Vascular Surgery Research Articles

Analyzing RBC Transfusion Practices Using Quality Indicators: A Retrospective Transfusion Audit.

Objectives Overordering of blood products, particularly packed red blood cells (PRBC), leads to inefficiencies and financial burdens within healthcare systems. The objective of this audit was to assess PRBC utilization practices against established quality indicators to enhance efficiency and reduce wastage in a newly established tertiary care hospital in Northern India. Materials and methods A retrospective audit was conducted in the department of transfusion medicine. Data were collected from departmental records and analyzed using various quality indicators, such as crossmatch to transfusion ratio (CTR), transfusion probability (%T), transfusion index (TI), and utilization rate (UR). Microsoft Excel was utilized for statistical calculations including range, percentage, ratio, and quality indicators. Results A total of 1,488 PRBC requisitions were received, 997 (67%) originated from various surgical specialties. The overall CTR was 1.88, with medical and surgical specialties having CTRs of 1.3 and 2.6, respectively. Overall %T was 53.8%, which in medical departments was 85% and in surgical departments was 38.5%. TI was 0.68 overall, which varied among medical (1.1) and surgical (0.48) specialties. The overall UR was 53.14%. Peri-operative blood loss (48%) and anemia (46%) were the primary indications for transfusions. Cardiothoracic and vascular surgery (CTVS), General surgery, and orthopaedics exhibited appropriate blood utilization practices, whereas ear nose and throat (ENT), pediatric surgery, urology, neurosurgery, and obstetrics and gynecology (OBGY) showed tendencies toward overordering and underutilization. Conclusion This audit highlights significant issues related to blood utilization practices, particularly overordering and underutilization in certain surgical specialties within the studied institution. While these findings underscore the potential benefits of implementing audit-driven policies to enhance efficiency and reduce wastage, the results are specific to this institution and may not be universally applicable. Further studies across multiple institutions are recommended to validate these findings and develop broader guidelines for optimizing blood utilization in healthcare systems.

A National Survey of Interventional Radiology Trainees on Peripheral and Aortic Endovascular Training.

The development of technical skills in peripheral and aortic endovascular intervention is an essential part of interventional radiology (IR) training. Access to endovascular training remains contentious, with IR and vascular surgery (VS) trainees competing for opportunities. The Collaborative Peripheral and Aortic Endovascular Training Survey (CPAETS) aimed to evaluate IR trainees' experiences, expectations, and barriers to endovascular training. CPAETS was a joint survey between the British Society of Interventional Radiology and the Rouleaux Club (UK Vascular Trainees' Association), open for 12 weeks and distributed to UK-based IR and VS trainees. This article focuses on IR trainee responses. Thirty-two responses were received from IR trainees across England, Scotland and Wales. Overall, 59% of respondents were satisfied with their endovascular training. IR trainees reported less regular hands-on experience of aortic endovascular procedures (50%) compared to peripheral endovascular procedures (93%). Consequently fewer trainees (65%) felt confident in achieving the necessary aortic endovascular competencies by the end of their training, compared to peripheral procedures (89%). Limited exposure to aortic endovascular procedures resulted in reduced confidence levels in performing aortic intervention as compared to peripheral procedures. Potential solutions to bridge some of these IR training gaps include greater pre-operative and post-operative presence, the use of simulators and IR fellowships to ensure adequate training opportunities. This article provides a snapshot of the current gaps in IR endovascular training in the UK, with insight into solutions that can enable trainees to develop clinical and technical competencies required for IR consultant practice.

Systematic review of clinical guidelines and consensus statements concerning heparin and protamine dosing and monitoring of anticoagulation levels for non-cardiac arterial procedures.

