiography (DA), magnetic resonance angiography(MR) and digital subtraction angiography(DSA) to compare clinical and technical outcome in patients whose revascularization was based on DSA or MR with those based on DA
Subintimal Angioplasty as a Primary Modality in the Management of Critical Limb Ischemia. A Parallel Group Study of Bypass versus Angioplasty in Aortoiliac and Femoropopliteal Occlusive Disease

Translational Research

I founded Tulip Endovascular in 2013.

Our pioneering work on stem cell therapy delivery catheter won the Cleveland clinic innovation award in December 2013.

I Also founded Embricon in February 2005 in conjunction with a team of Bioengineers, Scientists, and Financial consultants. Embricon is classified by Enterprise Ireland as a High Performance Start-Up (HPSU) company, focused on the research, development and commercialisation of innovative Endovascular Solutions. The company is committed to translational research and is based at the Business Innovation Centre at the National University of Ireland, Galway.

In November 2007 InterTrade Ireland’s Equity Network announced Embricon as the winner of the Best International Emerging Company in the All-Island Seedcorn Business Competition 2007, and Embricon received a prize fund to develop a novel and innovative technology for the surgical treatment of varicose veins.

Green Medical Ltd, of which I was a director and founding member, was sold to Cook Medical in 2005 with an impressive Intellectual Property Portfolio and patents relating to treatment of superficial venous malformations. My dedication to translation research is further evidenced by a catalogue of international patents and my involvement in international clinical trials, such as the multicentre Angioscore PTA trial (Scheinert et al, Catheter Cardiovascular Interv 2007;70(7):1034-9), the Insight multicentre clinical trial of the Cordis Incraft aortic endograft and the multilayer flow modulator stent registry.

Clinical Leadership

None of these principles of teaching would be possible without having a specialist high volume clinical unit in which to impart real-world knowledge.

Since my appointment I have worked hard to establish a world-class specialist vascular and endovascular unit.

Prior to my appointment in 2002, there was no dedicated vascular & endovascular surgical service in the West. Pre-2002 a negligible volume of Vascular Services were offered only under the auspices of general surgery services and less than a dozen endovascular procedures had been undertaken in the radiology department. My first undertaking was to establish a dedicated vascular clinical and academic unit.

Team Building

My team initially comprised of one NCHD, one vascular technologist and one administrative staff member. The volume of vascular procedures performed has increased over 100-fold to an average of 450 vascular procedures per annum, 90% of which are performed by minimally-invasive endovascular means with proven and published enhanced cost-effectiveness. We see over 7500 patients per annum, the highest volume for any consultant within the HSE according to their published figures. We now have eight NCHDs: Two NCHDs are dedicated clinical lecturers, one of who is completely funded by the Western Vascular Institute; three NCHDs are part-time and are co-sponsored by the WVI; we have a dedicated vascular nurse specialist, five vascular technologists and three administrative staff.

Introduction of Endovascular Technology and Deliberate Practice Volume

Demonstration of initially massive increase in vascular procedures with specialization and introduction of endovascular therapies. Numbers have started to decrease in recent years with screening, enhanced out-patient services, advances in non-operative management and improved medical therapies

The installation of endovascular equipment and technical know-how allows for minimally invasive therapies with reduced hospital stay and an increase in patient turnover. We have proven that high deliberate practice volumes, endovascular capabilities and specialist care have afforded patients significant improvements in clinical efficacy and quality of life and have led to significant improvements in cost-effectiveness and a reduction in healthcare spending.

A Shift towards Outpatient Services, Non-operative Management and Improved Medical Therapies

 We have made a protracted effort to initiate effective therapies that allow patients to be treated on an out-patient basis. Currently only 6% of patients seen are admitted to the hospital per annum, while only 5% will undergo surgery. Choosing the appropriate treatments has enabled us to continue to increase our limb salvage and survival rates in a cost-effective manner despite a fall in invasive treatments.

Our world-class out-patient vascular service is structured as follows:

Vascular Laboratory: This accredited lab uses non-invasive ultrasound scanning to provide emergency real-time vascular imaging for the West of Ireland.

ArtAssist Clinic: A dedicated innovative lower limb revascularization clinic, which run three days per week, The non-invasive ArtAssist device, first developed for NASA astronauts, enables us to treat patients in their own homes and has allowed us to enhance limb salvage and reduce the number of patients requiring major invasive limb salvage therapies

Wound Care: A specialist wound care clinic and veins unit is operational two days per week. It is run by a dedicated Nurse specialist who makes it possible to manage the vast majority of vascular related wounds as an out-patient service.

AAA Screening

The Vascular Laboratory offers minimally invasive duplex ultrasound screening in addition to diagnostic and peri-operative imaging services. Screening more than 550 patients per annum and detecting vascular pathologies at an early stage means that we have seen a dramatic fall in death from aortic rupture, amputation and stroke.

I have also been appointed clinical lead for the Saolta AAA screening programme. We are currently running a pilot study with outreach clinics to the most remote areas of the NorthWest region of Ireland. This programme uses duplex ultrasound for aortic and carotid screening and Ankle Brachial Indices for peripheral arterial screening and will shortly be rolled out nationally.

Working with Related Specialties

Our growing interaction with related services such as cardiology, cardiothoracic surgery, vascular radiology, neurology and endocrinology is typified by services such as acute stroke care, diabetic foot care, weekly multi-disciplinary meetings, concomitant surgeries such as cardiac and carotid revascularizations and combined cardiovascular clinical teaching.

Research and Scholarly Standing Profile

My Research portfolio displays a focused dedication to the management of vascular disease and an acute recognition of the dramatic changes that have occurred in vascular disease throughout my career. Contemporary vascular disease management has undergone a shift away from open surgery towards minimally invasive endovascular intervention. These catheter skills and the enhanced emphasis on cardiovascular risk management means that we as vascular specialists now have more in common with interventional cardiologists and vascular medicine physicians.

 

This paradigm shift is visible throughout my research portfolio and is reflected in my desire to embrace future directions and engage allied research groups. Medical Technology device innovation and bioengineering insights into imaging, tissue engineering and material properties combined with therapeutic genomic manipulation have a central role to play in the future of vascular disease management. This necessitates a multi-disciplinary approach to clinically focused vascular research and recognition of the role of biotechnology in endovascular therapeutics has encouraged me to engage scientists, engineers, related-clinicians and industrial partners.

Furthermore, my establishment of the Western Vascular Institute, as a clinical research institute and professional training centre which actively engages industry and promotes public education, demonstrates my view that an all-inclusive approach is vital to the advancement of vascular disease management. What is more, I have established a variety of dedicated research subgroups within the WVI which comprise a mixture of undergraduate and postgraduate students and professionals.