Advancements in vascular sciences is  the need of the hour. Lack of awareness and late diagnosis  of vascular diseases  can lead to  serious problems. The condition is known to affect a person during his most  productive period in his life. ‘Leg-attack’ can cause more serious consequences than a heart attack. To treat such life -threatening vascular conditions , stem cell therapy is a boon. Though   stem cell therapy is still experimental,it holds promise for the  future, says Dr. K R Suresh, Director, Jain Institute of Vascular Sciences in an interaction with Nandita Vijay. Excerpts:

How has India evolved in  peripheral vascular sciences?
India has come a long way from a mere 15 vascular surgeons and only one training centre  to  around  70 vascular surgeons and six  training units today . However, this is woefully inadequate for our billion plus  population which account for  50 million diabetics and 100 million smokers. We also need to take this specialty to major cities.

What are the latest developments  globally and how much of this could be adopted at Indian hospitals?
Minimally invasive endovascular procedures are making rapid progress and replacing traditional surgical procedures. Most if not all can be adapted in India and again cost is indeed a major factor as these are expensive than ‘open’ surgical procedures

Are there any visible trends in the segment?
Along with  minimally invasive procedures are cell-based therapies like stem cell, gene - based treatment options to help faster improvement.

Is stem cells a key option for the treatment of vascular conditions. Your facility has been a centre for clinical trials and therapies for leg ischemia and Burger’s disease among others. What in your opinion is the key  to  successful treatment   of these conditions?
Stem cell therapy is still experimental and still in evolution but  holds promise for the  future. At  present it cannot be considered a key option in therapy and should be offered only to those selected patients who cannot undergo or have failed well established therapies. These need to be done only in specialized vascular centres and as per ICMR ethical guide lines, which are unfortunately being flouted at present. JIVAS has the highest published data on stem cell therapy for Buergers disease and results have been very encouraging. This should be further tested by larger trials and at cannot be accepted as “standard” therapy’.This perhaps is still a decade away.

Do you think stem cells therapy can be prescribed as the first choice after drugs  for many of these conditions?
A vehement  no as  we are not even close to making this recommendation. Unfortunately there has been significant abuse of this therapy

What according to you are the key challenges in the country for the success of vascular science?
It is essential to  create  awareness among patients and doctors about seriousness of diseases like the ‘leg-attack’ which can cause more serious consequences than heart attack. Early identification and faster  referral to vascular surgeons is required. This is where AIIMS and the  Bangalore Medical College along with  large government hospitals need to develop dedicated vascular departments.

Could you give an overview of the achievements of JIVAS in the last one decade?
We started off operations in the Bhagwan Mahaveer Jain Hospitals as  Department of Vascular & Endovascular Surgery a decade ago which also included a diabetic foot clinic. Two years later, it was named as  JIVAS (Jain Institute of Vascular Sciences). In 2003, Vascular Surgery Fellowship programme commenced through NBE and Rajiv Gandhi University of Health Sciences. Going by the importance of the specialty, this course was converted to three year super specialty DNB in 2008  and was a first-of-its-kind in India. The first batch of  two candidates just passed out.

<b>How popular is this concept of Hybrid Operating Theatre’, the  first-of-its-kind in India ,unveiled by JIVAS?</b>
Hybrid OT which is a first of its kind in the country combines a major OT to perform complex vascular surgeries and facilities for minimally invasive endovascular procedures like angioplasty/stenting in one room. Many vascular patients need both and this can be done at one sitting. It  combines OT with cath lab. Most of the vascular units in the US and Europe have gone with this concept which is more cost- effective (since only procedure) and decreased complications and time of hospitalization.

What kind of investments did JIVAS make   in the last one decade to expand the  facility and what has been the cost of setting up Hybrid Operating Theatre’?
An  investment of about Rs. 4.5 crore was  made by Bhagwan Mahaveer Jain Hospital, as JIVAS is one of its units. Some equipment are donated by philanthropists and sourced with support from the World Diabetes Foundation, Denmark. This has allowed us to keep our costs low.  The new hybrid OT costs around  Rs. 85 lakh.

<b>How is the concept of vascular centres catching up  in India. What is the USP of  JIVAS to  attract patients  ?</b>
Unfortunately there are very few vascular centres in India,  There are around 15 hospitals with vascular surgeons, but no  real departments. Many of these do not offer comprehensive care  like  surgery and  angioplasty..JIVAS is perhaps the best equipped centre in India. It also has the highest numbers of vascular surgeons treating  complex vascular problems from surgery to angioiplasty, medical management, physiological testing, venous procedures. Our  diabetic foot clinic  is quite popular and is one of the centres of excellence for training by WDF, academics and research.

In keeping with Jain philosophy we cater to the needs of  both the rich as well as the poor.  In order to meet the needs of  poor patients , the cost is subsidised in general wards. There are free beds for  poor patients  and many major procedures are performed free of cost as the consumables are funded by philanthropists through a programme called  “PARVATH” ( Partnership for Vascular Therapy).

What are the future plans  of JIVAS ?
We  plan to start  eight  clinics in  Bangalore and seven across Karnataka  shortly  which  is in addition to the existing 10 centres. We also would have  five home- care mobile units, a footwear workshop and an outlet for  diabetic and vascular patients to purchase the products. We will increase our stem cell research and therapy efforts. Plans are underway to offer ambulatory surgical services and a regional centre of excellence and tele-teaching programmes.

Is cord blood stem cells or bone marrow stem cells the answer for future ailments?
Perhaps the best is embryonic stem cells, but there are huge ethical and moral issues involved. The safest is autologous bone marrow cells. Future would be cultured stem cells from several sources, which   can regenerate any tissue.