This systematic review was performed to examine all published practice Guidelines and Consensus Statements (together: GCS) on heparin dosing and monitoring during non-cardiac arterial procedures (NCAP). The objective was to scrutinize the recommendations and advice outlined within these GCS documents and to evaluate the supporting evidence for these recommendations. Additionally, the use of the activated clotting time (ACT) and target ACT values were explored. This systematic review was performed in accordance with the PRISMA Guidelines. Medline and Embase databases were searched to identify all GCSs in the English language on NCAP. The final literature search was performed in January 2023. This search was supplemented by searching websites of relevant professional vascular surgical organizations for GCSs. Titles and abstracts were assessed by two independent reviewers. Of 9716 titles identified, 27 GCSs met the predefined inclusion criteria: six GCSs regarding carotid intervention, seven regarding procedures for aneurysmal disease of the abdominal aorta and iliac arteries, 12 regarding interventions for acute and chronic peripheral arterial occlusive disease and two regarding open and endovascular interventions of thoraco-abdominal aortic aneurysms. Administration of heparin is advised for al NCAP. There was high variability concerning heparin dose: both standard dose as weight based dosing (30-150 IU/kg) was advised. Recommendations on repeated doses, ACT monitoring and heparin reversal using protamine also varied widely. In none of the GCSs, the type of the ACT measuring device or used cartridges were specified. Large variability was found between the included GCSs with regard to the recommendations on heparin dose and target ACT values during NCAP. Advice and recommendations in GCSs were based on low-quality studies or without providing any reference at all. The described variability in recommendations emphasizes the need for large prospective (randomized) studies or the incorporation of data on heparin and the use of ACT monitoring into verified vascular surgery registries, to develop evidence-based, practical and uniform applicable recommendations.

SP7.10 - Awareness and Knowledge of Medical Coding Education Amongst Vascular Surgeons: A National Survey

Abstract Aims Accurate medical coding plays a critical role in optimising healthcare delivery, facilitating appropriate reimbursement, supporting research and data analysis, and providing a foundation for public healthcare databases and policies. This survey aims to explore the familiarity and comprehension of medical coding among vascular surgeons. Methods Ninety-five responses were gathered from participants across diverse levels of vascular surgery. A notable 77.7% (n=73) of respondents indicated a lack of formal training in medical coding. Additionally, 70.5% (n=67) of vascular surgeons advocated for including medical coding within surgical training programs. Regarding assessing medical coding proficiency, 61.1% (n=55) correctly identified ‘BSS’ as an example of non-medical coding classification. Moreover, 67.7% (n=63) accurately recognised ‘OPCS-4’ as the classification system employed by the NHS for coding surgical procedures. Results Ninety-five questionnaire responses were collected from participants working in vascular surgery of various levels. A notable 77.7% (n=73) of the participants reported receiving no formal training in medical coding. Additionally, 70.5% (n=67) of vascular surgeons expressed that medical coding should be included in surgical training. Regarding assessing medical coding knowledge, 61.1% (n=55) of respondents correctly identified ‘BSS’ as the non-example of medical coding classification. When asked about the classification system used by the NHS to code surgical procedures, 67.7% (n=63) correctly identified ‘OPCS-4.’ Conclusion The study's findings reveal the need for more awareness, knowledge, and formal training in medical coding. Augmented education and training in medical coding, potentially through concise courses, are imperative for ensuring equitable reimbursement for healthcare services, facilitating data analysis for research and quality enhancement endeavours, and fostering effective inter-professional communication within the healthcare domain.

Perspective or Spectacle? Teaching thoracic aortic anatomy in a mixed reality assisted educational approach– a two-armed randomized pilot study

PurposeAnatomical understanding is an important basis for medical teaching, especially in a surgical context. The interpretation of complex vascular structures via two-dimensional visualization can yet be difficult, particularly for students. The objective of this study was to investigate the feasibility of an MxR-assisted educational approach in vascular surgery undergraduate education, comparing an MxR-based teaching-intervention with CT-based material for learning and understanding the vascular morphology of the thoracic aorta.MethodsIn a prospective randomized controlled trial learning success and diagnostic skills following an MxR- vs. a CT-based intervention was investigated in 120 thoracic aortic visualizations. Secondary outcomes were motivation, system-usability as well as workload/satisfaction. Motivational factors and training-experience were also assessed. Twelve students (7 females; mean age: 23 years) were randomized into two groups undergoing educational intervention with MxR or CT.ResultsEvaluation of learning success showed a mean improvement of 1.17 points (max.score: 10; 95%CI: 0.36–1.97). The MxR-group has improved by a mean of 1.33 [95% CI: 0.16–2.51], against 1.0 points [95% CI: -0.71- 2.71] in the CT-group. Regarding diagnostic skills, both groups performed equally (CT-group: 58.25 ± 7.86 vs. MxR-group:58.5 ± 6.60; max. score 92.0). 11/12 participants were convinced that MxR facilitated learning of vascular morphologies. The usability of the MxR-system was rated positively, and the perceived workload was low.ConclusionMxR-systems can be a valuable addition to vascular surgery education. Further evaluation of the technology in larger teaching situations are required. Especially regarding the acquisition of practical skills, the use of MxR-systems offers interesting application possibilities in surgical education.

