Trends in endovascular surgery training.

Abstract

To gather vascular surgery fellows' opinions on various issues related to endovascular surgery (EVS) over a 2-year period and analyze the responses to identify trends in EVS training. Vascular surgery fellows in 2 consecutive years were given a 2-page questionnaire inquiring about training protocols and local practice habits. Respondents included 64 vascular fellows from the academic year 1998-1999 (F98) and 52 vascular fellows from the academic year 1999-2000 (F99) (78% men in the entire population; mean age 34 years), representing a significant fraction of trainees in North America. Data from F98 and F99 were compared and analyzed. The majority (66%) of vascular surgery fellows were trained at university hospitals and performed EVS at the time of the survey: 83% in the F98 class and 92% in the F99 group (p=0.17). Utilization rates among the 9 interventions surveyed ranged from angiography (83%) and angioplasty (77%) to intravascular ultrasound (33%) and atherectomy (15%). Performance of endovascular grafting significantly increased among trainees (50% versus 81%, p<0.005), while atherectomy and angioscopy decreased. EVS performed in the operating room with portable imaging equipment decreased (67% versus 42%, p=0.02) as access to the radiology and cardiology suites increased. In most communities (63%), radiology specialists performed most of the EVS procedures, but the portion of communities where vascular surgery performed the majority of EVS procedures increased from 20% to 35% (p=0.10) from F98 to F99. Responders (90%) believed that EVS would become a major component of vascular surgery and comprise 30% of their future practice. The proportion of fellows who believed they were sufficiently trained in endovascular techniques increased from 30% to 50% (p=0.04), with the remainder willing to devote a short period (<3 months) for further training. The vast majority of vascular trainees perform EVS and believe that it will have an increasing role in their practice. Trends include increased endovascular grafting and performance of EVS by vascular surgeons in interventional suites.