Primary Aortic Coarctation Diagnosed in the Older Patient: Endovascular Treatment With Thoracic Covered Stents

Abstract

Objectives: This study determined the construct validity of a novel basic endovascular skills challenge on a virtual reality simulator. Methods: Subjects completed a basic endovascular skills challenge on the Simbionix ANGIO Mentor. The subjects were divided into three groups based on endovascular experience:novice (medical studentsandpostgraduate year1 surgery residents), intermediate (vascular surgery residents postgraduate year 2-7), and expert (vascular surgery faculty). Each task requires advancing a wire, catheter, and sheath to predetermined positions in a virtual vascular tree. The challenge is divided into five cases. Case 1 contains five tasks. Each subsequent task ismore complicated than the previous task. Time to completion and points (generated by the simulator) were compared for case 1 (tasks 1-5). Time and points were compared with each other to determine construct validity. Results: Twenty-two subjects (11 novice, 6 intermediate, and5 expert) completed the simulation.One-way analysis of variancewas computed for time to case completionwith the group as the independent variable. The result was statistically significant (P< .05). The results of the Tukey least significant difference post hoc test showed that the novice group was significantly different from the other two groups, which did not differ from one another. One-way analysis of variance was also computed for points accrued for case completion with the same groups. The result was statistically significant (P< .05). Post hoc tests were also computed for the groups, and the results were similar to those for seconds to completion. The novice group earned fewer points than the other two groups, which did not differ from one another. A scatterplot of seconds by points for the case reveals a strong but nonlinear association that is to be expected from the scoring method that assigns points by time. Conclusions: A novel endovascular skills challenge on the Simbionix ANGIO Mentor is able to differentiate novice from intermediate and expert operators.