ThP8.12 - To do or not to do-Temporal artery Biopsy in Giant Cell arteritis

Abstract Aims Temporal artery biopsy (TAB) remains the gold-standard diagnostic test for giant cell arteritis (GCA). Our aim is to evaluate the correlation between initiation of corticosteroid therapy, timing of biopsy, and histological diagnosis of GCA through TAB. Moreover, analyse the usefulness of this practice. Methods Operative notes of TABs performed by a Vascular Surgery department at a teaching hospital between August 2021 and January 2023 were reviewed. We looked into the relationship between histological findings and the timing of corticosteroid treatment initiation prior to TAB. Results A total of eight patients had a TAB, with a male-to-female ratio of 2:6. The median age of the patients was 68-years-old (range 53-84). TABs were performed within 16 days of the referral (range 2-16). All were performed on elective theatre lists and none on emergency theatre lists (CEPOD). All patients had started corticosteroids by the time they had TAB, with a median duration of 11.5 days before TAB (range 2-16). The histopathology report was positive for active GCA in 1 case (12.5%) where the TAB was performed on day 3. In another performed on day 16, histopathology showed signs of healed inflammation (12.5%). In all other cases the report was negative (75%). All patients completed a full weaning course of steroids regardless of histological findings. Conclusion GCA is a systemic inflammatory vasculitis. Prompt initiation of high-dose corticosteroids is the mainstay management to reduce risks of ischaemic-related complications. Our work suggests the timing of biopsy is a key determinant of histological diagnosis of GCA.

ThP8.11 - Causes of delay to surgical interventions in patients with transient ischaemic attack and stroke

Abstract Aims The UK National Institute for Health and Care Excellence (NICE) guidelines and vascular society of surgery Great Britain and Ireland (VSGBI) emphasize the importance of scheduling carotid endarterectomy (CEA) within 2 weeks of symptom onset to reduce the risk of recurrent stroke. However the National vascular Surgery report for 2023 showed that this target was met in only 52% of patients. This study aimed to examine the possible causes of these delays. Methods This study analysed patient or hospital-derived factors impacting the timing of surgical intervention for patients with symptomatic carotid disease. A retrospective database was established to gather data on CEAs performed during an 8-month interval (January to August 2023) at a major teaching hospital. Results 36 patients underwent CEA; 13 (36.1%) received the procedure within 2 weeks of symptom onset, while 23 (63.9%) experienced delays. The main reasons for not meeting the two-week timeframe were associated with surgical scheduling, patient presentation, and referral processes. Specifically, among the 23 patients facing delays, 10 (43.5%) were due to surgical scheduling, 6 (26.1%) encountered delays in presenting to medical services, 5 (21.7%) were affected by delayed patient referral or review, and 2 (8.7%) were from lack of patient fitness. None however ended up with recurrent stroke while awaiting surgery on best medical management. Conclusions Prompt surgical intervention can reduce the risk of recurrent strokes. 63.9% of CEAs encountered delays, primarily associated with surgical scheduling. Prioritised pooled lists may be the answer.

Monocentric prospective study to valid multidisciplinary diagnostic and therapeutic approach for Nutcracker syndrome.

Background: Nutcracker syndrome (NCS) is defined as left renal vein (LRV) compression by the superior mesenteric artery. NCS diagnosis is rendered complex by confounding symptoms. The study objective was to perform a prospective observational analysis of the diagnostic and therapeutic criteria of the patients with suspected NCS. When NCS diagnosis was confirmed, transposition of the LRV was carried out by mini-invasive robotic surgery (MIRS). Method: All patients addressed to the vascular surgery department for suspicion of NCS between January 2022 and June 2023 were included in the study. Patients were subsequently assessed by means of a computed tomography scan, dynamic duplex ultrasound and phlebography associated with an occlusion test of the left gonadic vein (LGV). Diagnostic criteria included aorto-mesenteric angle, LGV diameter and reflux, velocity ratios and diameters and the reno-caval gradient. Result: Thirty two patients aged 37 ± 14years had suspicion of NCS. Twenty presented an aorto-mesenteric angle below 20°, twenty three had a LGV diameter greater than 5mm and twenty two of the latter patients also had LGV reflux. A significant reno-caval gradient greater than 5mmHg was found in ten cases, thereby consolidating NCS diagnosis. Overall, thirteen patients neither presented NCS or pelvic varicosities; eight had pelvic congestion syndrome without NCS and were successfully treated by embolization. Eleven patients with confirmed NCS underwent LRV transposition in the inferior vena cava (IVC). Eight of the latter patients received a complementary pelvic varicosity embolization 2days later. Two months post-operation 100% of transposed LRV were permeable as assessed by duplex ultrasound controls and all of these patients reported an improvement of symptoms. Conclusion: An innovative multidisciplinary decisional algorithm establishes certitude in NCS diagnosis which can subsequently be treated radically by MIRS.

