General Surgery Resident Vascular Operative Experience in the Era of Endovascular Surgery and Vascular Fellowships

Abstract

Advances in endovascular surgery have resulted in a decline in major open arterial reconstructions nationwide. Our objective is to investigate the effect of endovascular surgery on general surgery resident experience with open vascular surgery. Between 2004 and 2014, 112 residents graduated from two academic institutions in Southern California. Residents were separated into those who graduated in 2004 to 2008 (period 1) and in 2009 to 2014 (period 2). Case volumes of vascular procedures were compared using two-sample t test. A total of 43 residents were in period 1 and 59 residents were in period 2. In aggregate, there was no significant difference in open cases recorded between the two periods (84 vs 87, P = 0.194). Subgroup analysis showed period 2 recorded significantly fewer cases of open aneurysm repair (5 vs 3, P < 0.001), cerebrovascular (14 vs 10, P = 0.007), and peripheral obstructive procedures (16 vs 13, P = 0.017). Dialysis access procedures constituted the largest group of procedures and remained similar between the two periods (35 vs 42, P = 0.582). General surgery residents experienced a significant decline in several index open major arterial reconstruction cases. This decline was offset by maintenance of dialysis access procedures. If the trend continues, future general surgeons will not be proficient in open vascular procedures.

Progressive shortfall in open aneurysm experience for vascular surgery trainees with the impact of fenestrated and branched endovascular technology

“…The decline in the number of OARs performed each year has resulted in significant apprehension within the vascular community given an associated link between institutional and individual surgeon case volume and the mortality rate of OAR. 12,13 Furthermore, vascular trainees will have progressive difficulty meeting graduation and minimal yearly competency requirements. Residents have performed progressively fewer open vascular repairs in addition to cerebrovascular and peripheral obstructive procedures in recent years, with case volume compensation occurring by way of open dialysis procedures.…”

“…Residents have performed progressively fewer open vascular repairs in addition to cerebrovascular and peripheral obstructive procedures in recent years, with case volume compensation occurring by way of open dialysis procedures. 13 Data from ACGME case logs show that 5þ2 and 0þ5 program vascular residents logged an average of 12.4 and 11.3 OARs, respectively, from 2014 to 2015 (averages added for unruptured and ruptured cases for both programs as well as chief and junior cases in the 0þ5 program). In the present study, our goal was to establish a predictive model for the effect of endovascular innovation on the average number of OARs performed by vascular surgery trainees.…”

Comparison of Early and Late Post-operative Outcomes after Supra-inguinal Bypass for Aortoiliac Occlusive Disease

“…2,3 This paradigm shift has also affected training programs so that now AFB is hardly performed by the graduating trainees of vascular programs. 1,4,5 Older patients with more advanced comorbidities and diffuse atherosclerosis or a combination of more proximal aneurysmal disease and common/external iliac occlusive disease are still more likely to require open surgical therapy. 6 The anatomical and technical complexity of the disease and the patient's comorbidities may influence the choice for open surgical revascularisation.…”