Conversations with members of the Harvard and Radcliffe Class of 1992.
Hosted by Will Bachman.

Episode: 56

Sharif Ellozy, Vascular Surgeon

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Show notes

Sharif Ellozy talks about his  journey since graduating from Harvard in 1992. Sharif is a vascular surgeon currently living in Manhattan. After graduation, he went to NYU for medical school. He completed his residency and fellowship at Mount Sinai and was on faculty there for 12-13 years before going to Cornell in 2016.  Sharif is also a father of two sons, and, throughout the years, he  has managed to maintain some of his Harvard friendships and connections to his family in Egypt. He is currently part of the Society for Vascular Surgeries Communication Council to help raise awareness of the field. Vascular surgeons are responsible for diseases involving blood vessels outside the heart and brain. Sharif explains how they treat these diseases with open surgical techniques, including bypasses, stents, and balloons. Vascular surgeons  also work with orthopedic surgeons, cancer surgeons, neurologists, or any time there is a challenge when dealing with blood vessels. Sharif talks about the diseases he commonly treats and the techniques he uses to perform surgery such as magnification in addition to muscle memory through repetition, and vascular repair techniques.

Sharif discusses his work as the Program Director for the Vascular Surgery Fellowship of New York Presbyterian Hospital, which he has been running since 2016. To further trainees’ education, Sharif has been involved in simulation training and runs a boot camp that has been operating since 2017. The boot camp is an in-person course with faculty from across the country and focuses on the technical side of vascular surgery and is designed to teach techniques without putting patients at risk. The program uses endovascular simulator and cadaver workshops to provide trainees with hands-on experience. This also gives them a chance to get to know the wider vascular community. 

The Vascular Podcast, Audible Bleedings

Sharif’s most proud accomplishment is the podcast he was asked to produce with the trainees. This podcast, Audible Bleedings, which was bought out to be the official podcast for the Society of Vascular Surgery, was trainee-driven and has become increasingly popular in the past couple of years. This is a great way for trainees to develop their content and professional development.

On the podcast, Sharif interviews prominent vascular surgeons, giving listeners insight into the personal life of a vascular surgeon, how they approach the difficulties in their work, and what the process of being a vascular surgeon looks like. During the pandemic, his podcast provided the vascular community with knowledge and insight. 

He interviewed two of his colleagues from Seattle, Ben Starnes and Nitin Singh, who are both vascular surgeons and military surgeons, to discuss the impact of the COVID-19 pandemic in Seattle. He also had another guest, Mel Sheehan, a vascular surgeon at LSU, who had been there during Katrina and stayed throughout the pandemic. The conversation focused on how to respond to unexpected situations and the process of being a vascular surgeon. 

Recent Developments in Vascular Surgery

Sharif points out that there are many specialists in the field, and talks about his focus, his practice, and recent developments in vascular surgery, including endovascular simulation and remote access points when the focus is on endovascular repair of abdominal aortic aneurysms. This procedure has revolutionized the treatment of these aneurysms, allowing patients to come in, have the procedure done percutaneously, under local anesthetic, and go home the next day. This technology has allowed for a much less invasive and much more convenient way of treating aneurysms, making it a major development in the field.

He also talks about the limitations of current technology when it comes to repairing aneurysms. He explains that it can be difficult to maintain blood flow to branch vessels, such as the arteries to the kidneys and intestines, while also excluding the aneurysm. To solve this problem, devices have been developed that have branches with holes to maintain blood flow while still excluding the aneurysm. It is also possible to print out a 3D model of the vessel ahead of time to help in designing the device. CAT can be used to create a 3D model of a patient’s blood vessels. 

Industry Collaboration in Health Innovations

Vascular surgeons continuously need to develop technology to help patients. To do this, they have to partner with industries that have the resources to develop new technology, and that it is important to seek out industry partners to provide necessary support and experience. In order to create solutions for patients, it is essential that vascular surgeons and industry collaborate. He mentions that it is the surgeon’s goal to do what is best for the patient and that they must remain aware that the job of industry is to sell the device. 

When reflecting on his career, Sharif initially found general surgery attractive because of the dynamic nature of the work and the ability to offer patients medical and surgical therapy. However, he grew to like vascular surgery due to its meticulous nature and the fact that it allows for minimally invasive procedures. He found his mentor, Dr. Michael Marion, Chief of the Vascular Division, and Dr. Larry Hollier to be inspiring and both were a major factor in his decision to pursue the specialty. 

Professors and Courses of Influence

Ellozy also recalled his college days at Harvard where he found courses such as Literature Arts where he read Chaucer, and Ethics, and International Relations. However, he found the most impactful course was  Cultural Illness and Healing taught by Arthur Kleinman. He specifically remembers a book they read called Forgive and Remember, which was written to help physicians deal with medical errors.