FP5.12 - Write what you know: A retrospective documentation audit

Abstract Aims The Royal College of Physicians (RCP) stipulates that every patient entry in the notes should be; dated, timed and signed by the author (name and designation included). Additionally, the content should have a standardised structure and layout with a chronological order to reflect a continuum of patient care. This audit aimed to assess the percentage of patient documentations that were compliant with these standards. Methods We retrospectively evaluated inpatient documentations for general, colorectal and vascular surgery for one week within a district general hospital setting. The data was obtained from electronic documentations. We assessed inpatient documentation for all relevant criteria as per RCP guidelines. Inpatient documentation included; the admission notes, post take ward round, daily ward rounds and inter-speciality discussions. Results A total of 88 patient related entries were reviewed. Of these 89.8% were dated. 42.0% of the entries were timed, with inter-specialty discussion having the highest percentage of recorded times. 93.2% had a standardised structure. The structure of admission entries was the most consistent with standards. 6.8% and 3.4% had the authors designation and signature respectively. Conclusion Clear informative documentation is pivotal for safe and effective patient care. Failure of patient documentation to meet the stipulated standards was established in this audit. Factors including inadequate junior doctor training, pace of ward rounds and reliance on electronic noting systems are potential reasons for poor compliance. Capitalising on opportunities to educate junior doctors is paramount in improving patient care.

Transarterial Coil Embolization for Type II Endoleak After Endovascular Aneurysm Repair (EVAR).

Background Endovascular aneurysm repair (EVAR) has evolved into treatment of choice for infrarenal abdominal aortic aneurysms (AAA). Type II endoleaks, although frequently benign, can lead to sac enlargement and rupture. Management of these endoleaks by endovascular means can be quite challenging and may require complex techniques and assistance of interventional radiologists, not always available in all vascular units. This is a single-center study of management of type II endoleaks with transarterial coil embolization performed by vascular surgeons and with minimum requirements regarding the necessary equipment. Methods From 2017 to 2022, 13 patients with type II endoleak were treated. Local anaesthesia and transfemoral or transbrachial approach was used. The superficial mesenteric artery (SMA) was catheterized and through the Riolan arch, coiling of the inferior mesenteric artery and/or the sac aneurysm was performed. Results The mean time period between the primary EVAR procedure and the transarterial intervention for the endoleak was 3.9 years. Primary technical success was achieved in 11 (84.6%) patients, whilesecondary technical success was 12 (92.3%). In the mean follow-up period, which was 2.6 years, the endoleak was treated successfully in 11 (84.6%) patients. Conclusions Transarterial coil embolization of type II endoleaks is a minimal low-cost procedure, with small percentage of complications, high technical and treatment success rates. It could be considered as a first-line treatment of unresolvable type II endoleaks, minimizing the need for open repair.

Heart rate variability as a dynamic marker of surgeons' stress during vascular surgery.

A surgeon experiences elevated stress levels when operating. Acute stress is linked to cognitive overload, worsening surgical performance. Chronic stress poses a significant risk to a surgeon's health. Identifying intraoperative stress may allow for preventative strategies that reduce surgeons' stress and subsequently improve patient outcomes. The aim of this study was to assess the feasibility of using heart rate variability as a marker of stress during vascular surgery. A total of 11 senior surgeons were evaluated performing three different vascular surgery procedures. Heart rate variability metrics (low-frequency to high-frequency ratio and standard deviation of the normal-normal interval) were determined from single-lead ECG traces at predetermined procedural performance points. State-Trait Anxiety Inventory-6, a validated stress tool, was used to assess surgeon-reported stress. Subjective reports of procedural difficulty were also collected. One-way ANOVA compared heart rate variability at key performance points with baseline. Pearson's coefficient assessed correlation between heart rate variability and subjective stress. Data were collected for six carotid endarterectomies, six open abdominal aortic aneurysm repairs, and five lower limb bypasses. Heart rate variability metrics indicating markedly greater stress were observed at key performance points across all procedures. Peaks in stress were consistent across different surgeons performing the same procedure. A significant correlation was observed between heart rate variability metrics and subjective State-Trait Anxiety Inventory-6 stress reports (r = 0.768, P =<0.001). The most difficult procedural steps reported corresponded with heart rate variability metrics displaying the greatest stress. Heart rate variability may be a viable approach to assess intraoperative stress and cognitive load during vascular surgery and could be used to evaluate whether a theatre intervention (for example timeout) could reduce stress in areas of surgical difficulty.

