For many, the words ‘heart care’ don’t bring to mind vascular specialties, but the heart and the body’s peripheral circulation are more closely intertwined than one might think. At Cleveland Clinic, the structure of our Heart, Vascular & Thoracic Institute reflects this overlap – facilitating collaboration for superior outcomes. For this reason, alongside his sheer inventiveness, we’ve chosen to include Sean Lyden, MD, Department Chairman, Vascular Surgery, in our ‘Heart of Innovation’ heart month campaign. Through his interview, Dr. Lyden opened our eyes to the decrease in vascular surgery invasiveness through time, the value of Cleveland Clinic’s unique institute structure, and the spotlight on cost of care that must accompany innovation.
A native of Youngstown, Ohio, Dr. Lyden earned his medical degree from the University of Cincinnati College of Medicine following an undergraduate degree from the University of Notre Dame. He served a residency in general surgery at the University of Tennessee Health Sciences Center in Memphis, where he was inducted into the Alpha Omega Alpha Medical Honor Society. He subsequently served a fellowship in vascular surgery at the University of Rochester-Strong Memorial Hospital in Rochester, NY. Dr. Lyden was appointed to Cleveland Clinic’s vascular surgery staff in 2001 and served as the Medical Director of Supply Chain Management from 2010 to 2016. In 2016, he assumed his current role as Department Chairman of Vascular Surgery.
Dr. Lyden’s specialty interests include aortic surgery, failed endovascular aneurysm repair, drug-coated balloon use in arterial disease, and popliteal artery entrapment syndrome. Actively involved in clinical care alongside his leadership, Dr. Lyden performs more than 200 procedures each year. Cleveland Clinic’s Vascular Surgeons are national and international leaders in treating patients with even the most complicated cases, using the most advanced techniques. Much of the group’s experience is in re-operative surgery or intervention for patients whose original procedures were performed elsewhere, and the department serves as a major referral center for these and other difficult cases throughout Ohio and the nation.
Cleveland Clinic has of the largest post-graduate training programs in vascular surgery in the US, and the department’s academic work has been published in scientific journals throughout the world. Dr. Lyden himself has authored and co-authored more than 85 articles in leading publications and has given more than 250 presentations of clinical findings at national and international medical symposia and conferences. He is currently involved in clinical trials studying various topics, including thoracic and thoracoabdominal stent grafting, lower extremity interventional therapies with drug-coated balloons, drug-eluting stents and percutaneous femoral popliteal bypass, carotid stenting, and deep venous thrombosis treatments.
Learn more about the intersection between heart and vascular care, progress made in the field, and forthcoming advancements through our conversation with Dr. Lyden below.
Question: Dr. Lyden, we know we can find your full biography on the internet, but can you tell us anything a little more personal about your relationship with medicine?
Sean Lyden, MD:
Responses have been lightly edited for clarity and length.
Actually, I had always dreamed of becoming a physician. Growing up, my interest in medicine stemmed from watching my best friend and first cousin interact with doctors and succumb to a debilitating childhood illness, Duchenne muscular dystrophy (DMD). I began research on DMD when I came back to Ohio for medical school at the University of Cincinnati, but I realized that my brain worked a little differently – I liked tinkering with things, taking things apart, putting them back together rather than dealing with intellectual puzzles. That really played well into becoming a surgeon. I was originally enamored with trauma, so I pursued trauma when I matched in general surgery, going to the University of Tennessee at Memphis – one of the busiest trauma centers in the country.
It was during that time that I first got to be involved in vascular operations and I was enamored. I trained in general surgery during the transition from only large open surgeries to minimally operations with everything done laparoscopically. I realized how much better it was to do things with a less invasive approach when feasible. During my fourth year of general surgery I watch an aortic aneurysm repair done with an endograft through the femoral arteries with the patient going home the next day instead of being in the hospital for 1-2 weeks. It was then I knew that minimally invasive vascular surgery was going to take off. So I pursued a vascular fellowship at the University of Rochester. It was an institution that was really pushing the forefront of care and minimally invasive options for vascular surgery. Then I found no other place to go but Cleveland Clinic when I’d finished. The enterprise was really known for its world-class heart and vascular disease care, and I was excited to get here in July of 2001.
The amazing part about being at Cleveland Clinic is that we’ve really helped evolve vascular surgery. One of the things that has changed most in my time is aneurysm repairs. Historically, aneurysm repair was done through a massive incision. Now, about 80% of the repairs we do are just done through small punctures in the groin. That original concept was developed by Juan Parodi, MD, who is an alumnus of Cleveland Clinic. He came up with the concept during his training here. I’ve had the honor of being a part of the teams that have helped lead to the approval of almost every abdominal aortic endovascular surgery device on the market, and working alongside one of my former partners who helped develop many of the devices that we now use on a daily basis.
Q: You mentioned you were right at the end of traditional vascular surgery and really got to see these minimally invasive methods takeoff – could you tell us a little more about that development? What about those projects launched at the Clinic? How were you involved?
One of the great things about the specialty of vascular surgery is that we really have evolved from all open operations to minimally invasive operations. When I first came to Cleveland Clinic, due to the massive volume of patients that we took care of, it was easy to become involved in clinical trials that led to the development of these devices. As an early clinician here, I was a co-investigator lending these therapies to our patients – from aneurysm repair to endovascular interventions of the lower extremity. But over time, I was able to lead some of those trials here at Cleveland Clinic, and now I’m leading many across the United States. Recently, I was the national trial leader in the development of a new aneurysm repair device, as well as lower extremity interventions.
