Endovascular Simulation Research Articles

Comparing the Efficacy of Endovascular Simulation Training in Different Training Formats: A Randomized Controlled Trial

High-fidelity endovascular simulators have demonstrated significant potential in enhancing interventionalists' performance metrics, including procedure time (PT), fluoroscopy time (FT), and contrast volume (CV) usage. However, it is less clear whether trainee performance, when assessed using both multidimensional global and procedure-specific rating scales (PSRS), improves in a manner consistent with these metric parameters. This study aimed to determine whether the structure of the training-conducted in block sessions or weekly intervals-impacts the effectiveness of the training. Twenty students were enrolled in this prospective, randomized, controlled, single-center trial. They were randomly divided into block and weekly training groups, each undergoing 6hrs of supervised endovascular training on a Mentice simulator over a span of 3weeks. At the outset and conclusion of their training, students performed a predefined peripheral endovascular intervention, which was assessed by an experienced interventionalist. Furthermore, participants were prompted to complete a survey at both the beginning and the end of the study. Both groups exhibited significant improvements in PT, FT, CV usage, global rating scale (GRS) scores, and performance-specific rating scale scores. However, no significant difference was observed between the 2 groups. The simulator training notably boosted the trainee's self-confidence. Simulator training not only enhances metric performance parameters but also improves performance as assessed by both GRS and PSRS. Whether the training is conducted in block sessions or weekly intervals did not affect its efficacy. As such, the training format can be tailored to best fit the specific circumstances and setting.

Remote feedback in endovascular simulation training: a mixed-methods study

BackgroundThere is an increasing need to increase simulation-based learning opportunities for vascular surgery residents in endovascular skills training. This study aims to explore the effectiveness of remote expert instructional feedback of endovascular simulation-based education, as a means of increasing training opportunities in this area for vascular surgery residents.MethodsA mixed-methods study design was adopted. Twelve vascular surgery residents from Ireland were tasked with completing two endovascular renal artery procedures: one with in-person expert feedback and the other with remote instruction. Participants ranged in experience levels from second year to final year of residency. Following the training activities, interviews and a questionnaire were employed to gather information on the usefulness of remote feedback.ResultsThere was no significant difference reported by participants using a post-event validated questionnaire between remote and in-person feedback. During the interviews, participants expressed mixed feelings about the presence of the educator while practicing, but they eventually saw no limiting factors to their practice when the trainer provided remote feedback. When receiving performance feedback remotely, clear communication and a shared knowledge of the task development are critical to success.ConclusionsWe believe these findings can inform the design and development of remote learning and assessment of endovascular skills training and ultimately provide increased opportunities for more skills practice for vascular surgical residents.

Early Results of a Randomized Trial on the Use of 3D-Printed Models for Endovascular Planning and Simulation in Patients Undergoing Peripheral Angioplasty

Early Results of a Randomized Trial on the Use of 3D-Printed Models for Endovascular Planning and Simulation in Patients Undergoing Peripheral Angioplasty

Face, Content, and Construct Validity of a Low Cost and Open Source Endovascular Simulator

Face, Content, and Construct Validity of a Low Cost and Open Source Endovascular Simulator

The changing face of surgical education: transfer of surgical and endovascular knowledge to young surgeons.

The goal of vascular surgery education is to provide the best possible training to vascular residents and fellows and to assure the highest standards of care for patients with vascular disease. In the USA, the currently used Vascular Surgery Milestones Program includes milestones as set targets at five levels, from novice to expertise, to assess the trainees' performance in knowledge, skills, attitudes, and other attributes of competencies. Competencies are broad and foundational domains of ability, the most important being the care of the patient. The soon to be introduced Entrustable Professional Activities (EPA) Project, a competency-based assessment, appears to be the best way to evaluate that trainees are ready to practice independently. Transferring surgical and endovascular skills to trainees has been, however, a challenge, because of the decreased number of open surgical procedures, the increasing number of the endovascular interventions, the decreased work hours for residents and that learning on patients in the operating room is no longer acceptable. Simulation laboratories, using 3D reconstructions of real patient's aneurysms has been most helpful to teach even complex endovascular procedures. In open or endovascular simulation laboratories, deliberate practice with focused attention and specific goals of improving performance should be combined with expert feedback. Greatness is not coded into our DNA but comes from deliberate practice, dedication and perseverance.