Conservative management and surgical approaches in the treatment of Peripheral Obstructive Arterial Disease (POAD): An overview

Introduction: Peripheral Obstructive Arterial Disease (PAD) is a condition in which there is a narrowing or blockage of the arteries that supply the lower limbs. The main objective of this systematic review was to identify studies that addressed the pathophysiology, epidemiology and signs and symptoms of PAD, with special emphasis on surgical intervention strategies. Methods:The search was conducted in renowned databases such as PubMed, Scopus, SciELO, Cochrane Library, LILACS, UpToDate and Embase, using controlled descriptors from DeCS. In order to effectively search for studies, descriptors such as "Peripheral Arterial Disease", "Vascular Surgical Procedures", "Myocardial Revascularization", "Angioplasty", "Vascular Grafting", "Thromboendarterectomy" and "Vascular Surgery" were used. These descriptors were combined with Boolean operators "OR" and "AND" to improve the precision of the search. The methodological approach adopted allowed for a thorough and comprehensive search, ensuring the inclusion of relevant studies. Results: The final sample consisted of 28 articles published in indexed scientific journals, addressing different aspects of POAD, such as symptomatology, epidemiology and surgical approach. The articles were available in full for analysis and were written in Portuguese. Analysis of the studies provided a better understanding of the pathophysiology of POAD, identified the main symptoms and examined the different surgical approaches used in treatment.Conclusion: The comprehensive systematic review of the literature on POAD provided valuable information on the disease and its surgical treatment modalities. The results obtained are essential for guiding clinical practice and assisting in decision-making regarding the management of POAD. The methodological approach adopted ensured the inclusion of relevant studies and provided a solid basis for understanding PAOD and providing appropriate care to patients.

Outcomes of Femoral Popliteal Bypass in Octogenarians.

Femoral-popliteal bypass (FPB) surgery is a common lower extremity revascularization procedure. As the population continues to age, this procedure is being performed increasingly on older patients. This study investigated whether outcomes differ in this population. Patients over and less than 80 years old who underwent FPB between 2009-2013 were queried using an existing hospital registry. Demographics, comorbidities, intraoperative complications, perioperative outcomes, and two-year patencies were compared. Twenty-four patients in the octogenarian cohort (OC) and 72 patients in the non-octogenarian cohort (NOC) were identified. There was a lower prevalence of smoking (p=0.018) and higher prevalence of hypertension (p=0.021) among octogenarians. Other medical characteristics were similar (p<0.05). There were no differences in use of vein versus PTFE (p=0.002) as a conduit, or above (OC 20.0% vs. NOC 36.7%), versus below knee (OC 80.0% vs. NOC 63.3%) distal anastomosis (p>0.05) between the groups. There was a difference (p<0.01) in indication for procedure (OC/NOC): claudication (0%/44%), limb salvage (71%/31%), and rest pain (29%/25%). There were no differences in 30-day readmissions (17% vs. 21%; p=0.59) or incidence of postoperative (25% vs. 19%; p=0.56) or intraoperative complications (8.3% vs. 4.2%; p=0.52). Length of stay (LOS) was longer and statistically significant in octogenarians (12 days vs. 7 days; p=0.032) and remained significant after multivariate linear regression (p=0.015). Patencies in OC were lower and dropped faster after six months; however, there were no statistically significant differences in patencies at any time interval (p>0.05). The position of the distal anastomosis relative to the knee, conduit type, and indication were not independently predictive of patency outcomes (p>0.05). The safety and efficacy of FPB in octogenarians is similar to the general population despite LOS in octogenarians being 5.98 days longer. While the difference in indication suggests that vascular surgeons are more conservative in treating octogenarians, our analysis did not reveal significant differences between populations and suggests that lower extremity bypass can be performed safely with comparable results in this cohort. A larger cohort is needed to validate these results.

