Introducing Cleveland Clinic in Florida’s New Director of Vascular Services

Board-certified vascular surgeon Greg Kasper, MD, FACS, MBA, recently joined Cleveland Clinic’s Heart, Vascular & Thoracic Institute in Florida, where he serves as Director of Vascular Services and the Len Stuart Distinguished Chair in Vascular Surgery.

Dr. Kasper is based in Stuart and practices at multiple Cleveland Clinic locations across southeast Florida. His specialty interests include aneurysm repair, arterial embolism, carotid artery disease, critical limb ischemia, deep venous reconstruction, and lymphedema.

A graduate of the University of Cincinnati College of Medicine, Dr. Kasper completed his residency in general surgery and a fellowship in vascular surgery at Good Samaritan Hospital in Cincinnati, Ohio. He also pursued a fellowship in endovascular procedures at the Arizona Heart Institute in Phoenix and earned an MBA from the University of Michigan Ross School of Business in Ann Arbor.

Dr. Kasper brings three decades of experience in a field of medicine that has changed dramatically during his career. By the time he completed advanced training in 2001, the endovascular revolution was well underway. Just a few years later, in 2005, vascular surgery transitioned from a subspecialty to a distinct specialty of surgery by the American Board of Surgeons.

In this Q&A, Dr. Kasper discusses his goals for vascular services at Cleveland Clinic in Florida, the impact endovascular therapies has had on the field of vascular surgery, and thoughts on the future of vascular health in America.

Q:What leadership experience and approach do you bring to your new role?

A: Early in my career, when I was in private practice in Toledo, Ohio, I was appointed chief of staff for St. Vincent Medical Center. At the time, I was the youngest to serve in that capacity at Mercy Health – Toledo, a seven-hospital system. It was a formative experience and one of the opportunities I had to create a positive culture focused on goal alignment and patient-first advocacy.

I’ve always considered myself a servant leader, where my aim has been to put others in a position to succeed. I also have a passion for trying to make things better. To do so, I believe it’s important to align the goals of the individual with the goals of the organization to achieve a win-win situation for patients. That’s the approach I’ve applied throughout my career.

More recently, I served for nearly a decade as President and Chief Medical Officer of the Jobst Vascular Institute in Toledo, Ohio. It is part of ProMedica, a not-for-profit healthcare system. I was also Vice President of Medical Affairs for ProMedica for five years, including during the COVID pandemic.

Q: What are some of your goals for Vascular Services at Cleveland Clinic in Florida?

A:Delivering a consistent level of high quality care and patient outcomes earns the trust of patients and the communities we serve. I’m really impressed by Cleveland Clinic’s commitment to ensuring that level of consistency across the enterprise, both here in the U.S. and abroad.

My goal is to provide excellent care for patients in Florida by aligning the goals of the physicians who care for our patients – some of whom are employed and some of whom are in private practice – with the organization’s goals. The easy part is that we all want great outcomes for our patients. Achieving that entails adhering to best practices and focusing on quality and outcomes metrics while customizing some of our processes to reflect the uniqueness of each service location. This is a highly collaborative endeavor, and I’m excited to be a part of it.

I’m also very focused on improving patient care through clinical research. I came from an endowed research institute, where we were involved in NIH-sponsored research, including the C-TRACT trial for iliofemoral deep vein thrombosis and the PE-TRACT trial for pulmonary embolism.

I actually lost my brother at 49 to a pulmonary embolism. He was in the hospital when it happened, but the cardiac surgeon wasn’t able to remove the clot. I look at some of the technology and devices that we have available to us now, and there's a chance that he might have had a different outcome if it had occurred just a few years later.

So I’m very motivated. We can't improve and innovate unless we’re asking the question, “Is there a better way?” Here at Cleveland Clinic in Florida, there are opportunities to collaborate on research initiatives with our colleagues in Ohio in addition to launching our own studies. One of my goals is to expand access to clinical trials for our patients in Florida by becoming a sub-principal investigator and site for many of the trials conducted at the main campus.

Q: How has the field evolved during your three decades as a vascular surgeon?

A:I was training in vascular surgery in the 1990s, on the cusp of the endovascular revolution. Early in my training about 90% of my practice was traditional open surgical techniques. By the time I got into private practice, it had morphed and about 70% of my practice consisted of endovascular therapies. That is a huge shift in a very short amount of time.