Validating a 3D-printed endovascular simulator for use in training surgical residents

ObjectiveThree-dimensional (3D)-printed endovascular models can be an accessible alternative to expensive, state-of-the-art endovascular simulators but currently lack the rigorous validation needed to be dependable educational tools. This study describes the manufacture of a 3D-printed endovascular model of an aorta and determines the construct validity and preliminary content and face validity of the model. MethodsA 3D-printed aorta was created using segmented data from a patient computerized tomography scan and a FormLabs 3B 3D printer with FormLabs Clear resin. Participants were asked to perform two tasks from a femoral access point: catheterize the contralateral common iliac artery and the superior mesenteric artery. Participants were assessed for task completion, technique, and time. Performance was compared between levels of education (medical student vs lower-year resident vs upper-year resident vs attending) and levels of endovascular experience (<5 procedures vs 6-20 procedures vs 21-100 procedures vs >100 procedures). Users completed questionnaires assessing the face and content validity of the simulator after their participation. Results48 participants were recruited (12 medical students, 19 lower-year residents, 13 upper-year residents, and 4 attendings). Of these, 26 participants had performed <5 procedures, 10 had performed 6 to 20 procedures, 7 had performed 21 to 100 procedures, and 5 had performed >100 real-world procedures. Neither education level nor experience level correlated with task completion. Increasing levels of training progressively increased rates of correct technique for both tasks combined (8% vs 21% vs 46% vs 75%, P = .032) and decreased cumulative time (307.3 vs 252.2 vs 185.8 vs 139 seconds, P = .005). Similarly, increased levels of experience progressively increased rates of correct technique for both tasks combined (7% vs 50% vs 71% vs 80%, for increasingly experienced groups, P < .001) and decreased cumulative completion times (276 vs 237 vs 187 vs 113 seconds, P = .003) for both tasks. Multivariate analysis showed that training level was not a predictor for time taken to complete any task, while experience level was a predictor for superior mesenteric artery cannulation time (P < .02). Participants rated the model as having somewhat realistic haptics, dissimilar “look and feel” to the operating room, and strongly believed that the model was valuable for practicing endovascular surgery. ConclusionsThese findings verify the construct validity of this endovascular simulator, as those with the most real-world experience used a correct technique more often and completed the tasks the fastest. Survey results supported the content validity of the model. Basic 3D-printed endovascular models should be considered as an affordable, readily accessible adjunct to surgical education.

Regional Differences in Education: Can We Bridge that Gap with Simulation-Based Training?

AbstractInterventional radiology (IR) training is not uniform throughout the world with clear limitations to education, training, and procedural exposure based on regions within different countries and the world. Varying technical exposure can lead to limitations in technical and therapeutic opportunities for patients. Since hands-on exposure to specific procedural skills may not occur in some locations, high fidelity endovascular simulation training can provide an opportunity for technical skills to be learned with an effort to increase patient exposure to care as well as improve technical procedural skill learning.