Progressive Acute Lower Extremity Ischemia Resulting From Cardiac Myxoma Embolization: A Case Report.

Cardiac myxomas are the most common primary benign tumors of the heart. The occlusion of peripheral arteries and complete obstruction of the abdominal aorta by a tumor embolus presents with distinct clinical manifestations. Herein, we present the case of a 38-year-old male with acute paresthesia, muscle weakness, erythematous, and violaceous changes in skin color localized to the dorsum of the left forefoot initially treated as cutaneous vasculitis. Further studies revealed the total occlusion of the terminal abdominal aorta by a saddle embolus from a cardiac myxoma. A multidisciplinary team consisting of cardiothoracic and vascular surgeons were involved in treating the patient, which resulted in full resolution of the case. This paper details the progression of acute bilateral limb ischemia to chronic limb threatening ischemia resulting from the total occlusion of the terminal abdominal aorta by a saddle embolus.

Establishing an autogenous vascular access program in a Guatemalan comprehensive pediatric nephrology center.

The Guatemalan Foundation for Children with Kidney Diseases collaborated with Bridge of Life, a not-for-profit charitable organization, to establish a vascular access program. We reviewed our experience with graded surgical responsibility and structured didactic training, creating arteriovenous fistulas (AVF) for Guatemalan children. Pediatric vascular access missions were completed from 2015 to 2023 and analyzed retrospectively. Follow-up was completed by the Guatemalan pediatric surgeons, nephrologists, and nursing staff. AVF patency and patient survival were evaluated by Kaplan-Meier life-table analysis with univariate and multivariable association between patient demographic variables by Cox proportional hazards models. Among a total of 153 vascular access operations, there were 139 new patient procedures, forming the study group for this review. The mean age was 13.6years, 42.6% were female, and the mean BMI was 17.3. Radial or ulnar artery-based direct AVFs were established in 100 patients (71.9%) and ten of the 25 transposition procedures. Brachial artery inflow was required in 29 direct AVFs (20.9%). Two patients underwent femoral vein transpositions. Access-related distal ischemia was not encountered. Seven of the AVF patients later required access banding for arm edema; all had previous dialysis catheters (mean = 9, range 4-12). Primary and cumulative patency rates were 84% and 86% at 12months and 64% and 81% at 24months, respectively. The median follow-up was 12months. Overall patient survival was 84% and 67% at 12 and 24months, respectively. There were no deaths related to AVF access. Safe and functional AVFs were established in a teaching environment within a Guatemalan comprehensive pediatric nephrology center.

A multi-institutional study from the United States Resident OPerative Experience (ROPE) Consortium examining factors influencing vascular surgery specialization among general surgery residents

ObjectiveThere remains a progressive projected deficit in the vascular surgery (VS) workforce for decades. Despite the expanding integrated VS residency pathway, the fellowship training model remains critical in supporting our future workforce. Therefore, it is imperative to understand the resident and program-specific factors that influence VS specialization among general surgery (GS) residents. MethodsData from the United States Resident OPerative Experience (ROPE) Consortium, which comprises 20 Accreditation Council for Graduate Medical Education-accredited GS residency programs across the United States, were queried for resident demographics and residency program-related details. Logistic regression analysis was used to identify factors associated with VS specialization. ResultsFrom 2010 to 2020, a total of 1343 graduating GS residents were included in the study. Of these, 135 (10.1%) pursued VS fellowship training. Residents pursuing VS were more frequently male (80.7% vs 62.8%; P < .0001) and younger (median age, 32 vs 33 years; P = .03) compared with other GS residents. Racial and ethnic group, underrepresented in medicine status, and international medical graduate status were similar between the VS and non-VS groups. Residency program-level details were also similar between groups, including program type (university vs community-based), region, size, resident volume, dedicated research experience, and National Institutes of Health funding. Dedicated vascular rotations were common among all GS programs (95.4%), and total months spent on a VS rotation (median, 4 vs 4.5 months; P = .11) did not differ among residents pursuing VS and all other residents. The presence of a collocated traditional (5 + 2) VS fellowship (91.1% vs 90.4%; P = .79) or integrated (0 + 5) VS residency (56.3% vs 55.0%; P = .77) were also similar between groups. On multivariate analysis, only male sex (odds ratio, 2.34; 95% confidence interval, 1.50-3.81; P < .001) was associated with pursuing VS fellowship. Factors that did not impact VS specialization included resident age, underrepresented in medicine status, international medical graduate status, program volume, dedicated research experience, or total months spent on a VS rotation. ConclusionsIn this multi-institutional study, we did not find any program-specific factors that influence VS specialization among GS residents. Notably, the presence of a collocated 0 + 5 residency or 5 + 2 fellowship program did not appear to deter GS residents from pursuing a VS fellowship. These data suggest that individual factors, such as mentorship, may be more impactful in recruiting GS residents to the VS specialty.

