Anthony Comerota, MD, accepted the Career Achievement award on Wednesday morning at ISET. The award is a tribute to Dr. Comerota’s many accomplishments in his 37 years of clinical and research experience, including serving as principal investigator of 7 major national trials and co-investigator on others.
Dr. Comerota wanted to be a physician from an early age and specifically sought a field with a surgical component, ultimately choosing vascular surgery after his first clinical rotation. “It was not a difficult decision,” he said. “The technical components of vascular surgery were very attractive, the clinical outcomes were evident, the level of gratification was enormous, and we had the opportunity to manage the full spectrum of vascular disease.”
Pioneering innovative techniques to improve patients’ outcomes has been especially gratifying to Dr. Comerota. One memorable case involved a young woman with a large thoracoabdominal aneurysm. Dr. Comerota was concerned that she would end up paralyzed, but he performed an axillofemoral bypass, thus permitting normal perfusion to the mesenteric arteries, renal arteries and the lower extremities and thereby avoiding intestinal, renal, and lower extremity ischemia. “The outcome was very good,” he said. “She did very well postoperatively and this approach became a standard for us in the management of thoracoabdominal aneurysms.”
Opportunities for collaboration were very important in challenging cases. For example, patients with postthrombotic iliofemoral and vena caval occlusion are often disabled due to severe lower extremity venous hypertension. Collaboration with colleagues in interventional radiology allows re-establishment of unobstructed flow from the common femoral vein to the vena cava, Dr. Comerota explained. This can be life changing for patients so affected.
“One of the characteristics of our profession is you have the opportunity to interact with excellent individuals, who show their deep concern for others,” he commented.
Throughout his career Dr. Comerota has also collaborated with colleagues from the Sol Sherry Thrombosis Research Center to conduct numerous original investigations establishing the mechanisms and benefits of antiplatelet medications, anticoagulants, and various treatments involving thrombolytic therapy. Most recently, Dr. Comerota’s research has focused on the venous system. Efforts in the postthrombotic venous system have led Dr. Comerota and colleagues to learn that postthrombotic veins can be opened and recanalized successfully.
Dr. Comerota also recently was a steering committee member of the ATTRACT trial, a large NIH-funded randomized trial demonstrating that patients with iliofemoral venous thrombosis will benefit significantly from strategies of clot removal versus anticoagulation alone. The overall results from the ATTRACT trial were published in December 2017 in the New England Journal of Medicine, and Dr. Comerota expects the analysis of the patients treated for iliofemoral DVT to be published within the next month.
Dr. Comerota’s research efforts and clinical experience have been driven by a desire to better understand the reasons underlying patient care decisions. “There ought to be an objective explanation for the procedures we do and the medications that we give. If we cannot articulate why a particular treatment has benefits, then we don’t adequately understand the mechanisms involved leading to patient benefit….or harm,” he said. He added, “Thinking through patients’ problems pathophysiologically, and how best to normalize physiology, generally will lead to the best long-term outcomes.”
Helping the next generation of physicians, nurses, and technologists to properly approach clinical problems is “a great opportunity,” said Dr. Comerota. He has attended and participated in ISET as a faculty member for many years and considers it one of the outstanding forums for education. Mentorship also makes a lasting impact, he noted. One of Dr. Comerota’s mentors was the director of his fellowship program, Dr. John J. Cranley, whose philosophy and character profoundly influenced Dr. Comerota. “Dr. Cranley always sought to do what was right for the patient. He was 100% honest and supportive, ethical and respectful. He had enormous energy and an enormous impact.”
The encouragement of family was also key in facilitating Dr. Comerota’s success. “The support I had at home from my wife, Elsa, and my three children, Anthony, Maya, and Mark, was critically important. I wouldn’t have been able to have the career that I’ve had without them,” he said.