Managing Vascular Trauma: Trauma Surgeons versus Vascular Surgeons

Abstract

Objectives Changes in vascular trauma care and trainee exposure to vascular surgery have raised questions regarding who should take care of vascular trauma patients. This study aimed to determine nationwide trends and perceptions regarding the management of vascular trauma amongst vascular and trauma surgeons. Material and Methods Online surveys were administered to trauma surgeons through the American Association for the Surgery of Trauma (AAST) and to vascular surgeons through the Vascular and Endovascular Surgery Society (VESS) and Western Vascular Society (WVS) in February 2021. Demographics, practice-related information, and interest in, experience and comfort level with vascular trauma were queried. Trainees and those practicing outside the United States were excluded. Results were analyzed using Stata/BE v16.1. Results 247 surgeons were included in the final study population, of which 163 (66%) were trauma surgeons (T) and 84 (34%) were vascular surgeons (V). Vascular surgeons were younger (46 v 51y, P < .001) and had fewer years in practice (10 v 17y, P < .001). Vascular surgeons had greater experience and comfort with managing vascular trauma, but less interest in both vascular and endovascular trauma care when compared to trauma surgeons. Inability to maintain skillset (27%) and unfamiliarity with techniques (32%) were the most common barriers to practicing vascular trauma cited by trauma surgeons. Discussion Despite significant interest in practicing vascular trauma amongst trauma surgeons compared to vascular surgeons, most feel unprepared to do so. Collaboration between vascular and trauma surgeons could close the experience gap and appeal to the interests of both groups.

Emergency vascular repairs in trauma: Predictors of poor prognosis and a novel scoring system

“…However, by 2015, only 70% of graduating general surgery residents were comfortable performing a vascular anastomosis, and by 2022, 64% of trauma surgeons and 89% of vascular surgeons responded that modern trauma surgeons were not trained for/capable of operative management of vascular trauma. 10 Despite these survey results, a 2022 study by Karam et al 18 noted equivalent outcomes between femoral and brachial artery repairs by trauma surgeons and vascular surgeons. Their group stated that trauma surgeons are able to safely repair some infrainguinal arterial injuries, and vascular surgery should be consulted for "select cases," although criteria for consultation were not defined.…”

“…Vascular surgeons managed more complex repairs in our study, and 84% of trauma surgeons and 99% of vascular surgeons believe that vascular surgeons are better suited to manage vascular injuries at specific locations. 10 However, the decision to consult vascular surgery needs to be data driven to give trauma surgeons the confidence to manage lower-risk injuries and preserve their skill set while protecting vascular surgeons, who are less interested in trauma, from overutilization. 10 The UT Houston Score may be a reasonable way to protocolize risk-stratified vascular surgery consultation.…”

“…8 Subsequently, the expansion of vascular-only training programs and fewer total number of open vascular procedures have threatened the volume and confidence of residents, vascular fellows, and general surgeons performing vascular repairs. [9][10][11] Vascular trauma has become more regionalized, with 99% of vascular procedures performed at level I/II trauma centers. 3 Meanwhile, over half of trauma surgeons report performing vascular interventions less than once a month, and nearly 30% report an inability to maintain their vascular trauma skillset.…”

Epidemiology and outcomes of traumatic vascular injury repair by trauma surgeons and vascular surgeons in a collaborative model

“…In addition, there has been a decline in the share of vascular trauma primarily managed and repaired/reconstructed by trauma surgeons (TS), and thus decreased exposure among surgeons completing trauma fellowship training 12 . Many TS currently feel unprepared to manage vascular trauma compared with VSs, despite maintaining a significant interest and preference to do so 13 …”

“…12 Many TS currently feel unprepared to manage vascular trauma compared with VSs, despite maintaining a significant interest and preference to do so. 13 The responsibility for vascular trauma evaluation and management is highly variable across the United States due to trauma center organization, subspecialty staffing, credentialing and local vascular trauma protocols, as well as individual surgeon comfort and skillset. 2 There is also significant heterogeneity in terms of volume of cases, skills and duties among the surgeons involved.…”