3D‐Printed Patient‐Specific Circles of Willis with an Intracranial Aneurysm and their Application to Neurointerventional Endovascular Simulation (Adv. Mater. Technol. 15/2023)

3D‐Printed Patient‐Specific Circles of Willis with an Intracranial Aneurysm and their Application to Neurointerventional Endovascular Simulation (Adv. Mater. Technol. 15/2023)

3D‐Printed Patient‐Specific Circles of Willis with an Intracranial Aneurysm and their Application to Neurointerventional Endovascular Simulation

AbstractCerebrovascular replicas are effective platforms that can simulate endovascular interventions in the treatment of intracranial aneurysm (IA), and an IA typically forms in the tortuously structured cerebral artery circulation known as the circle of Willis (CoW). Effective and reliable endovascular procedure simulation before actual clinical treatment is greatly helpful for neurosurgeons, but the simulation performance depends on how identical a CoW replica is to a patient's CoW. Herein, a tubular, transparent, and patient‐specific CoW replica is fabricated with realistic dimensions and elasticity using a combination of 3D printing and dip coating technique. First, a real‐scale CoW core substrate is constructed using an extrusion‐based 3D printing technology, then the thickness of the vascular wall is manipulated by coating the core substrate layer by layer, and finally the core substrate is dissolved to produce a tubular CoW structure. A liquid‐assisted dip coating method is utilized and optimized for uniform and high‐quality coating layers on the tortuous CoW core substrate. Moreover, the effectiveness of the CoW replica is demonstrated through an in‐house neurointerventional endovascular simulator. The proposed method paves a new way for practical and reliable endovascular simulations, which would help significantly improve the clinical outcomes of current IA treatments.

Qualitative and Quantitative Assessment of Invasive Surgery Skill Based on a Custom Training Simulator.

Qualitative and quantitative assessment of interventional performance is a vital component in the evaluation of endovascular surgery skill training. We established a custom simulator with qualitative and quantitative metrics for endovascular performance training. The simulator included an in vitro silicone phantom, mock circulation loop, visual module, force-sensing module, and custom software for image and force data postprocessing. Two tasks to deliver the guidewire to the target location of the carotid artery were conducted by the expert (n=4), novice (n=6), and test (n=4) groups. Seven features with significant differences extracted from the expert and novice groups were applied for qualitative assessment using the support vector machine (SVM) and quantitative assessment using the Mahalanobis distance (MD). Significant differences were observed in kinematic and force data between experts and novices during the intervention procedure. The median value of finished time for task 1 was 26.88 seconds for experts and 63.36 seconds for novices. The maximum speed for experts and novices was 32.79 and 7.43 cm/s, respectively. Moreover, the classified results depicted that the accuracy of qualitative assessment for task 1 and task 2 was 96.67% and 90%, respectively. As for the quantitative data, the residents had higher scores than individuals majored in biomedical engineering at 2 tasks (70.06±5.30 vs 41.81±6.58 for task 1, p=0.001). The proposed endovascular intervention skill training simulator provides qualitative and quantitative metrics on intervention performance skills and may be a useful tool in future interventional surgical training. This simulator comprised an in-vitro silicone phantom, mock circulation loop, visual module, force-sensing module, and custom software for image and force data post-processing. Seven interventional performance features were used for qualitative assessment using the support vector machine and quantitative assessment using the Mahalanobis Distance. From the observations, we conclude that this endovascular intervention skill training simulator provides qualitative and quantitative metrics on intervention performance and may be a useful tool in future surgical training.

Recurrent neural networks for generalization towards the vessel geometry in autonomous endovascular guidewire navigation in the aortic arch

PurposeEndovascular intervention is the state-of-the-art treatment for common cardiovascular diseases, such as heart attack and stroke. Automation of the procedure may improve the working conditions of physicians and provide high-quality care to patients in remote areas, posing a major impact on overall treatment quality. However, this requires the adaption to individual patient anatomies, which currently poses an unsolved challenge.MethodsThis work investigates an endovascular guidewire controller architecture based on recurrent neural networks. The controller is evaluated in-silico on its ability to adapt to new vessel geometries when navigating through the aortic arch. The controller’s generalization capabilities are examined by reducing the number of variations seen during training. For this purpose, an endovascular simulation environment is introduced, which allows guidewire navigation in a parametrizable aortic arch.ResultsThe recurrent controller achieves a higher navigation success rate of 75.0% after 29,200 interventions compared to 71.6% after 156,800 interventions for a feedforward controller. Furthermore, the recurrent controller generalizes to previously unseen aortic arches and is robust towards size changes of the aortic arch. Being trained on 2048 aortic arch geometries gives the same results as being trained with full variation when evaluated on 1000 different geometries. For interpolation a gap of 30% of the scaling range and for extrapolation additional 10% of the scaling range can be navigated successfully.ConclusionAdaption to new vessel geometries is essential in the navigation of endovascular instruments. Therefore, the intrinsic generalization to new vessel geometries poses an essential step towards autonomous endovascular robotics.