 

Timestamps:

09:21 Treating Aneurysms, Clots, and Varicose Veins 

11:42 Surgical Suturing Techniques 

16:38 Audible Bleedings Podcast 

19:39 Vascular Surgery and the Impact of the COVID-19 Pandemic 

20:30 Vascular Surgeon’s Practice: A Day in the Life 

24:46 Endovascular Surgery and Simulation 

30:55 Endovascular Repair of Abdominal Aortic Aneurysms 

34:32 The use of New Technology in Healthcare 

37:32 Becoming a Vascular Surgeon and Harvard College Experiences 

 

Links:

Forgive and Remember 

AudibleBleeding.com

 

CONTACT INFO:

https://www.instagram.com/sharifellozy/?hl=en

https://www.linkedin.com/in/sharif-ellozy-215a2920/

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Transcript

 

92Report_Sharif Ellozy

Will Bachman, Sharif Ellozy

 

Will Bachman  00:01

All right. So, and I, from I started listening to the first to one of your episodes of audible bleed. Okay. Yeah. And

 

Sharif Ellozy  00:13

it’s a little niche for the nonvascular. surgeon, but

 

Will Bachman  00:17

it’s awesome. I mean, the Nisha, the better, I think, for podcasts, that’s the whole beauty of it. So, the mean, so my typical format, right is pretty open ended, I just normally just will ask you to tell me about your journey since graduated from Harvard. And then you can kind of take that in whatever direction you like, you know, you can focus on the most recent part of your career, you can, you know, spend time earlier on, you can, you know, talk about extracurricular stuff or focus on work, it’s kind of up to you, and then I’ll be, you know, just asking some follow up questions, but I kind of take your lead on, on what you want to focus on. And then I do put spend some time at the end, where I’ll ask about any courses or professors at Harvard that still resonate with you doesn’t have to be professional for something, you know, I got this interest in like, medieval history or something. And I still like read books on it, whatever. And, yeah, and then I’ll give you a chance to course talk about your podcast at the end, then share any links to, you know, if people want to follow up and find out what you’re doing, you know, you can share your contact info or not sure, your website, whatever. Excellent. And then in terms of, in terms of this actual audio, this is the first time I’ve ever done this, where if you know, he’s in middle school, so if you can just send me afterwards, like, I guess, will I be able to download the mp3 or how well, so

 

Sharif Ellozy  01:45

what? So what this platform, what they do is they record the audio locally on each of our computer, so it records my track separately from yours, and then uploads it. And so you get like much higher quality audio than you get from, like a zoom, which is condensed, you know, yeah. Okay. And so what I’ll ask you is, once we finished recording, I’m gonna ask you to stay on so I can make sure everything’s uploaded. It’ll tell me when it’s all uploaded. And they’ve got some they’ve got some backups. So like, there’s an internet backup and stuff like that. But the once that’s done, I can send you the audio as individual tracks, or as a combined track, whatever you prefer.

 

Will Bachman  02:21

And the individual tracks they will be, there’ll be like synced. Yeah. And they’ll be sort of synced, right? Yeah.

 

Sharif Ellozy  02:27

So the reason we do that, so when we edit them, a lot of times, there’s like some background chatter, we’ll have like, you know, three or four people on and so this way you can, it makes it very easy to mute someone, but not lose the audio for someone else. And so

 

Will Bachman  02:41

now that’s perfect. We that’s why I normally record with two tracks as well. Because that way, we can also do volume adjustments on each track. So that so you can see the two tracks would be good. And yeah, the two tracks would be good. So yeah, I’ll stay on afterwards. What I actually suggest we do if it’s okay with you, is I suggest we actually turn the cameras off. Okay. I find that I just get distracted if I’m like trying to, I like to really focus on what you’re saying. So I’m just gonna turn my camera off. Okay. And then I can just focus more on what you’re saying. Okay, so. Alright, hold on just a second. Okay. All right. Okay, so, all right. We will. I guess we can start now. You’re ready to go?

 

Sharif Ellozy  03:27

Yeah. Yeah.

 

Will Bachman  03:28

I mean, it’s, it’s 100. And then one question. I want to make sure I pronounce your name properly. Is it Sharif? Lozi.

 

Sharif Ellozy  03:36

That’s perfect. All right. Perfect. Okay.

 

Will Bachman  03:39

All right. Here we go. Okay, so the our few seconds. And I’ll just I’ll, I’ll do a little intro and roll it into it. All right. Hello, and welcome to the 92 report. conversations with members of the Harvard and Radcliffe class of 1992. I’m your host will Bachman. You can view the transcript for this episode and all episodes at 92 report.com where you can also sign up for a weekly email where you can find out just the show notes from each episode. I’m here today with Sharif Lozi. Sharif, welcome to the show. Thank you well. So Sharif, let’s start with Tell me about your journey since graduating from Harvard.

 

Sharif Ellozy  04:30

Sure. So I am currently vascular surgeon living in Manhattan. In some ways, my journey has been very direct and sort of standard. You know, I graduated from Harvard 92 And then I went to med school at NYU. I stayed on in the city. I went to Mount Sinai for my surgery, residency and vascular surgery fellowship. And then I was on faculty at Mount Sinai for, I think 12 or 13 years before I came to Cornell here In 2016, so professionally, it’s been all within the space of a few blocks. But I’m also a father, I have two sons use fun Adam, one’s a sophomore in college and one’s a junior in high school. And, you know, I’ve been sort of maintained a lot of my friendships with my classmates from Harvard, many of them in New York area, but some of them in Boston. And I’ve got a lot of ties to Egypt, which is where my family’s from.

 

Will Bachman  05:35

Tell me a bit about what exactly is a vascular surgeon or sort of a idiot question, I’m, I’m assuming has something to do with like blood vessels, but I’m, I’m kind of a totally naive. So let’s help me understand what that Sure sure.

