Venous Endovascular Simulation Training - Initial Observations

Abstract

Endovascular simulation training has been advocated as a method to improve the endovascular skills of interventional trainees but only procedures involving arteries have been reported. We describe our experience in venous endovascular simulation training for performance of diagnostic venography and inferior vena cava (IVC) filter placement. Endovascular simulation performance data on 4 vascular surgery fellows and one radiology resident were evaluated over a 14-month period. Simulated diagnostic and therapeutic procedures were performed in the IVC and renal veins using a VIST endovascular simulator (Mentice Inc., Gotenburg, Sweden). All procedures were proctored by a faculty observer with immediate formative feedback. Internal (simulator based) and external (physician developed) metrics were measured and obtained. Paired Student's t-test was used to compare combined initial (procedure 1) vs. final (procedure 20) performances. A postperformance questionnaire was completed by all of the trainees. 100 simulated endovascular venous procedures were performed. Each trainee performed 20 nonselective cavagrams, 20 selective bilateral renal vein venograms, and 20 IVC filter placements. The Table below lists the values ÷ SD for procedures 1 and 20. Compared to their clinical experience a greater number of simulated diagnostic venous procedures and IVC filter placements were performed (100 vs 25, P<.001). Time to completion for simulated nonselective cavagram, selective bilateral renal vein venography and IVC filter placement decreased significantly from procedure 1 to 20 (P<.05). By procedure 20 total procedure and fluoroscopy times had been reduced by more than 50% (P<.006 and P=.07). Combined wire, catheter, and fluoroscopic errors were significantly reduced by the final procedure (P<.04). Procedural checklist (quantitative assessment) and global rating scale scores (qualitative assessment) were increased significantly by procedure 20 (P<.005) (instructional effectiveness). Questionnaire feedback indicated that venous endovascular simulator training coupled with immediate formative feedback improved endovascular skill sets and should be incorporated into fellow and resident training. The simulation program was reported as being useful for acquiring both basic and advanced endovascular skills in the venous system.TableVariableProcedure 1Procedure 20Total procedure time (sec)2195 ± 4551066 ± 270Total fluoroscopy time (sec)948 ± 435477 ± 82IVC cavagram (sec)487 ± 166187 ± 66Bilateral renal vein venograpy (sec)1265 ± 571450 ± 162IVC filter placement (sec)2029 ± 487989 ± 273Combined errors (#)8 ± 41 ± 2IVC Filter movement (mm)17 ± 157 ± 12Procedural checklist score (max 42)23 ± 541 ± 5Global rating scale score (max 95)41 ± 587 ± 14 Open table in a new tab Initial observations indicate endovascular simulation training improved the skill sets of vascular surgery and radiology trainees performing specific simulated venous procedures (diagnostic venography and IVC filter placement). Endovascular simulation training in the venous system offers an effective method in which to enhance skills training in catheter-based techniques.