The awesome part about our lives as vascular surgeons, is that we still sometimes do really big operations, but we can do it anywhere through a small puncture and have the patient have the same result with much less pain and suffering. The fact that patients come and seek new and innovative care has really been one of the fun things about being at Cleveland Clinic.
Q: Anything you’d like to highlight about the clinical trials you’ve been involved in?
Over my career here, I’ve been involved in probably 135 different trials. Right now, our department actually has about ten active trials – treating aortic dissections, treating thoracoabdominal and abdominal aortic aneurysms, novel treatments for patients who have gangrene or tissue loss in their legs with drug-eluting stents, drug-coated balloons, and other new innovative technologies.
One of the things I’m involved with is a startup that was born out of an idea of our department in vascular surgery, and is now an emerging company called Centerline Biomedical. Centerline is trying to eliminate the use of radiation (via x-rays of fluoroscopy) during cases through an innovative mapping software that can tell you where you are in 3D space. And so, even though we've done a lot of trials in the past, the lessons we’ve learned from those prior trials have continued to guide the newer therapies and the newer devices we’re developing today.
Centerline Biomedical’s platform technology aims to revolutionize endovascular repair in addition to a variety of vascular applications. The company received 510(k) marketing clearance for their Intra-Operative Positioning System (IOPS™) from the FDA in 2019, and in December 2020, successfully completed the first surgical case in its MOTION clinical trial. Learn more about Centerline Biomedical or contact Jim Zalar (email@example.com).
Q: How would you describe the intersection between vascular surgery and cardiac care? I know at Cleveland Clinic they reside under one Institute – how does this facilitate collaboration?
It’s interesting; even as an adult, my parents were always confused with what I do as a vascular surgeon. Everybody knows a neurosurgeon works on the brain, and a heart surgeon works on the heart, but vascular surgeons really help repair and fix the arteries and veins in the rest of the body. We were originally a separate department in 2004, but when Cleveland Clinic went with the institute model, it brought the best of everything we could do together. So now, vascular medicine, vascular surgery, cardiology, and cardiac surgery – we all work seamlessly together.
We all have our own skill sets for different parts of patient care, but making sure we talk and interact with one another on a daily basis really helps us get some of the sickest people through some very complex medical problems. It’s really a unique place to be where we’re able to simultaneously reduce risk factors for our patients and address some of the other complications up by the heart and chest. We work on many combined cases with our cardiac surgical colleagues – using innovative treatments for both lower extremity and aortic disease. I don’t really know of any institution that has the congeniality, the collaboration that we have – it’s truly care that’s centered around the patient.
Q: What are your predictions for the future of vascular surgery?
I think vascular surgery is an awesome specialty – we continue to evolve. One of the things we've seen as a trend, if we talk the last 20 years, is the push to do minimally invasive procedures. And the devices we have allowed that to happen. But I think one of the things that keeps Cleveland Clinic unique is our volume is high enough that we still have the skillset to do the open procedures when they're needed, as well as manage the endovascular procedures when they fail. So a lot of our practice here is referrals from other vascular surgeons to take on complicated problems that they don't feel comfortable with.
It’s amazing that we sit on the cutting-edge, and continue to develop the most novel devices to treat people with minimally invasive punctures in their arms or groins, but when those things occasionally fail, open surgeries remain a need. Unfortunately, we’re seeing fewer and fewer places with surgeons coming out with those skill sets, which makes these individuals harder to hire as staff. Fortunately we can provide those opportunities to our trainees.
Q: Is there emphasis on this issue at Cleveland Clinic or nationally?
Nationally, it’s a big discussion amongst the program directors in vascular surgery and the Society for Vascular Surgery. I think one of the concepts that they’re trying to figure out is post-graduate training for sub-specialties in vascular. We’ve always been a small specialty, so much so that we’ve not sub-specialized – but I think we’re starting to. Specialized centers of excellence are going up, and we’re recognizing the need for secondary education after your training. Everybody has a specialty interest, and at Cleveland Clinic, we’re really trying to allow people to get those skill sets they weren’t exposed to in their original medical training.
Q: You were in the Supply Chain space at Cleveland Clinic for almost seven years – anything you’d like to share about that experience that’s appropriate for this conversation?
In my role as Medical Director of Supply Chain, I was to integrate physicians and help them understand the cost of healthcare so Cleveland Clinic could make wise choices. The ‘at home’ equivalent would be like buying a car. I make choices about how nice of a car I need and how it’s going to last to be smart with my money. I think in healthcare, physicians don’t understand that it is our money we are spending in the end, and the tough pro and con decisions are relevant. So we spent a lot of time trying to educate clinicians about having the best tools, but getting the best price. I was tasked by Toby Cosgrove, MD, to lead that initiative, and out of that, we’ve really grown a purchasing organization that has helped other institutions figure this out.
We’ve been featured in several presidential elections for how we’re able to provide cost-efficient care, and I think it’s because we have clinicians at the table. Having the caregiver help make those decisions is another thing that makes Cleveland Clinic a unique place. We’ve really found that it’s not stopped our ability to innovate, but it has helped our doctors realize that at the end of the day, part of doing the best thing for our patients is spending our money and their money wisely.