Endovascular aortic aneurysm repair kicked off the trend, followed by an explosion of lower extremity endovascular interventions for limb salvage, lower extremity pain due to arterial insufficiency, and peripheral artery disease.

I was fortunate during my advanced training to participate in a three-month endovascular fellowship at a top tier institute, where I gained extensive experience in endovascular aortic aneurysm repairs with multiple devices that were primarily being done in Europe. Years later, I was the one teaching these techniques at a facility where we had vascular surgeons from all over the world come to be trained.

Q: What challenges do you see for training future vascular surgeons?

A:I feel very fortunate to have trained at a time when I received solid training in both open and endovascular techniques. I think the generations before and after me have not been as lucky. Having the full complement of tools in your tool chest allows a surgeon to really customize treatment for the individual patient.

During my time at Jobst, I served as Program Director of the Vascular Surgery Fellowship. It was a great opportunity to pursue my love of teaching. Now in my new role, I’m enjoying working with the general surgery residents at Cleveland Clinic Weston Hospital, and I look forward to growing the Vascular Surgery Fellowship Program at Cleveland Clinic in Florida.

There is definitely a need. Today there are fewer training opportunities for open surgery because endovascular therapies are so popular. Future vascular surgeons need access to training programs that offer high volumes of a good mix of open and endovascular procedures.

A lot of the work I’ve done with various professional societies – the Society of Vascular Surgery, the Midwest Vascular Surgery Society, and the Association of Program Directors in Vascular Surgery – has focused on the education and training needs of the next generation.

There's also nothing better than on the job training with an attending that has good experience in both approaches. That’s why my practice has continued to evolve. About 60% of my cases use endovascular therapies. When I work with younger colleagues who know I have extensive experience in open cases, they'll often ask me to assist with their more complex cases.

Q:What innovations are having the biggest impact in vascular surgery?

A:The biggest place we've seen significant growth is treating acute and chronic deep vein thrombosis. The technology has advanced, and we are discovering more and more ways to treat these complex scenarios. Mechanical thrombectomy and deep venous reconstruction are showing significant benefit to short-term and long-term patient outcomes.

Another area where we’ve seen advanced techniques have a real impact is the endovascular revascularization of the leg for limb salvage. With deep venous arterialization, we convert a vein to receive arterial flow. This revascularization can dramatically improve oxygenation of the tissues in the foot, for example, helping patients with diabetic wounds that may not have other revascularization options.

Cleveland Clinic has wound care centers in Stuart, Port St. Lucie and Vero Beach. I'd like to see us grow and expand these services because there's a tremendous need. I have a lot of personal experience in this area, including research involving skin supplements and substitutes that can be applied to help wounds heal quicker.

Q: How has the treatment of carotid artery stenosis evolved?

A:When I was a medical student in the early 90s, I was involved in some of the original carotid artery trials looking at surgery versus medical therapy for preventing stroke. By the end of my training, surgery had won out when a certain level of stenosis or narrowing was involved. Then there were trials comparing stenting to surgery, and after that more trials comparing advanced medical therapies.

Today we have a newer method called TCAR, or transcarotid artery revascularization, where we make a small incision in the neck to insert a stent in the carotid while temporarily reversing blood flow through the vessel to lessen the risk of debris breaking loose and traveling upstream.

All these approaches have gone up against traditional open surgery to clean out the carotid and none of them have as low a risk profile as surgery. While carotid endarterectomy remains the gold standard, the benefit of a bigger tool chest is the ability to customize treatment to the individual needs of the patient.

Q: What concerns you most about the future of vascular care?

A:People are living longer, which is going to create access challenges on the healthcare system and exacerbate the shortage of vascular surgeons in the future. Because we are treating older patients with significantly more comorbidities, we really have to consider how we can get a patient through an episode of care with the least amount of harm while achieving a good outcome for where that patient is in life.

The growing popularity of vaping is another concern. We know that nicotine is a very potent vasoconstrictor; it raises blood pressure and heart rate. We need to better understand the effect of vaping and nicotine on the vascular system, especially the long-term impacts on vessel walls.

Still, it's an exciting time in medicine, and I think we're just scratching the surface of what we're going to see in terms of the impact of GLP-1 inhibitors on overall population health. We're seeing the potential to get some of the endemic obesity under control, which is going to help address hypertension and diabetes in a significant way and have a positive impact on patients experiencing vascular disease.