Validating a 3D-Printed En7dovascular Simulator for Use in Training Surgical Residents

Endovascular simulators have become a standard in education for surgical residents. However, these products are expensive to purchase and maintain, limiting their accessibility. Endovascular models created using in-house 3D printing can be an affordable alternative but currently lack the rigorous validation needed to be a dependable educational tool. The purpose of this study is to determine the construct validity of a 3D-printed endovascular model of an aorta. A 3D rendering of an aorta was created using a patient computed tomography scan and subsequently printed on a Form B printer with transparent clear V4 resin (Fig 1). The pieces were combined to create a final product with a material cost of $50. Participants were asked to perform 2 tasks from a femoral access point: catheterizing the contralateral common iliac artery and cannulating the superior mesenteric artery (SMA). For each task, a 5-point rubric was created to assess whether all components of the tasks were done correctly. Participants were also assessed on the time taken to perform the tasks. Participants’ level of education (medical student vs surgical resident vs attending) and level of endovascular experience (<5 procedures = no experience, 6-100 = some experience, and >100 extensive experience) were noted. Of a total of 37 participants, 12 were medical students, 21 were residents, and 4 were attendings. A total of 26 participants had no experience, 6 had some experience, and 5 had extensive experience. Neither education level nor experience level had a significant bearing on whether either task was completed. Those with higher education completed the SMA task more accurately (P = .007), but this pattern was not observed for higher levels of experience. Univariate analysis shows that both higher education and greater experience resulted in faster times for both tasks, but multivariate analysis shows that only the level of experience was a predictor for faster completion (Fig 2, P = .02). This is reinforced by the finding that among participants with no experience, higher levels of education do not result in faster times (P = .16). These findings verify the construct validity of this endovascular simulator, as those with the most real-world experience completed the tasks the fastest. The observation that residents did more of the steps correctly than medical students may be because they have greater knowledge of endovascular procedures, but this did not translate to faster performance, which requires muscle memory. Basic 3D-printed endovascular models should therefore be strongly considered as an affordable, readily accessible adjunct to surgical resident education.Fig 2Combined time, in seconds, for participants with no experience, some experience, and extensive experience to complete the catheterization of the contralateral common iliac artery and superior mesenteric artery (SMA). Error bars show 95% confidence interval (CI). Increasing real-world endovascular experience trends with decreased completion times, with statistical significance (P < .05) achieved between the “no experience” and “extensive experience” groups, denoted by *.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Feasibility of Network-Based, Online Endovascular Simulator Training in Real Time: Results from a Pilot Study.

To test the feasibility of an online, simulator-based comprehensive interventional radiology (IR) training curriculum in times of COVID-19-induced travel restrictions. A network of six VIST simulators (Mentice, Gothenburg, Sweden) was installed in six geographically different radiology departments. Two courses with six sessions each took place. 43 participants were recruited on a voluntary basis among local residents. The training sessions were conducted in real time with interconnected simulation devices and were led by experts in the field of IR on a rotational basis. The participants attitude toward various topics was quantified before and after training on a seven-point Likert scale (1 = "not at all", 7 = "to the highest degree"). In addition, post-course surveys were conducted. The courses led to an improvement for all items compared with baseline: interest in IR (pre: 5.5, post: 6.1), knowledge of endovascular procedures (pre: 4.1, post: 4.6), likelihood of choosing IR as a subspecialty (pre: 5.7, post: 5.9). Experience with endovascular procedures (pre: 3.7, post: 4.6) improved significantly (p = 0.016). In the post-course surveys high satisfaction rates with the pedagogical approach (mean 6), the teaching content (mean 6.4), and the duration and frequency of the course (mean 6.1) were observed. The implementation of a simultaneous endovascular online training curriculum in different geographic locations is feasible. The curriculum has the potential to meet the demand for training in IR in times of COVID-19-associated travel restrictions and can complement future training in the context of radiologic congresses. · The implementation of a simultaneous endovascular online training curriculum in different geographic locations is feasible. For interested residents, the presented online curriculum can offer a low-threshold and comprehensive entry into the world of interventional radiology at the site of their training..

