The endovascular performance spectrum of vascular surgery departments in Germany: Results of an online survey among senior department physicians.

T Schmitz-Rixen,G Torsello,M Steinbauer,R T Grundmann

doi:10.1007/s00772-016-0157-3

Abstract

AimTo survey the scope of vascular surgery services in Germany.MethodA total of 308 senior German vascular surgeons received a 19-point questionnaire pertaining to department structure and scope of services. Of these surgeons 223 replied between 16 August 2015 and 23 October 2015 (response rate 72 %), with 62.2 % reporting an additional qualification as an endovascular surgeon according to the guidelines of the German Society for Vascular Surgery and Vascular Medicine (Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin, DGG) and 43.5 % as a DGG® endovascular specialist.ResultsThe number of respondents fully authorized to train in vascular surgery was 71.3 %, while 28.3 % were authorized for limited training. Authorization as a DGG® endovascular surgeon was reported by 24.2 % and authorization as a DGG® endovascular specialist by 17 % of respondents. All respondents performed endovascular interventions on pelvic vessels and 99.1 % also reported carrying out femoral and popliteal endovascular interventions. Endovascular procedures in crural vessels were carried out by 90.1 % and 93.7 % of vascular surgeons performed endovascular procedures in the region of the abdominal aorta (segment V), arteriovenous (AV) fistulas and shunts (85.2 %), upper extremity vessels (80.3 %), the thoracic aorta (segment III, 68.2 %), renal arteries (62.8 %) and visceral aorta (segment IV, 60.5 %). In all 43.5 % of respondents reported experience with endovascular procedures on the carotid bifurcation. Percutaneous arterial procedures formed the focus of endovascular activity, totalling on average 259 interventions per year and department, followed by diagnostic angiography (without intervention) at 166 procedures per year and hybrid arterial interventions at 141 interventions per year.ConclusionThis survey revealed a high level of endovascular expertise among vascular surgeons in Germany. This applies not only to the scope of endovascular activities in diagnosis and treatment but also to the number of estimated annual procedures.

Highlights

Background and objectiveEndovascular interventions have become part of the standard repertoire of vascular surgeons
The CRITISCH study [2], which was supported by the German Society for Vascular Surgery and Vascular Medicine (Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin, DGG), recently showed that endovascular treatment was the preferred approach in critical limb ischemia (CLI), representing the treatment of first choice in 53.4 % of cases, followed by bypass surgery in 23.7 %
Between 16 August and 23 October 2015 a total of 308 senior vascular surgeons were surveyed on departmental structure and scope of services using a 19-point questionnaire

Summary

Introduction

Background and objectiveEndovascular interventions have become part of the standard repertoire of vascular surgeons. Sachs et al [1] identified 563,143 patients in the nationwide inpatient sample (NIS), representing a sample of approximately 20 % of all hospitalizations in the USA who underwent interventions for intermittent claudication (IC) or critical limb ischemia (CLI) in the period between 1999 and 2007. Of these patients 218,655 (38.8 %) were treated by an endovascular procedure, i.e. percutaneous transluminal angioplasty (PTA) and stent, 280,021 underwent peripheral bypass graft (49.7 %), 36,307 (6.4 %) aortofemoral bypass and 5.1 % a hybrid procedure. The statistics for 2013 show 40,668 arteriograms of neck vessels, 77,140 of abdominal vessels, 138,860 of pelvic vessels, 159,990 of lower extremity vessels and 43,668 super-selective arteriograms, excluding coronary angiograms

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Conclusion