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Results: Overall, 190 procedures were performed by 7 vascular surgeons at 3 institutions between 2013 and 2017. The mean procedural time for all cases was 68.9 6 9.5 minutes (Fig). When the procedural time of cases 1 to 10 (mean, 74.8 6 9.6 minutes) was compared with that of cases 11 to 50 (mean, 67.5 6 9.0 minutes), a significant difference was noted (P ¼ .014). ANOVA results between all bins of procedural times showed that the first 5 cases were statistically longer than cases 31 to 50. Mean flow reversal time was 9.7 6 3.5 minutes. When flow reversal times were compared using ANOVA testing, cases 1 to 10 were statistically similar and all cases within 11 to 50 were also similar, but the two groups differed from each other (P < .001). For flow reversal time, the first 10 cases had mean reversal times of 14.5 6 3.7 minutes compared with 8.6 6 2.3 minutes for cases 11 to 50 (P < .001). Patients of cases 1 to 10 experienced postoperative stroke (2/68 [2.94%]) not significantly different from patients of later cases (1/122 [0.82%]; P ¼ .292; Table). Similarly, postoperative mortality rates were similar in the <10 and >10 case groups (1.47% vs 1.64%; P ¼ 1.00). All three strokes and two of the three deaths (both in cases 11-50) occurred in symptomatic patients, which represented 42% of the overall cohort. Conclusions: A learning curve does exist for the TCAR procedure, but it is relatively steep. After 10 cases, surgeons are able to reduce procedural times by 10% (74.8 to 67.5 minutes) and, more important, flow reversal times by an average of 40% (14.5 to 8.6 minutes). The critical steps in the TCAR procedure may be easily adopted by a broad group of vascular surgeons learning this technique.

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communities also had a higher rate of loss of primary patency (36% vs 28%; P ¼ .04) and occlusion (21% vs 14%; P ¼ .003).Conclusions: Infrainguinal bypass patients come from disproportionately distressed communities. These patients have an increased rate of major adverse limb events that persists long term. Socioeconomic drivers are a key component in vascular disease that have the potential to impact outcomes. These differences warrant further investigation into mitigating the increased risk of adverse events.