Implementation and Evaluation of a Comprehensive Simulation Curriculum for the IR/DR Integrated Residency

Endovascular simulation is a validated training method, allowing residents to improve technical skills with interventional equipment in a risk-free environment. The purpose of this study was to assess the utility and efficacy of supplementing the IR/DR Integrated Residency training program with a dedicated 2-year endovascular simulation curriculum. Trainees participated in a 2-year curriculum that included the completion of 8 modules using a high-fidelity endovascular simulator (Mentice AB, Gothenberg, Sweden). Procedural modules included IVC filter placement, transarterial chemoembolization, trauma embolization, uterine artery embolization, prostate artery embolization, and peripheral arterial disease interventions. Each quarter, two trainees were filmed while completing an assigned module. Sessions led by IR faculty were held with film footage review and didactics on the assigned topic. Pre- and postcase surveys were collected to evaluate trainee comfort and confidence and assess the validity of the simulation. At the conclusion of the 2-year period, a postcurriculum survey was sent to all trainees to determine how residents viewed the utility of the simulation sessions. Eight residents participated in the pre- and postcase surveys. The simulation curriculum significantly increased trainee confidence for these 8 residents. A separate postcurriculum survey was completed by all 16 IR/DR residents. All 16 residents felt that simulation was a helpful addition to their education. A total of 87.5% of all residents felt that the sessions improved their confidence in the IR procedure room. A total of 75% of all residents believe that the simulation curriculum should be incorporated into the IR residency program. Adoption of a 2-year simulation curriculum can be considered for existing IR/DR training programs with access to high-fidelity endovascular simulators using the described approach.

Focus on Radiation Protection Improves Both Correct Behavior and Procedural Performance During Simulation-Based Training – A Randomized Comparison

To explore whether simulation-based endovascular training with focus on radiation safety could improve correct behavior without jeopardizing the learning of procedural skills. Twenty-four residents without previous endovascular experience completed 10 clinical scenarios on a virtual-reality endovascular simulator with software for peripheral endovascular interventions. Participants were randomized to receive feedback (n=12) or not (n=12) on radiation protection (RP) performance after each case. Expert assessments were done at the first, second, fourth, seventh, and 10th case on RP and endovascular skills (ES). Automatic simulator metrics on procedure time, contrast dose, handling errors, and estimated radiation exposure to patient and operator were registered. Outcome metrics were analyzed by two-way mixed analysis of variance pairwise comparisons with independent t-tests. Correlations were explored using Pearson's r for internal consistency reliability. The RP performance was similar in both groups at their first attempt (P=0.61), but the feedback group significantly outperformed the control group over time (P<0.001 for all comparisons). The feedback group was however slower to learn the ES at start (P=0.047 at second performance), but after 7 attempts no difference was shown (P=0.59). The feedback group used more time (19.5 vs. 15.3min; P=0.007) but less contrast (60 vs. 100mL; P<0.001). The number of errors was the same in both groups, but all metrics regarding radiation exposure favored the feedback group (P-values from 0.001 to 0.008). Simulation-based training (SBT) is effective to acquire basic endovascular intervention skills and concurrently learn RP behavior when feedback on radiation culture is provided.