The Geographic Distribution of Vascular Surgeons and Trainees by State in 2023

Approximately 1.4 vascular surgeons/100,000 persons are estimated to fulfill current patient needs in the United States (US), but an ongoing shortage exists. The aims of this study are to provide an updated nationwide state-by-state workforce analysis and compare the distribution of practicing vascular surgeons and training opportunities. Vascular surgeons in the US were identified using the National Provider Identifier registry in 2023. Only board-certified and actively licensed vascular surgeons were included. To estimate the number of vascular surgery graduates per year in each state, integrated residency and fellowship-matched positions (trainees) were ascertained from the National Resident Matching Program website. Surgeons and trainees were totaled by state, and densities were calculated using the 2020 US Census Bureau state populations. These two cohorts were also examined together using simple linear regression and geographic mapping. This study included 3399 board-certified vascular surgeons and 228 newly matched trainees. The average densities of vascular surgeons and trainees in the US are 1/100,000 persons and 0.06/100,000 persons, respectively. The five states with the lowest densities of vascular surgeons are AR, ND, NV, OK, and WY, averaging 0.4/100,000 persons. Eight states (AK, ID, KS, ND, NM, NV, RI, WY) had zero training programs offering positions in 2023 and ranked in the lowest quartile for the number of practicing vascular surgeons (Figure 1). Simple linear regression demonstrated a statistically significant correlation between state rates of vascular surgeons and trainees (p < 0.001). States with zero training positions also have the fewest vascular surgeons per capita. Statewide attention to expanding vascular surgery training opportunities targeted in these areas could positively impact the current maldistribution and shortage of vascular surgeons.

Academic productivity and content from social media influencers in vascular surgery compared to complementary specialties

ObjectiveSocial media (SoMe) plays a growing role in disseminating scientific information to health care professionals, patients, and the public. This study analyzes the influence of vascular care providers on Twitter (now X), comparing top influencers across specialties and exploring the connection between social media impact and academic productivity. MethodsA text search of Twitter bios in 2022 identified all United States-based users who self-identify as vascular surgeons (VSs), cardiothoracic surgeons (CTSs), interventional cardiologists (ICs), or interventional radiologists (IRs). The top 100 influencers in each specialty were selected based on number of followers. Social Authority (SA) was also used to evaluate Twitter influence. Standardized internet searches and publicly available data were used to obtain H-index, publication number, university affiliation, and professorship. The Twitter API was used to generate a tweet archive of each user’s last 3200 tweets, and specialty-related hashtags and mentions were compared. ResultsWe identified 8321 Twitter handles of users across four specialties, of which 1489 were included for analysis: VS (n = 310), CTS (n = 152), IC (n = 672), and IR (n = 355). Of the top 100 influencers ranked by follower count, most CTS (72%) and VS (67%) users were academically affiliated. Top VS influencers had a higher SA compared with CTS influencers (48 ± 6.0 vs 38 ± 11.4; P < .001) but lower SA than IC influencers (55 ± 6.4; P < .001). VSs also had fewer followers per user than ICs (1606 ± 1338 vs 4420 ± 7415; P < .001), but not CTSs or IRs. Among academically affiliated Twitter users, VSs had similar H-indices (19 ± 16), publications per user (88 ± 106), and citations per user (2547 ± 5182) as ICs, CTSs, and IRs (P > .050 for all). Academic rank was similar across specialties (P = .99), with most users representing assistant professors (30%-44%). A total of 1,063,419 of the most recent tweets from all users were analyzed. Forty-seven of the top 100 most tweeted handles belonged to individual IC accounts, and included international physicians and those who did not self-identify as ICs based on their bio text. Only six of the top 100 most tweeted handles were VSs. Over 20,000 unique hash tags were identified in the tweet archive. Of the top 100 most tweeted hashtags, 21 contained general cardiology subject matter, 16 related to IC-specific subject matter, eight pertained to VS-specific subject matter, and 12 were disease-specific hashtags that are treated by multiple specialties. ConclusionsWhen compared with complimentary specialists, VSs have lower SoMe influence than ICs, but similar influence as CTSs and IRs. VSs should engage with complimentary specialists to increase their SoMe reach and enhance the dissemination of vascular surgery-related content.

