Traumatic celiac artery injuries are rare and highly lethal with reported mortality rates of 38–62%. The vast majority are caused by penetrating trauma with only 11 reported cases due to blunt trauma (Graham et al., 1978; Asensio et al., 2000, 2002). Only 3 of these cases were complete celiac artery avulsions. Management options described depend upon the type of injury and have included medical therapy with anti-platelet agents or anti-coagulants, endovascular stenting, and open ligation. We report a case of a survivor of complete celiac artery avulsion from blunt trauma managed by open bypass.

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Background During the COVID-19 pandemic, cardiovascular patients were found to be presenting to hospitals with myocardial infarctions and cerebrovascular accidents at progressed disease states. We noticed a parallel in acute limb ischemia (ALI) patients presenting during Massachusetts’ COVID-19 State of Emergency declaration. We question whether patients developed a hesitancy to seek medical attention at hospitals due to fear of COVID-19. Our objective was to compare acuity of ALI, interventions, and limb survival in patients presenting before, during, and after a state of emergency. Methods Four timeframes were set to compare patients presenting peri-2020 COVID-19 State of Emergency and patients presenting during a pre-pandemic era at a tertiary, academic institution. A reference period from 2019, Pre-State of Emergency period, State of Emergency period, and Post-State of Emergency period were designated. Patient characteristics, interventions, and outcomes data were collected. Unpaired t-test, ANOVA, and Chi-square statistical analyses were used. Results A total of 95 patients presenting with ALI were identified. Compared to Reference group, state of emergency group had more patients presenting with Rutherford Class III, 12.9% vs 35%, and less patient presenting with Class I, 45.1% vs 0%, P = .02. State of emergency group had more delayed presentations with ≥6 hours after symptom onset, 45% vs 85%, P = .01. Above-knee amputations were performed in 20% of patients during state of emergency and 31.6% for Post-State of Emergency, vs 6.5% in the Reference group; P = .03. There was no difference in intensive care unit admission, length of stay, or mortality between patients from different groups. Conclusion During a state of emergency, ALI patients were noted to present later from symptom onset, have greater disease severity, and more likely to undergo amputations. We suspect delay in presentation and limb lost to be attributed to reluctance to seek immediate medical attention.

ACGME) requires evaluation of vascular surgery trainees by Clinical Competency Committees in 31 milestones that are based on six core competencies. This study sought to understand the vascular trainees' perception regarding their education in these milestones and how well they think they are currently evaluated.Methods: We administered an anonymous online survey to 71 trainees at 13 academic vascular surgery programs spanning the country. Trainees were asked about their education, their evaluation for the specific vascular surgery milestones, and their beliefs on how this education should be obtained.Results: The overall response rate was 73%, with 70% of residents and 76% of the fellows responding. Education of milestones within the core competencies of professionalism and communication skills was thought to be predominantly trainee-driven, and the majority of trainees agreed this education should be trainee-driven (P ¼ .54 and P ¼ .77, respectively). The majority of trainees believed education in both practice-based learning and system-based practice milestones is currently trainee-driven; however, the majority of trainees thought these should be attendingdriven (P ¼ .006 and P ¼ .004, respectively). Finally, the majority of trainees believed education in patient care and medical knowledge should be attending-driven, and while the majority of trainees thought their education is currently attending-driven in these two competencies, significantly more trainees thought they should be getting this training from attendings compared with where they actually receive the training (P ¼ .0001 and P ¼ .03, respectively). Eightytwo percent of respondents believe that milestones within the patient care and medical knowledge domains are appropriately and adequately evaluated. Conversely, 69% and 65% of respondents (respectively) believe that milestones within the practice-based learning and system-based practice domains are poorly and inadequately evaluated.Conclusions: When viewed through the lens of the vascular surgery milestones, trainees report a measurable, significant difference in how their education is received and how they think it should be delivered for milestones within four of the six ACGME competencies. Additionally, improved evaluation is needed in milestones within the practice-based learning and system-based practice competencies.