 

Sharif Ellozy  05:50

It’s actually, it’s funny, you bring that up, because vascular surgeon, it’s a small specialty, you know, and it actually has maybe less awareness in the water culture. And this is something that we’re trying to improve. We even so I’m a member of the Society for Vascular surgeries communication Council, and we had a meeting on Friday, just about the branding of vascular surgeons and getting information out there to the lay people. So you know, I’ve been asked,

 

Will Bachman  06:18

so you’re busy, you’re at work professional obligations, right now getting the community getting the word out there?

 

Sharif Ellozy  06:25

Absolutely. All right. So, you know, the joke is that, you know, I know a lot of vascular surgeons who all say that, even their mother doesn’t know what they do. And they think that their cardiac surgeons, we are specialists in diseases involving blood vessels throughout the body, outside of the heart and the brain. So we’re basically like plumbers for the body. It’s a, it’s a field, that was an outgrowth of general surgery. And we use the same techniques that cardiac surgeons do and that cardiologists do and that we treat diseases with either open surgical techniques. So we’ll, you know, we can reconstruct the vessels with bypasses, or we use stents and balloons to open them from the inside. And it’s, it’s kind of nice, because we interface with a lot of different surgical specialties. So everybody worries about bleeding in the operating room. And so you know, they call us for that. And so we work with orthopedic surgeons, we work with cancer surgeons, we work with urologists, anytime there’s blood vessel involved in the structure that they may feel is challenging, they get us involved.

 

Will Bachman  07:37

Okay, so, tell me a little bit more about, like diseases that affected blood vessels, the thing that you work on, I am curious to know about that, I have no idea what those would be

 

Sharif Ellozy  07:49

sure. So probably the most common diseases we treat with is atherosclerosis, which is hardening of the arteries, and everybody knows about it in the heart. That’s what leads to heart attacks, it’s probably one of the biggest disease burdens in Western society, because of the effects of smoking and diabetes and high blood pressure. And so we address patients who have problems with blockages in their arteries, and that can lead to stroke. So that’s one of the things we deal with is blockages in the carotid artery. It can lead to problems with walking. So if you have blockages in the artists or your legs, you can get pain with walking, you can get gangrene, I mean, there are it’s a broad spectrum but but we’re responsible for improving blood flow to these affected organs. And then aneurysm diseases is sort of it’s a separate thing. A lot of people think that they’re similar, but aneurysms are where blood vessels are dilated. So they’re bigger than normal. And as they get larger, there is a risk of rupture associated with that. So the blood vessel gets weaker as it gets larger. And so that’s that’s probably the second most common disease we treat with on the arterial side. And then we treat diseases of veins and so commonly, either clots in the veins or varicose veins, those those are those are the common things to treat as vascular surgeons.

 

Will Bachman  09:21

So, one thing I’ve always wondered about certain surgeons and surgery is like, for something so small as a vein, how in the world do you, like, do anything like how do you, you know, if you if it’s cut, how do you stitch together? It’s so small, you can barely see it? I mean, I can’t imagine how you could do little tiny little stitches to stitch the edges together, or is it some like machine or tool or something that just crimps it together? How do you do something that when it’s so small, I can understand okay, you know, maybe cutting out some you know, tumor or something You can imagine slicing someone open and like just cutting it out. But when that’s so small, how do you how do you like do anything? Is your hand just super steady? Or how does it work?

 

Sharif Ellozy  10:11

So I think it’s a, there are a couple of things, one, the really small vessels, often you don’t have to put them back together. So if they’re really tiny, usually there are other vessels around that, that compensate for that. But when we if you have a vessel that you need to reconstruct, so if it’s artery that supplying the blood flow to a certain area tissue, we use magnification. And so we use things called loops. So they’re glasses that have magnifying lenses built into them. There are even surgeries done under the microscope, that’s not typically us so much. Sometimes plastic surgeons will do that when they do what’s called a free flap. So they’ll take tissue from one area of the body, and reimplanted somewhere else and connect the arteries and the veins together, and they use a microscope for that, but but magnification is a big part of what we do. And then a lot of it is just training, just like anything you get, you know, there’s repetition and muscle memory, and you get the better things. It’s like practicing for piano or something like that. There are skills that you learn along the way.

 

Will Bachman  11:16

So, okay, but like so. Is it? Are you actually, you know, if it’s so so for the super, super small vessels, you just say, okay, tough luck, you know, there’s other vessels in the area. But for the reasonably sized ones, they’re still they’re pretty small. So are you actually kind of doing stitches, like individual stitches with thread to kind of sew two arteries together? Or is there some other sort of technique that you’re using to, you know, to connect them back up if they get cut?

 

Sharif Ellozy  11:42

So you know, the the, it is, for the most part stitching with thread, yeah, they have different types of stitches that you use, and there are very fine sutures. So they’re typically on a vessel, we’ll, we’ll start with something called Prolene, which is just a nylon, so it’s inert. And it’s a monofilaments, almost like fishing line, but it’s much smaller. And there are needles that are attached them, and you just you just sell it just like just like you might sell your soul, you’re so darn your socks. I mean, you know, the, they say that the the separation between a surgeon and a tailor is about a generation. And so it’s a lot of the same techniques. Some of the early grafts, so when they were looking at the replacement of vessels, you know, they used to use cadavers, grafts, but that’s not a great solution, because they tended to dilate over time, and there was a limited supply of them. And so they had to come up with artificial replacements for grafts and for the aorta. There was a surgeon up at the at the Arthur Vorhees at the Columbia he was a surgery resident, and he started using parachute fabric. And so it was basically a type of nylon. It was Vigneron, and it’s like a type of nylon polymer. And they had all the surplus graph. I think this was in the 50s from the Korean War. And so he basically took the graft and sewed it on his wife’s a sewing machine into tubes. And then they use that as a replacement for aortas. And so, and they would start with silk at the time, we’ve progressed beyond that. But yeah, same same techniques as as Taylor, basically.

