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Background: Surgical training is constantly adapting to better prepare trainees for an evolving landscape of surgical practice. Training in vascular surgery additionally underwent a paradigm shift with the introduction of the integrated training pathway now more than a decade ago. With this study, we sought to characterize the needs and goals of our current vascular surgery trainee population. Methods: The Association of Program Directors in Vascular Surgery Issues Committee compiled a survey to assess demographics, current needs, and goals of trainees and to evaluate trainee distress using a validated seven-item Physician Well-Being Index. The survey was distributed electronically to all current vascular surgery trainees and recent graduates in the academic years 2016-2017 and 2017-2018, and responses were recorded anonymously. Results: During the 2 years of the survey, the response rate was 30% (n = 367/1196). The respondents were 55% (n = 202) integrated vascular residents and 45% (n = 165) vascular surgery fellows. In each year of the survey, 60% (n = 102/170) and 58% (n = 86/148) of trainees expressed a desire to pursue academics in their careers, whereas 37% (n = 63/174) and 35% (n = 53/152) indicated their program had structured academic development time (2016-2017 and 2017-2018, respectively). Fifty-five percent (n = 96/174) and 52% (n = 79/152) stated that the overall impact of collaborative learners was positive. More than 60% of respondents in both years of the survey indicated experiencing one or more symptoms of distress on a weekly basis. The frequency of distress was associated with older age and with the presence of an advanced degree in both years of the survey. Sex, level of training, presence of collaborative learners, and having protected research time were not associated with frequency of distress in either year of the survey. Conclusions: These results highlight an opportunity for programs to further evaluate the needs of their trainees for academic development during vascular surgery training to better accommodate trainees' career goals. Further investigation to identify modifiable risk factors for distress among vascular surgery trainees is warranted.

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Endovascular aneurysm repair (EVAR) has reduced perioperative mortality for patients undergoing abdominal aortic aneurysm (AAA) repair despite the increase in elective aneurysm repair for the elderly. However, Medicare will not cover screening for beneficiaries older than 75 years, and AAA treatment in this population depends on incidental detection. Thus, we risk stratified elderly patients undergoing elective AAA repair to identify a subset of elderly patients who would potentially benefit from an expanded screening policy.Methods: We reviewed all patients undergoing elective EVAR in the Vascular Quality Initiative between 2003 and 2017. We used the beta coefficients from Cox regression models to construct a risk model for 5-year survival in patients >75 years old.Results: We identified 26,967 patients undergoing elective EVAR, 11,351 (42%) of whom were >75 years old. Perioperative mortality for the entire cohort was 0.9% (75 years, 0.6%; >75 years, 1.4%; P < .01). Although perioperative mortality varied directly with age, it was only 2.1% in the oldest group of patients (>85 years old). Factors included in our risk model for 5year survival in the elderly included age, aortic diameter, smoking status, white race, body mass index, renal function, diabetes, congestive heart failure, statin use, anemia (hemoglobin level <10 mg/dL), chronic obstructive pulmonary disease, prior aortic surgery, and beta blocker use. Total point values were 0 to 21 and classified patients into four risk categories. The lowest risk group (0-4 points) included 21% of the patients older than 75 years, whose 5-year survival was 89%, equivalent to that of patients younger than 75 years. Less than 1% of patients older than 75 years fell into the highest risk category (15+ points), who experienced 50% 5-year survival (Fig) . Five-year survival in the four risk categories was statistically significantly different (P < .001), with a Harrell C statistic of 0.71.Conclusions: Elective EVAR in the elderly is associated with acceptable perioperative mortality. Our risk score can be used to define optimal patients for expanded screening based on expected postoperative 5-year survival to justify removing this Medicare coverage restriction.

with a median follow-up of 298 days. Across all strata of severity of PAD and type of revascularization, black and Hispanic patients had better survival but worse limb outcomes than white patients after controlling for patient, treatment, and anatomic factors. Blacks had 10%-24% decreased hazard of mortality but 7%-35% increased hazard of MALE and 60%-125% increased hazard of amputation. Hispanics had a 31%-70% decreased hazard of mortality but 13%-46% increased hazard of MALE and 43%-69% increased hazard of amputation. CONCLUSION: Black and Hispanic patients have markedly inferior limb outcomes after lower extremity revascularization compared to white patients but superior overall survival. Additional investigation and novel strategies to minimize racial disparities in limb outcomes are needed.