Evaluation of Robotic-Assisted Carotid Artery Stenting in a Virtual Model Using Motion-Based Performance Metrics

Purpose: Robotic-assisted carotid artery stenting (CAS) cases have been demonstrated with promising results. However, no quantitative measurements have been made to compare manual with robotic-assisted CAS. This study aims to quantify surgical performance using tool tip kinematic data and metrics of precision during CAS with manual and robotic control in an ex vivo model. Materials and Methods: Transfemoral CAS cases were performed in a high-fidelity endovascular simulator. Participants completed cases with manual and robotic techniques in 2 different carotid anatomies in random order. C-arm angulations, table position, and endovascular devices were standardized. Endovascular tool tip kinematic data were extracted. We calculated the spectral arc length (SPARC), average velocity, and idle time during navigation in the common carotid artery and lesion crossing. Procedural time, fluoroscopy time, movements of the deployed filter wire, precision of stent, and balloon positioning were recorded. Data were analyzed and compared between the 2 modalities. Results: Ten participants performed 40 CAS cases with a procedural success of 100% and 0% residual stenosis. The median procedural time was significantly higher during the robotic-assisted cases (seconds, median [interquartile range, IQR]: 128 [49.5] and 161.5 [62.5], p=0.02). Fluoroscopy time differed significantly between manual and robotic-assisted procedures (seconds, median [IQR]: 81.5 [32] and 98.5 [39.5], p=0.1). Movement of the deployed filter wire did not show significant difference between manual and robotic interventions (mm, median [IQR]: 13 [10.5] and 12.5 [11], p=0.5). The postdilation balloon exceeded the margin of the stent with a median of 2 [1] mm in both groups. Navigation with robotic assistance showed significantly lower SPARC values (–5.78±3.14 and –8.63±3.98, p=0.04) and higher idle time values (8.92±8.71 and 3.47±3.9, p=0.02) than those performed manually. Conclusions: Robotic-assisted and manual CAS cases are comparable in the precision of stent and balloon positioning. Navigation in the carotid artery is associated with smoother motion and higher idle time values. These findings highlight the accuracy and the motion stabilizing capability of the endovascular robotic system. Clinical Impact Robotic assistance in the treatment of peripheral vascular disease is an emerging field and may be a tool for radiation protection and the geographic distribution of endovascular interventions in the future. This preclinical study compares the characteristics of manual and robotic-assisted carotid stenting (CAS). Our results highlight, that robotic-assisted CAS is associated with precise navigation and device positioning, and smoother navigation compared to manual CAS.

A cadaveric perfused model with antegrade arteriovenous pulsatile circulation: a new tool for teaching endovascular skills.

Background:The benefits of using cadaveric humans in surgical training are well documented, and knowledge of the latest endovascular techniques is essential in the daily practice of vascular surgeons. Our study explores the feasibility of an affordable human cadaveric model with pulsatile and heated antegrade perfusion for reliable and reproducible endovascular or surgical simulation.Methods:We undertook cannulation of 7 human cadavers embalmed in a saturated salt solution to create a left-to-right central perfusion with a heated solution, from the ascending thoracic aorta to the right atrium. To that end, we used surgically created carotidojugular and femorofemoral arteriovenous fistulas. Biomedical engineers designed a prototype pump for pulsatile circulation. We monitored invasive blood pressure and temperature. We used this model for training for endovascular thoracic aortic procedures and open vascular surgeries.Results:The prototype pump achieved a pulsatile flow rate of 4.7 L/min. Effective cadaveric perfusion was achieved for several hours, not only with an arterioarterial pathway but also with arteriovenous circulation. The arterial pressures and in situ temperatures accurately restored vascular functions for life-like conditions. This new model made it possible to successfully perform thoracic endovascular aortic repair, subclavian artery stenting and simulation of abdominal open vascular trauma management. The saturated salt solution method and a specifically designed pump improved cost competitiveness.Conclusion:Endovascular simulation on human cadavers, optimized with the pulsatile and heated perfusion system, can be a dynamic adjunct for surgical training and familiarization with new devices. This reproducible teaching tool could be relevant in all surgery programs.