 

Will Bachman  13:19

Wow, that is amazing. Tell me about some of your professional accomplishments that you are proud of stuff.

 

Sharif Ellozy  13:28

Sure. So I am the program director for the vascular surgery fellowship. But the New York Presbyterian Hospital, which is we have two campuses. So I’m at the Weill Cornell campus. And we also have at the Columbia University Medical Center. It’s all the same hospitals codes considered New York Presbyterian Hospital, we have one fellowship for both campuses. And so I came over in 2016. And I’ve been the program director since then. And training edge education is a is something that’s very important to me, and so that the being the program director is probably the role that I’m most proud of.

 

Will Bachman  14:04

And what are some kind of initiatives or changes that you’ve been driving with that?

 

Sharif Ellozy  14:11

So we’ve been involved in simulation training. So we run a boot camp that we that we’ve been doing, since I think, I think the first year was 2017 and 2018. With a little bit of a hiatus for the for the pandemic, but it’s an in person course that we would invite trainees early in their fellowship. We’d have faculty from across the country, and it’s all hands on. And so you know, the technical side of vascular surgery, you can learn it in the operating room, like in an apprenticeship model, or you can figure out alternatives where you can train people on techniques that maybe patients aren’t at risk during the training. There’s a little bit less stress on the trainees and And they’re also opportunities to train them on sort of unique situations may not come up so often. So we had a course where you have endovascular simulator. So it’s computer based simulation, where, you know, we do things under X ray guidance. And so basically on a computer model, you can simulate the X ray findings that were that we’re treating, and they can work with devices. And it simulates as if you’re doing a real case, we have open models that simulate so they’re made of latex and silicone, they simulate the tissue and you can reconstruct vascular structures that way. And we’d have a cadaver workshop as well to work on the anatomy. And that was something that was that we developed that we developed here at Cornell has been very popular and really a lot of fun. And it’s also useful because of we allow people to meet some of the faculty across the country and introduce the trainees to sort of the wider vascular community. And there’s some professional development that goes along with that as well. But I think probably the thing I’m most proud of, is my trainees, approach me to be involved with them in a podcast. And so this is something we started at our, at our fellowship in 2018. But it sort of there wasn’t a podcast, and there wasn’t there wasn’t a podcast in the fields for vascular surgery. And it gained a lot of attention, a lot of popularity. And eventually, we were bought out as the official podcast for the site of vascular surgery. And this is something that it’s trainee driven, in terms of developing the content. And it’s, it’s really expanded in the last couple of years. And that’s been a lot of fun. And I’ve learned a lot from that process.

 

Will Bachman  16:38

And we should say the name of it, it’s audible bleedings Correct. Fi got it. Right. Audible blue. And before we spoke here, I will admit, I have not been like a, you know, subscriber from the beginning of that show. But I listened to an episode before we spoke. Very cool show. And I think the more niche the better with podcasts. So you’re really talking to, you know, people that are training to be vascular surgeons, what are some of the your favorite discussions from that show that you’ve had?

 

Sharif Ellozy  17:08

So, the way we started out one of our one of our one of my fellows, his name is Kevin Kinnear, he had started a general surgery podcast. And so it was called behind the knife. And it was started as sort of free online medical education for trainees. And so basically, they would develop a lot of content, they would interview people talk about their clinical interests, they would develop some review episodes for people studying for their exams. And so we started out with a number of interviews of prominent vascular surgeons. And what I liked about that is you get to see a side of them, you don’t see when they’re presenting at meetings, or when you know about their work, you can see what their personal life is like, you can understand how they approach some of the difficulties in their work, you sort of pull the kimono back on the process of being a vascular surgeon, and I like that aspect. We ended up we, you know, we, when the pandemic came along, there was a lot of thirst for knowledge in the basket in the basketball community about what’s going on. What, what can be done, and a lot of people were sort of stuck at home. And then, you know, there was there was time to listen to these podcasts. Probably one of the most memorable episodes was because the pandemic hit Seattle, earlier than it had done in the in the in the rest of the country. And we had two of my colleagues, Ben Starnes, and Nitin Singh, who were vascular surgeons in Seattle. They also happen to be military surgeons, so they’re both in the army. And they had training involved, they’ve been involved in responses to the mass casualty events. And so we had them on very early to discuss the impact of the COVID 19 pandemic and sort of what to expect because Seattle was ahead of the curve compared to the rest of the country. And as another guest, I had one of my colleagues, Mel Sheehan, who was a vascular surgeon that LSU Louisiana State University, who happened to be there during Katrina, and he stayed throughout the pandemic, and he was, you know, his response to sort of unexpected circumstances and when you’re when you’re thrust into a role that you’re not comfortable with in medicine and how to respond to that, and that was probably the most memorable episode in the first couple of years. And I think I would recommend that to lay people who maybe don’t are not interested vascular surgery, but you may find that that episode. Interesting.

