Training in Vascular Surgery in Europe – the Impact of Endovascular Therapy

Abstract

Vascular Surgery has been defined by the Division in endovascular procedures not part of the curriculum, while in U.K. it is not mandatory. Training in endoand Board of Vascular Surgery of the Union Europeenne des Medecins Specialistes (UEMS), as the clinvascular surgery is mandatory in the other 12 countries, and in 9 of these, vascular surgery is an ical and scientific discipline concerned with the diagnosis, treatment and prevention of diseases afindependent specialty. These variations can be looked upon as weakness by some but as a strength by others. fecting arteries, veins and lymphatics. Modern vascular surgery took off as a dynamic and It seems that the vascular surgical community in Europe has to come to terms with some facts of life: rapidly evolving branch of general surgery in the 1950s largely due to technological developments in (1) Conventional percutaneous balloon angioplasty prosthetic grafts by the textile and polymer industries. (PTA) is now an established therapeutic modality. The recent introduction of endovascular techniques (2) The volume in absolute and relative terms of endoand devices has raised the question of whether vasvascular prostheses for aneurysmal and arterial cular surgeons should become involved with this new occlusive diseases is small despite its prominence technology. The answer comes from the past and the in the literature. origins of our specialty. Vascular surgeons were the (3) Endovascular procedures are currently performed first to adapt to new ideas and technological inin too many centres and in too small numbers per novations and it seems absurd to back away from centre. endovascular techniques just because they were not (4) Endovascular AAA repair is still an experimental taught to us during training. There are parallels here procedure with unknown long-term clinical with laparoscopic surgery: most surgeons undertaking results. laparoscopic procedures learned the technique after their initial training. Specialties should be based on For open vascular surgical procedures it is well body systems and diseases, not on treatment modestablished that surgeon and hospital volume are asalities. sociated with better outcomes for patients who unThe current status of training across the EU and dergo carotid endarterectomy and AAA repair both the involvement of vascular surgeons in endovascular in U.S.A. and Canada. In the same studies, cerprocedures are shown in Table 1. This shows the tification in vascular surgery was associated with statresults of a survey conducted in April 2001 among the istically better outcomes following AAA repair national representatives of the European Board of compared to non-certification in vascular surgery. Of Vascular Surgery (EBVS). We can see that in only three course, certification does not guarantee that a surgeon countries (Denmark, Ireland and Norway) is training will perform a better operation compared to a noncertified colleague. However, it does indicate that the individual has gone through a period of dedicated ∗ Please address all correspondence to: C. Liapis, 131, Vas. Sofias Str., 11521, Athens, Greece. training in a structured training programme. Why then