Three-dimensional surface mesh optimization and centerline extraction of vasculatures for endovascular intervention simulation

Understanding vasculatures is important for endovascular intervention simulation (EIS). A recent trend attempts to represent vasculatures with three-dimensional (3D) surface meshes by multiview image and graphics-based techniques used in optical and laser scanners. Conversion from image volume data to 3D surface meshes, however, suffers from staircases and noise. Most existing methods in geometric processing often consider mesh smoothing in their independent settings. However, this approach either is ineffective in removing the artifacts or introduces additional types of artifacts (e.g., volume shrinkage and shape distortion). We propose an effective yet vascular-oriented mesh optimization framework. We first employ a weight-adaptive vertex resampling to eliminate staircases; then, we subdivide vascular meshes to denser ones; and finally, we exploit the constrained biquadratic Bezier surface fitting to produce optimized meshes. In EIS, clinicians are interested in the centerline of surface meshes as well as surface meshes. However, centerline extraction from vascular meshes is still challenging. We adopt an existing centerline extraction approach for vascular meshes based on the observation that human blood vessels are generally composed of piecewise cylindrical shapes. Tests on vascular data illustrate that our optimization approach achieves higher quality results regarding surface smoothness compared to previous approaches. In addition, our extraction approach effectively obtains complete centerlines from real data.

Cadaver Simulation is Associated with Increased Comfort in Performing Open Vascular Surgery Among Integrated Vascular Surgery (0+5) Residents and Recent Graduates

With the evolution in vascular surgery toward increased endovascular therapy and decreased open surgical training, comfort with open procedures by current trainees is declining. A proposed method to improve this discomfort is simulator training. We hypothesized that open, cadaver, and endovascular surgery simulation would be associated with increased self-perceived comfort in performing corresponding procedures. Integrated (0+5) vascular surgery residents and recent graduates in the United States were asked to complete a survey quantifying comfort via a Likert scale with procedures and experience with simulation training. Simulation groups were then matched using coarsened exact matching. Ordinal logistic regression assessed the association between simulation experience and comfort in performing procedures. Surveys were completed by 68 trainees and 20 attending surgeons in their first 5years of practice. On unmatched analyses, there were no significant differences in comfort in performing any open or endovascular aorto-mesenteric or peripheral vascular procedures between respondents who reported experience with open or endovascular simulation, respectively. However, respondents who reported cadaver simulation experience (58%, 51/88) had a significantly higher reported comfort score performing open juxtarenal aortic repair (2.4 vs. 1.7), superior mesenteric artery thrombectomy or bypass (2.5 vs. 1.9), inferior vena cava or iliac vein repair (2.2 vs. 1.7), axillary-femoral artery bypass (3.4 vs. 2.5), femoral-popliteal artery bypass (3.7 vs. 2.8), and inframalleolar artery bypass (2.8 vs. 2.1; all P<0.05). After matching on training level, number of abdominal cases completed, and number of open vascular cases completed, ordinal logistic regression demonstrated that previous cadaver simulation was significantly associated with increased comfort in performing open aortic repairs, venous repair, visceral revascularization, and peripheral bypasses. In this nationally representative sample, cadaver, but not open or endovascular, simulation was associated with increased comfort in performing open vascular surgery. Providing cadaver simulation to trainees may help to improve comfort levels in performing open surgery. Integrated vascular surgery training programs should consider implementing these experiences into their curriculum.

Abstract No. 283 The impact of endovascular simulator training on simulated procedural performance, knowledge acquisition, and attitudes toward interventional radiology in medical students

Abstract No. 283 The impact of endovascular simulator training on simulated procedural performance, knowledge acquisition, and attitudes toward interventional radiology in medical students