 

Will Bachman  19:39

Excellent. You mentioned sort of the process of being a vascular surgeon and you’re kind of alluded to a little bit earlier, that you often get brought in on things. Tell me about kind of your practice in terms of, you know, is it a lot of the client patients coming directly to you, for a are referred to you for a specific disease of, you know, their arteries? Or are you also called in a lot to, you know, attend surgeries by your colleagues like, how does your practice break down in terms and I’m also curious what sort of a typical week would look like or, you know, one day a week, you’re, you know, in surgery for your own patients or for patients of, you know, with colleagues, talk to me a little about just the day to day, the week to week of your, of your practice. Sure,

 

Sharif Ellozy  20:30

  1. So I would say as vascular surgeons, there’s a broad variety in terms of practice types people are in academic practice, they’re in private practice, they can specialize in certain disease processes. And so everybody’s a little bit unique. But my practice, I’m in an academic practice, and so I am an employee of the medical school. I see patients one day a week in my clinic, and so I will be seeing patients as the first time I evaluate them. So someone may have a patient with a carotid stenosis, or an aneurysm or a problem with their blood flow to their legs, they send them to me for evaluation. I also see my post op follow ups and their patients who have operated on that you follow because once once you’re out by them, that your patient for life, and so they come in for surveillance. And so these are patients I’ve known for years that come to see me in regular follow up. Then I typically have two days a week where I can book my own cases. So they’re elective cases. So if someone I see in the office needs surgery, I say, Okay, this is where you’re coming in. I often, in the course of the week, I’ll help out. One or two or three days, with surgeons in other fields. So for example, we have the Hospital for Special Surgery across the street from us. And so there’s a lot of spine surgery that’s being done, where they ask us to help them with the exposure. So if they’re working on the spine, from the front, there are blood vessels and organs that sit there that we get them out of the way so that the spine surgeons can work safely. And so we’ll work in conjunction with them for that. We’re also across the street from Memorial Sloan Kettering Cancer Center. And so there are often cancer cases where there are blood vessels involved. And in order to allow for a curative resection, sometimes you have to take out a blood vessel and replace it. And so they’ll help us with that will help they’ll ask us for help with that. And so we work with them in that I would say about probably 70% of my cases are elective, and 30% are urgent or emergent. And sometimes we’ll get called in if someone has a, you know, a challenge in the operating room itself, and they need some help, we’ll we’ll help out with that. And that’s, that’s probably about 5% of cases.

 

Will Bachman  22:42

Now, my world professionally is, you know, helping connect companies to independent consultants. And so it’s always this game of availability and you know, slotting people in and finding who’s available. I’m curious in your world, right? So you got your own cases going on, you have some emergent cases. How does it actually work? Like, do you have your friend, you know, Dr. Jane over at the other place that hey, you know, Sharif, are you available to, you know, come in here and like, oh, yeah, I could do two to four let’s schedule like, how does the whole scheduling and pulling people together? And if you’re not available, do they go to vascular surgeon number two? How do you pull those teams together? Sure. It’s my question. So

 

Sharif Ellozy  23:22

you know, they have this axiom that the the keys to practice building and medicine are the three A’s availability, affability and ability. And they often say that ability is probably the least important thing in terms of getting your practice, but them. So I think there’s a lot of interpersonal referrals. So there are people you work with on a regular basis, and they’ll call you directly. There is, you know, often you know, sometimes they’ll say just call vascular. And so they’ll get online and they’ll find whoever’s on call and pages. I think what I’m very, very lucky to have is I have excellent partners. And so there are in our group, four of us here at our campus, and we have one partner who’s another hospital, but everybody’s really great. And so it provides a good balance because, of course, he can’t be available 24/7 365 days a year, that’s, that’s a recipe for burnout. But you want to be able to provide a service to your referring doctors, and since we have a good group, we you know, help each other out and there’s always someone available and we make sure that the that the our referring doctors feel like they can turn to us and have the problem solved.

 

Will Bachman  24:46

I want to get back to something that you mentioned earlier, which was when you’re talking about being program director and the sort of simulator endovascular simulator, so endovascular is minor is that when you’re Um, you’re not actually opening the patient up, but you’re just sending your instruments up through their blood vessels.

 

Sharif Ellozy  25:05

Yeah. So endovascular typically is considered a minimally invasive approach to vascular disease. And so, traditionally, you’d have to make an incision over the vessel expose the artery or the vein, clamp it. So to open, you know, take out the blockage or so a bypass that was the traditional open surgical approach. But they have developed over the last, you know, probably now, 50 years, 60 years, alternative techniques to remotely access the circulation through catheters and wires. And so you can put a needle into an artery pass a wire, and pass a tube over that wire, and get two arteries from a remote access. So you go in their groin, or you go in their wrist, and you can access body vessels all throughout the body. And then you can deliver therapy to that area. So either you can open it up with a balloon, maybe place a stent to keep it open, you can seal something off from the inside, if it’s bleeding with coils, or plugs, or, you know, liquid embolic agents like glue, there are all sorts of things you can do remotely, it’s sort of like building a ship in a bottle. And since our patients generally have a lot of comorbid illnesses, like diabetes, high blood pressure, heart disease, they’re they tend to be elderly, being able to offer them a minimally invasive solution that is less stressful for the body is very attractive. And so that’s, you know, that’s really taken off. And that’s become, you know, part and parcel of what we do as vascular surgeons.

