Vascular surgeon Lynne Henderson Kelley, M.D., began surgery training only a decade ago, and yet, already, the way she works has changed radically.
Kelley entered vascular surgery at a time of transformation, when practitioners were increasingly using less-invasive techniques for treating patients with clogged or weakened blood vessels. No sooner had she finished her fellowship at Mass General a year and a half ago than she flew to France to develop her expertise in endovascular surgery. Practicing these techniques, in turn, has led her to collaborate more and more with interventional radiologists, who not only help diagnose vascular problems but also work side by side with vascular surgeons in the operating suite, supplying what amounts to X-ray vision during surgery. Kelly holds a joint appointment with the Department of Radiology and spends two days a week in the angiography suites performing both diagnostic and therapeutic interventions.
“Vascular surgery is an entirely different specialty now compared to when I entered residency,” says Kelley, who joined the Yale faculty as an assistant professor last February.
Kelley both embraces both the new and traditional approaches while maintaining a healthy degree of skepticism. “You have to have a critical eye,” she says. “Just because we have the new technology, it is not necessarily the better technology.”
Indeed, although surgeons and patients alike are interested in the less-invasive techniques made available by endovascular surgery, its long-term effectiveness has not been methodically compared with that of time-tested open surgery techniques. And so, on the one hand, Kelley is building her skills in endovascular surgery and brainstorming with product engineers to fine-tune the design of implantable grafts (tubes that reconstruct damaged or blocked vessels from within), while on the other hand, she and her colleagues are preparing to join a major study to find out how well one of the new, minimally invasive techniques really works. Yale has applied to participate in a large nationwide trial of carotid stenting, which involves balloon angioplasty and placement of a metal stent into the carotid artery. That study will randomly assign 2,500 patients either to carotid artery stenting, performed through a small incision, or to conventional surgery, in which surgeons open the neck, incise and unclog the artery and then sew it closed. The key question: does stenting prevent stroke as well as open surgery does?
Kelley laid the groundwork for surgical research during medical school at Dartmouth and during a two-year research fellowship at Brigham and Women’s Hospital in Boston. (There she met her husband, independent publisher Charles Kelley, while training for the Boston Marathon, which she completed in four hours and two minutes.)
New techniques, she says, require not only manual skill but also the analytical skills to evaluate them. “Each new advance has to be put in the context of proven treatments,” she says, adding that she enjoys the fast pace of change. “Every day there’s something to learn and see.”