The impact of endovascular procedures on fellowship training in lower extremity revascularization

Nandivada, Prathima; Lagisetty, Kiran H.; Giles, Kristina A.; Pomposelli, Frank B.; Chaikof, Elliot L.; Schermerhorn, Marc L.; Wyers, Mark C.; Hamdan, Allen D.

doi:10.1016/j.jvs.2012.01.082

Cited by 22 publications

(12 citation statements)

References 11 publications

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“…1 The impact of the surgical fellow has been evaluated in different specialties, showing no negative impact in the patients' outcomes. 2,3 On the other hand, the progressive interest of the surgeons toward minimally invasive surgery has opened the doors to more advanced techniques, such as natural orifice transluminal endoscopic surgery (NOTES), 4,5 which has, as its main principle, abdominal access through natural orifices such as the mouth or vagina to avoid abdominal wall incisions and make surgery less invasive. However, the challenge of obtaining access through such organs with no spillage and the closure of the luminal incision remain concerns.…”

Section: Introductionmentioning

confidence: 99%

Impact of Fellowship During Single-Incision Laparoscopic Cholecystectomy

Romero

Arad

Kosanovic

et al. 2014

JSLS

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Section: Introductionmentioning

confidence: 99%

Impact of Fellowship During Single-Incision Laparoscopic Cholecystectomy

Romero

Arad

Kosanovic

et al. 2014

JSLS

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“…The positive correlation between infrapopliteal endovascular and vein bypass operations suggests that those training programs that care for a high volume of patients with infrapopliteal disease treat it more commonly using both approaches. 12,13 Trainees at such programs have greater experience in treating infrapopliteal disease by both methods than do trainees at lower volume infrapopliteal programs. It would be unrealistic to cluster lower extremity procedures by vessel and modality, but we would suggest separating out infrapopliteal interventions for both endovascular and open modalities.…”

Section: Discussionmentioning

confidence: 99%

Vascular fellow and resident experience performing infrapopliteal revascularization with endovascular procedures and vein bypass during training

McCallum

Wyers

Soden

et al. 2018

Journal of Vascular Surgery

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Objective: Endovascular aneurysm repair has led to a significant reduction in vascular trainee experience in the surgical treatment of aortic aneurysms. We sought to evaluate whether the vascular training paradigm or the "endovascular first" approach to lower extremity vascular disease has had a similar effect on trainee experience with infrapopliteal endovascular therapy and vein bypass. Methods: Deidentified data were provided by the Vascular Surgery Board on the number of procedures performed by each 2014 fellowship and residency (0 þ 5) graduate during training. Data were analyzed using parametric and nonparametric methods, where appropriate. Results: Of 125 trainees (109 fellows, 16 residents), 33 (27%) performed 10 or fewer infrapopliteal vein bypasses and 37 (29%) performed 10 or fewer infrapopliteal endovascular procedures during their training. Eleven trainees (9%) performed 10 or fewer of both procedures. There was a positive correlation between number of infrapopliteal vein bypass and endovascular procedures performed (r ¼ 0.19; P ¼ .03). There was no difference between fellows and residents in the mean number of bypass operations performed during training (17.3 vs 19.1; P ¼ .50; range, 0-53). However, residents performed more infrapopliteal endovascular procedures than fellows did (median, 29 vs 16; P ¼ .03; range, 0-128). Conclusions: More than one in four graduates of both training paradigms finish with a low number of infrapopliteal bypasses and endovascular interventions. The number of these procedures needed for proficiency is not known. Vascular surgery training programs should critically evaluate the number of infrapopliteal procedures required to achieve proficiency.

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“…[11] Recent data from the Board of Vascular Surgery suggest that many graduating vascular fellows are not adequately trained in performance of tibial or pedal bypass, which could serve to exacerbate this pattern. [32]…”

Section: Discussionmentioning

confidence: 99%

Regional variation in patient selection and treatment for lower extremity vascular disease in the Vascular Quality Initiative

Soden

Zettervall

Curran

et al. 2017

Journal of Vascular Surgery

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Introduction Prior studies on the cause and effect of surgical variation have been limited by utilization of administrative data. The Vascular Quality Initiative (VQI), a robust national clinical registry, provides anatomic and perioperative details allowing a more robust analysis of variation in surgical practice. Methods The VQI was used to identify all patients undergoing infrainguinal open bypass or endovascular intervention from 2009 to 2014. Asymptomatic patients were excluded. The 16 regional groups of the VQI were used to compare variation in patient selection, operative indication, technical approach, and process measures. χ2 analysis was used to assess for differences across regions where appropriate. Results A total of 52,373 interventions were included (31%). Of the 16145 bypasses, 5% were performed for asymptomatic disease, 26% for claudication, 56% for chronic limb threatening ischemia (CLI) (61% of these for tissue loss), and 13% for acute limb ischemia (ALI). Of the 35,338 endovascular procedures, 4% were for asymptomatic disease, 40% for claudication, 46% for CLI (73% tissue loss), and 12% for ALI. Potentially unwarranted variation included proportion of prosthetic conduit for infrapopliteal bypass in claudication (13–41%, median 29% P<.001), isolated tibial endovascular intervention for claudication (0.0–5.0%, median 3.0% P<.001), discharge on antiplatelet and statin (Bypass: 62–84%, P<.001; Endo: 63–89%, P<.001), and ultrasound guidance for percutaneous access (Claudication: range 7–60%, P<.001; CLI: 5–65%, P<.001). Notable areas needing further research with significant variation include proportion of CLI vs. claudication treated by bypass (38–71%, P < .001) and endovascular intervention (28- 63%, P < .001), and use of closure devices in percutaneous access (claudication 26–76%, P < .001; CLI 30–78%, P < .001). Conclusion Significant variation exists both in areas where evidence exists for best practice and therefore potentially unwarranted variation, and in areas of clinical ambiguity. Quality improvement efforts should be focused on reducing unwarranted variation. Further research should be directed at identifying best practice where no established guidelines and high variation exists.

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The impact of endovascular procedures on fellowship training in lower extremity revascularization

Cited by 22 publications

References 11 publications

Impact of Fellowship During Single-Incision Laparoscopic Cholecystectomy

Impact of Fellowship During Single-Incision Laparoscopic Cholecystectomy

Vascular fellow and resident experience performing infrapopliteal revascularization with endovascular procedures and vein bypass during training

Regional variation in patient selection and treatment for lower extremity vascular disease in the Vascular Quality Initiative

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