 

Will Bachman  26:42

And when you’re operating this and doing the endovascular surgery, is it? Is it a bit like you have this remote control device? Or are you you just sort of push a button and it stitches something up? Or do you actually like using your fingers? And then there’s some glove that detects what you’re doing? And it does that on the other side? Like, how does that how does the interface work?

 

Sharif Ellozy  27:05

So the the simplest things are catheters and wire, so they’re basically tubes, that, you know, so you send a wire through a vessel, and then you can send a tube over it that’s got a shape on the tip, and so you can rotate it, you can change the direction of where the wire is gonna go. There are then devices that like a balloon, you can inflate remotely. So you’re doing it manually, typically, and you’re holding on to the catheter from one end. But they’ve developed alternative things like now they’re, you know, they’ve started develop robotic catheters. So you’re not directly, you know, deforming the tip of the robot, the robot is you’re controlling it, but the but there’s some interface from that from that standpoint, but that hasn’t been as widely adopted in vascular yet as it is, in general surgery. Like you’ll hear about robotic surgery in general surgery, where a lot of the bariatric surgery that surgery for obesity is being done that way.

 

Will Bachman  27:59

Wow. So you now have this endovascular simulator. So you’re you it feels like you’re maybe working on a person, and you’re, you’re kind of pushing up on the catheter, but it’s actually going to person, it’s going to do a simulator device, and you can see stuff on your screen. So you can train people almost like a pilot could train on a simulator.

 

Sharif Ellozy  28:22

Exactly. I mean, that the the pilot metaphor is very apt here. So you know, there’s sort of mission simulation in, in, in amongst pilots, and they can go over certain critical incidents, like a failure of an engine or something like that. And you can do the same thing in endovascular simulation. And so it’s, you know, the endovascular cases are being done under X ray guidance. And so you’ll take an x ray, and you can see what the picture looked like. They can model it so you can get you can show the same pictures. And then you can have certain things happen in the case, like you can rupture an artery and so how do you handle that, you know, you can model things that don’t happen frequently, but you need to know how to handle them. And just like in simulation training for a pilot, the, you know, that allows you to be prepared when something comes something unexpected happens.

 

Will Bachman  29:15

You mentioned earlier, just referring to some individuals as notable vascular surgeons. What makes someone or how does someone become to be a highly regarded vascular surgeon like what are the developments or accomplishments that would lead to renown?

 

Sharif Ellozy  29:36

Sure, probably the most straightforward thing is, you know, people publish their research and so either basic science or clinical research and they publish their outcomes and they can develop, they can influence the development of therapy by by their techniques, and, you know, usually there’s there’s a whole infrastructure in place in terms of meetings. and national meetings and then journal publications. And so people get, get known for that. And they get the develop a reputation for that. And so that’s probably the most traditional way. I think there are people who are also known for their education, for example, if they have trained a number of surgeons who have gone out and you know, practice in the community or across the country, you can get reputation based on being a mentor and training a lot of surgeons. And in the last couple of years, even social media has gained some role in people, you know, advancing their reputation amongst their colleagues.

 

Will Bachman  30:47

Is that right? Is there is there a one or two vascular surgeons that come to mind? Who are social media, kind of stars? I

 

Sharif Ellozy  30:55

mean, there are there are, you know, again, it’s a small community, so your only stars amongst other vascular surgeons, but there are plenty people who are very active on social media. And often that’s how they gain their wider, wider renown,

 

Will Bachman  31:09

famous to the family, what, what are, what are some of the developments over the past couple years that have been exciting to people in the field.

 

Sharif Ellozy  31:19

So I think probably the thing that’s most at the forefront of technology is is is endovascular repair, abdominal aortic aneurysms. So the have developed devices. So you know, we’ve been doing endovascular repair of infrarenal abdominal aortic aneurysm, that means that’s, that’s an aneurysm in the abdomen below the level of the kidney arteries. For I think now, probably about 40 years now I have to double check. But that was first reported by an Argentine surgeon, and it revolutionized the treatment of aneurysms because an aneurysm repair is a very open is a very stressful operation for the patient undergo, and they tend to be an older and sicker patients. And the endovascular approach has now gotten to the point where patients can come in, have it done percutaneously, under local anesthetic, and go home the next day, and really resumed their normal activity almost immediately. But what limits the technology is when you have to maintain blood flow to a branch vessel, so you have the arteries to the kidneys of the arteries to intestines coming off the aorta if the aneurysm involves that area. And it’s a more complex repair, because you’re building a ship in a bar, you’re basically building a ship in a bottle, you’re accessing the artery and passing something from inside and realigning the aorta from within. And you have to maintain blood flow to those branches, while not filling the aneurysm itself. And so they’ve developed devices that have branches in them that have holes, basically, to allow for blood flow to the, to the, to these important vessels without while still excluding the aneurysm. And that requires a level of precision in terms of designing it. So they’re often made custom made for those people or people are starting to, you know, do it themselves. So physicians may end up making holes in the grafts and modifying them themselves. From my standpoint, it’s interesting because sometimes these customized devices, you can do things like you can print out a 3d model of the vessel ahead of time and sterilize it and use that to help in designing your device. And I think that that’s, that’s, that’s interesting stuff. But that’s one example of sort of exciting technology, there are other things like there are ways to treat the vessels going to the brain for stroke, new technologies in that, you know, there’s all sorts of things that are exciting to the like to the to the sort of the nerd and the nerd messengers the technology.