Assessing the quality of ChatGPT's responses to questions related to radiofrequency ablation for varicose veins

ObjectiveThis study aimed to evaluate the accuracy and reproducibility of information provided by ChatGPT, in response to frequently asked questions about radiofrequency ablation (RFA) for varicose veins. MethodsThis cross-sectional study was conducted at The Aga Khan University Hospital, Karachi, Pakistan. A set of 18 frequently asked questions regarding RFA for varicose veins were compiled from credible online sources and presented to ChatGPT twice, separately, using the new chat option. Twelve experienced vascular surgeons (with >2 years of experience and ≥20 RFA procedures performed annually) independently evaluated the accuracy of the responses using a 4-point Likert scale and assessed their reproducibility. ResultsMost evaluators were males (n = 10/12 [83.3%]) with an average of 12.3 ± 6.2 years of experience as a vascular surgeon. Six evaluators (50%) were from the UK followed by three from Saudi Arabia (25.0%), two from Pakistan (16.7%), and one from the United States (8.3%). Among the 216 accuracy grades, most of the evaluators graded the responses as comprehensive (n = 87/216 [40.3%]) or accurate but insufficient (n = 70/216 [32.4%]), whereas only 17.1% (n = 37/216) were graded as a mixture of both accurate and inaccurate information and 10.8% (n = 22/216) as entirely inaccurate. Overall, 89.8% of the responses (n = 194/216) were deemed reproducible. Of the total responses, 70.4% (n = 152/216) were classified as good quality and reproducible. The remaining responses were poor quality with 19.4% reproducible (n = 42/216) and 10.2% nonreproducible (n = 22/216) . There was nonsignificant inter-rater disagreement among the vascular surgeons for overall responses (Fleiss' kappa, −0.028; P = .131). ConclusionsChatGPT provided generally accurate and reproducible information on RFA for varicose veins; however, variability in response quality and limited inter-rater reliability highlight the need for further improvements. Although it has the potential to enhance patient education and support health care decision-making, improvements in its training, validation, transparency, and mechanisms to address inaccurate or incomplete information are essential.

The comprehensive value of the modern vascular surgeon to the orthopedic surgery service

ObjectiveOrthopedic surgery is among the highest compensated specialties in modern practice. Vascular surgeons are consulted frequently during orthopedic operations, however, the comprehensive value of the vascular surgery service to the safe delivery of orthopedic care has not been characterized previously. MethodsElectronic medical records were retrospectively queried for all operations performed by orthopedic surgeons requiring operative vascular surgical consultation from June 2013 to December 2023. Data were collected on case-specific details, reasons for consultation, and total charges. Work relative value units were calculated for each primary orthopedic procedure using the Centers for Medicare and Medicaid Services physician fee schedule. ResultsA total of 952 operative vascular surgery consultations were required over the study period. Consults were requested by 56 orthopedic surgeons across all eight orthopedic subspecialties at our institution. Operative vascular consultation was requested across 108 different procedure types. A total of 94 consults (9.9%) were emergent, intraoperative requests, with the remaining 858 consults (90.1%) occurring in the preoperative setting. The most common causes for consultation included surgical exposure (n = 832 [87.4%]), inadvertent bleeding (n = 44 [4.6%]), need for bypass (n = 12 [1.3%]), and acute limb ischemia (n = 11 [1.2%]). Total charges for all operative consultations exceeded $91.5 million, and the calculated total work relative value units for all primary orthopedic procedures was 19,384.5. A total of 54 cases (5.7%) occurred after hours, on a weekend, or both. ConclusionsVascular surgeons are integral to the provision of orthopedic surgical services, inclusive of all orthopedic subspecialties, for both the prevention and treatment of iatrogenic vascular injury. The around-the-clock availability of a vascular surgeon enables the orthopedic surgery department to generate significant revenue for the hospital system. These findings are important to the ongoing discussions regarding the value and compensation of the modern vascular surgeon.