6 May 2021

Hear from Prof Bijan Modarai [pictured below] on the importance of bringing surgeons and academics together across King’s Health Partners to discuss innovative ideas.

Prof Bijan Modarai is Professor of Vascular Surgery at King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, King's College London Chair in Vascular Surgery, and a British Heart Foundation Senior Clinical Research Fellow.

We took five minutes to learn more about his work and role in King’s Health Partners Academic Surgery – a new programme that brings surgeons together across our partnership to collaborate in surgical science and improve education for future surgical trainees.

What is your current role and what can you tell us about your career up to this point?

I am Professor of Vascular Surgery at King’s College London and Guy’s and St Thomas’ NHS Foundation Trust and a British Heart Foundation Senior Clinical Research Fellow.

I completed my Basic Surgical Training at Guy’s and St Thomas’ NHS Foundation Trust before being awarded a British Heart Foundation Clinical PhD Studentship in 2002. I graduated with a PhD in Biochemistry in 2006 and completed a Higher Surgical Training as a National Institute for Health Research (NIHR) Academic Clinical Lecturer at King's College London and as an Endovascular Fellow at The Royal Prince Alfred Hospital in Sydney.

I was appointed as a Senior Lecturer in Vascular Surgery at King's College London and Honorary Consultant Vascular Surgeon at Guy’s and St Thomas’ NHS Foundation Trust in 2012, having secured a British Heart Foundation Intermediate Clinical Research Fellowship.

What do you think the opportunities and benefits are of bringing together clinicians and academics in your surgical field?

As a King’s College London appointed British Heart Foundation Senior Clinical Research Fellow, it is very important that any academic outputs are delivered into clinical practice. As an academic, you have to prioritise and make sure you deliver the academic outputs, along with supporting people in your academic discipline. I work with a sizeable team of scientists at predoctoral and postdoctoral level, and also clinical academics, clinical fellows and clinicians aiming to do PhDs.

At the same time, it is vital to put patients first by excelling as a clinical surgeon. That means, for me, I focus my clinical work in one particular specialty area. I am fortunate to have a profile for my clinical as well as my research work. That has been made possible by the fact that I have focused on endovascular treatment of the aorta. This is an exciting field in vascular surgery. It is a technical field, which pertains to imaging and allows a focus on a specific clinical area that our department excels at, for which we have an international reputation.

Can you tell us more about your involvement with our Academic Surgery programme?

This is a fantastic initiative and Prof Prokar Dasgupta, Professor of Surgery, King’s Health Partners, is to be congratulated for raising the profile of surgery and academic surgery within King’s Health Partners. The fora established allow us to interact with others across King’s Health Partners. The initiatives that Prokar has set up, including the meetings we have had as groups of surgeons to outline what we all do, including the King’s Health Partners Surgical Grand Rounds, allows exposure to each other and excellence that there is in clinical academic surgery at King’s Health Partners.

It also allows us to project a profile internationally and to invite our international colleagues to interact with us. Since we have done the surgical grand rounds, I have had colleagues contact me from across the globe, who have said that they have been made aware of the grand rounds through social media, they have watched episodes, and they are looking to instigate similar series in their own institutions, because it is such an important initiative. I think a lot of this will go a long way to cement the expertise that we have at King’s Health Partners. The goal has to be to increase the academic impact that surgeons have, to produce translational, surgical research, that is very high impact and meaningful. That’s what we should be striving to produce and I think what Prokar is doing will go a long way towards that. 

How has your field changed over the past few years, and more recently, as a result of COVID-19?

Vascular surgery is becoming more minimally invasive.

Historically, vascular surgery was mainly done by using maximally invasive surgery, such as open surgery to the aorta. Over the past decade, one of the obvious advances in vascular surgery is we are increasingly able to treat using minimally invasive endovascular techniques under x-ray guidance. It does not mean that every patient is suitable for it, but it has increased our treatment options and we are one of the main locations in the world that is able to do these kinds of advanced endovascular treatments. As the endovascular devices used for minimally invasive surgery evolve over time, the applicability of this technique will increase even more. 

Emergency work continued during COVID-19.

As a result of COVID-19, we have been disrupted, as much as anyone else has. 50% of vascular surgery is an emergency discipline, so we had to do what we could to manage the emergency presentations safely and operate when necessary. Our elective surgeries were also delayed, colleagues did a lot of work trying to facilitate those elective surgeries that were delayed, and we are currently in the process of working through the backlog.

We lent on our research expertise to repurpose our research for COVID-19 patients.

We were also able to continue some of the research applicable to COVID-19, during the COVID-19 period. One of the compelling things that we have managed to do is to repurpose a piece of translational research, that we have been doing for the past decade, in using cells to grow new blood vessels in legs that have peripheral arterial disease - a common condition where a build-up of fatty deposits in the arteries restricts blood supply to leg muscle. The repurposing relies on the fact that these cells are also anti-fibrotic, and fibrosis is a significant problem that affects the lung after COVID-19 infection.

Mr Ashish Patel, Clinical Senior Lecturer in Vascular Surgery at King’s College London and Consultant Vascular Surgeon, has been spearheading a first in man clinical study of these cells in patients with lung fibrosis after COVID-19.  This study, funded by King’s Health Partners and the Rosetrees Trust, started in late March 2021.

What do you think the next few months and years holds for your work?

We are in a unique position to deliver clinically impactful research that directly addresses the needs of the vascular surgical patient, our niche. We do that by using translational basic science expertise - the marker for what our success in the past been.

The next few years will allow our team to push forward novel diagnostic and treatment strategies, in treatment of the ischemic limb, including using advanced therapeutics and advanced imaging techniques to improve the treatment of these patients. Another aspect for the future of our work is to refine the treatment of aortic aneurysmal disease, improving devices, improving the selection of patients and preventing complications.

One of the areas that we are increasingly learning about is the damage caused by radiation exposure during x-ray guided procedures, so we are doing some work to understand the biologic consequences of that in both the operators and the patients. This ties in with the endovascular interventions that we perform to treat vascular disease.  

We also work in the area of venous disease, an area of vascular surgery that is rapidly evolving, including novel diagnostic and treatment strategies. Colleagues who lead this work at King’s Health Partners include Prof Alberto Smith who is  Professor of Vascular Sciences, Mr Prakash Saha, Senior Lecturer in Vascular Surgery and Consultant Vascular Surgeon and Prof Stephen Black, Professor of Venous Surgery.

What advice would you give to aspiring surgeons in your field?

The advice I would give is to have ambitions and goals and be focused, you cannot be a jack of all trades. You need to focus on a particular clinical and academic area that you want to excel in. Mentorship and advice are very important. At the end of the day, you are the one to make the choice, but having varied mentors and advice is incredibly useful. Do not be afraid of approaching people. We like people who are ambitious and driven, and we like to help them. Make sure that you approach people and let them know about your intentions and your ambitions. Be kind and respectful and work well within a team. Do not be impatient. If you are good, the cream always rises to the top and you will get there if you bear all that in mind.

Want to benefit from King’s Health Partners Academic Surgery? Take a look at our new website detailing its key areas of focus.