 

Will Bachman  34:18

Okay, that is so cool that you can print a 3d model of that individual person’s artery, would you have to first put some, like, how would you get the data for that?

 

Sharif Ellozy  34:32

So the cat, everybody gets a CAT scan ahead of time and so the CAT scans are very, they’re submillimeter in terms of their resolution, they’re very precise mapping a patient and it basically gives you a three you can you can build a 3d model off of that with their blood vessels, you know, where the, the size of the wall is, you know if there’s any thrombus or clot inside that and you can make your model based off that

 

Will Bachman  34:56

and I’m getting the impression that vascular surgeons with these Like tinkerers, like Yeah. Tell me about this guy is like, sewing up some parachute stuff to us. And people are 3d printing very much vessels at home and poking little holes in the in the devices do you get tell me about the salespeople that come to sell you and on the new tools and that are out there and devices and so forth? How much of your time do you, you know, open up to those sorts of conversations with salespeople? And do you just save your time for big conferences where you can walk around the demo Hall? Or do you occasionally meet with salespeople? And how do you decide which ones to meet with? And so forth? Sure.

 

Sharif Ellozy  35:48

I mean, that that’s a that’s a very tricky question. And it’s an it’s an important question. So just like you said, vascular surgeons are tinkerers, and you have to you have to develop technology to provide solutions that that can help patients, you have to do that in partnership with the in with industry. Because, for the most part, you know, they’re the ones who have the resources to develop new technology. And if you’re using a new device, you also often need their support in terms of, if something is new to you, and you want to make sure it’s safe, you really want to have the benefit of more experience. And so often the device companies will, you know, they’ve, they’ve run the trial, and they’ve seen, you know, hundreds of these cases where this may be, you know, your first case using the device, and so there’s some insight that can be helpful for helping the patient there. But also, their goal is often to sell devices, and you have to, your goal has to be to offer the patient what’s best for them. And so you have to look at everything critically as well. And so I think that there are you develop relations, where you trust the input of certain certain people and you know, it’s it’s sort of a balance, you know, the, the, you know, the, your, you want to be also aware of new technology that comes out and be educated on and if you get if it can offer some value to your patients. But, you know, the, I think you have to have some you have to look at things critically to see if it is really helpful, or if it’s really just something that they’re trying to sell.

 

Will Bachman  37:32

What attracted you to the specialty of vascular surgeon like, when you were in med school, or at the point where you were deciding what kind of surgeon you wanted to be when you grew up? How did you end up where you are? Sure.

 

Sharif Ellozy  37:43

So I, I was general surgery resident, so you know, it was in med school, I liked surgery. I think you always find people that you want to model yourself after. And so when I did my rotations in med school, the surgeons on the general surgery service are the ones I thought were the most sort of dynamic, and they had really great fun to knowledge, they were able to offer the patient, sort of both medical and surgical therapy. And so you were, and the interventions were very dramatic in terms of making people feel better quickly, you know. And so that’s what I liked about general surgery. I didn’t really like vascular surgery, when I was an intern, it tended to have the sickest patients, the often were challenging clinically and getting them better. And it wasn’t that appealing to me. But when I was a fourth year residents and rotating on the services as a senior as a chief resident, I got more of an appreciation for the technical side of the surgery. It’s very gratifying, you know, it’s meticulous, but the and it can be challenging, but that’s that’s part of the, that’s part of the gratification from it. And I got it, and we were doing a lot more endovascular at that point. So I could see the the benefit from these minimally invasive approach offering patients things which they wouldn’t have been able to tolerate an inefficient open approach. And then I found a mentor. And I think that for me, that was the probably the most important thing, always finding people that you want to be like. And so Michael Marion was my he was the chief of the vascular Division at the time. He’s now the chair of surgery at Mount Sinai, but he took an interest in me. And he, you know, his approach to patients I thought was fascinating. There was also Dr. Larry earlier who was the chair of surgery, he was another vascular surgeon there. Both of them were really outstanding clinicians. And at the time, if I wanted to be a vascular surgeon, I would have had to apply through the match. And it would have been, I would have had to defer my fellowship for a year because the timing of it was you know, usually applies a fourth year but But I realized that like I enjoyed vascular surgery but that was passed the the the timing for The application and sort of meant an extra year commitment in terms of training. And it wasn’t really something I was interested in. But Dr. Mayer, and approached me in May of that year, and he said, Look, we went through the match, there was a problem with the match, there’s a spot available, take your time, think about if you want to be our fellow, just get back to me by tomorrow morning. And, you know, it was a one year training at the time, so it was an extra year, and most surgeons are, the thing that I’m most worried about is the possibility of bleeding in the operating room. And so I thought, you know, I’d get excellent training and learn how to handle that, even if I didn’t want to be a vascular surgeon, what’s an extra year of training, and so I took it, and it happened to be a good fit. And just having someone who took an interest in me, you know, like Dr. Mann did was probably the biggest thing that influenced me into going to vascular surgery.

 

Will Bachman  40:50

So interesting how one person can shape your path. I’d like to turn back to college. Were there any courses or professors that you had at Harvard, that continue to resonate with you whether for professional reasons, or purely personal?

 

Sharif Ellozy  41:06

Sure, I mean, you know, it’s interesting, I was a biochemistry major. And I thought it was helpful, because I really enjoyed some of the courses and I got all my pre med requirements done. As part of the requirements for biochemistry, I didn’t have to do a thesis if I want to be honors. And so that was all great, but a lot of a lot of the courses that I really found most memorable, afterwards, were totally unrelated to my major. You know, like, I remember, you know, I had take Chaucer for, I can’t remember what the what the requirement, it was, I think arts and literature, and art and art, exactly arts, or beers and, and it was first time I really, I really, you know, the teacher was able to translate the Middle English, help us get an understanding of any, and I really enjoyed the stories and I started to enjoy my writing a little bit better. And I think that I never really, I was always a science person, I never really appreciated how important being able to express yourself in the written fashion matters, you know, until I got to college. And that’s something that helped me later on. You know, I took ethics, international relations, I thought that was fascinating, even though nothing to do with what I was doing. Professionally, but probably the most impactful course, was course that Arthur Kleinman taught called cultural illness and healing. And so his actually, his daughter was one of our classmates and climate, she was with us in Cabot house. But I think if I remember correctly, he was a sociologist, and a physician, I can remember he was a psychiatrist or an internist. But he was talking about the cultural impact the impact that culture has on being sick and how it affects your identity and also the process of healing and and so it was basically like a sociology course and anthropology course on illness. And they’re even some stuff that I took from that course that I’ve used later on. So there was a book we read called forgiven, remember, which was the was originally the sociology thesis of government, Charles boss, who was a he did his fieldwork in a in the late 60s around time, and Nixon, and at the time, medical errors were really a black box. So you know, we know now about like malpractice issue, there’s a lot of openness about medical errors, but back then, no one really knew what was going on with errors, you know, someone come in and have a complication. And, and, and there was not a lot of openness of discussion, and he wanted to learn how surgeons dealt with error and how they learned from it. And so he basically put on a white coat, and he wandered around the halls with the surgical teams. And he worked as like one of the interns, he helped them change dressings and everything, but he observed the surgeons as part of his fieldwork. And his thesis was, how they deal with error. Andy Devine defined different types of errors and dealing with medical errors is sort of the is the core of professionalism in medicine, because everything goes well, it’s very easy to be professional, but if you have a complication, and you have a patient who’s not doing as well, addressing that, dealing with the family dealing with the patient themselves is the is how you demonstrate professionalism and medicine, you know, and the books are resonated with me and then I was going through med school and I reread it again, with more insight and then residency, I reread it again. And then when I was at Mount Sinai, I ran the surgery clerkship for the medical students. So I was in charge of their their surgery experience. And so I had them read a one of the chapters from this book, which define the different types of medical errors. And then I had them read a chapter from Atul Gawande, his book complications and just use that as a discussion point, like a launching point for discussion on an understanding of profession. wasn’t medicine so that that I think that course probably more than any other courses, one that’s resonated with me since then

 

Will Bachman  45:07

see it the title of that book again,

 

Sharif Ellozy  45:08

forgive and remember. So anybody who’s interested in going and learning about professionals in medicine, it’s a great book. It’s a, it’s it, I think they’ve had they’ve released it with a second edition. Some of the stuff is a little dated, like I said, the work the the work was done in 1969. So some of the attitudes towards women in surgery, maybe a little bit of their time. But but it was really, it’s a really great book.

 

Will Bachman  45:33

Amazing. I love that recommendation. Sharif, if folks wanted to check out your podcast, just find out what you’re doing. Where would you point them online? Any any links or websites that they that you want to share? We can we can put in the show notes? Sure.

 

Sharif Ellozy  45:51

I mean, you know, we have a website for Audible leading, it’s audible leading.com. Actually, let me just let me double check, I’ll pull it up here just to be certain that I’m not miss speaking, but that it’s useful for anybody interested in learning about vascular surgery, learning about the professional development, there’s a lot of stuff that’s you know, as we’ve as we’ve rolled in different people into the podcast, and then we have probably about 30 people developing content, it really is taken on a life. So that’s probably where I would go online. And then, obviously, I’m always happy to reconnect with any of the class members. I’ve got my roommates from college and friends from Cabot house and friends from our year. But you can reach out to me on Instagram or on LinkedIn, I’ll be happy to share my links for those.

 

Will Bachman  46:46

Amazing, thank you. This is a great conversation three, thank you so much for being so patient with my very naive questions and explaining stuff to me and listeners, if you go to 92 report.com, you can sign up for the email. We’ll let you know about the next episode. Sharif, this was a great conversation. Thanks so much for taking the time. Oh, well,

 

Sharif Ellozy  47:07

let me let me thank you. And I really want to actually, thank you for developing this project. I mean, I’ve listened to probably about eight or 10 of the episodes and it’s really nice to hear what our classmates are doing what they’ve gone off to do in life and I really want to applaud you for for for doing this.

 

Will Bachman  47:23

Thank you very much for those kind words. All right. And boom, we can stop the recording. I’ll turn my camera back on that was let’s see here. Capture camera. Turn right. How do we turn up there we go. There we go. Awesome. Great conversation.

 

Sharif Ellozy  47:38

Oh, good. I’m glad you’re here. Let me stop