Specialty Of Vascular Surgery Research Articles

Addressing burnout in surgery and vascular surgery

ObjectiveBy exploring the scientific literature, this article seeks to equip health care professionals with the knowledge to identify solutions to burnout within surgery and vascular surgery. MethodsA narrative literature review included French and English articles and was conducted in April 2023 with the help of PubMed and Google Scholar databases. Our search included specific Medical Subject Heading terms such as “burnout,” “solution,” and “healthcare.” The review focused on surgical specialties, with a particular lens toward vascular surgery when evidence was available. However, it was broadened to include non-surgical specialties to address knowledge gaps. Through the literature review, we canvased information about operational interventions against burnout, which was then described descriptively. ResultsWe presented a summary of interventions to mitigate burnout as a tiered approach, categorized into three groups that encompass the individual, the team, and the system. Research supports individual-focused interventions that enhance work-life balance and the use of other tools such as peer support groups, coaching, and counseling. Team-based strategies encompass relationships and mentorship as vital positive factors that curb burnout rates. Finally, the literature advocates for organizational support through good leadership and institutional investment into the workforce’s culture and well-being for solutions to burnout at the system level. ConclusionsThe prevalence of burnout in health care professionals is a public health crisis. Indeed, contemporary evaluations in the vascular surgery specialty demonstrate that nearly one-half of the workforce has experienced burnout. This paper explores the current literature to identify solutions that could help address burnout for vascular surgeons. Current literature supports a tiered approach to mitigate burnout that encompasses elements at the individual, team, and organizational levels.

Vascular laboratory workshop increases medical student understanding of vascular diagnostic studies and promotes interest in vascular surgery specialty

ObjectiveThe rising prevalence of vascular pathology and its associated costs in the United States burdens the health care system. This study tackles the impending shortage of vascular surgeons by examining ways to increase medical students’ interest and competence in vascular surgery. It assesses the impact of a two-session vascular laboratory (VL) workshop on medical students’ understanding of vascular pathologies, their ability to interpret VL studies, and their interest in pursuing a career in vascular surgery. MethodsApproval was obtained for this survey-based study from the Institutional Review Board at the University of Maryland School of Medicine. The study involved two cohorts: the VL group (n = 30), consisting of medical students that participated in the VL workshop during their vascular surgery rotation, and the control group (n = 25) consisting of medical students on a General Surgery (GS) rotation not exposed to the VL workshop. The VL group attended two workshops that included lectures, hands-on training, and clinical shadowing. After the workshops, they completed surveys assessing their understanding of vascular pathologies and VL assessments. The GS group, recruited via email, also completed surveys evaluating their exposure to vascular surgery and understanding of VL studies. Both groups were assessed using subjective and objective multiple-choice questions. ResultsFollowing the VL workshop, the vast majority of the VL group reported greater confidence with understanding, ordering, and performing vascular lab testing. Conversely, 72% (n = 18/25) of the GS cohort self-reported little to no confidence in their understanding of the VL or ability to determine the appropriate VL study based on indication. The VL group demonstrated significantly better performance on objective questions related to vascular pathologies compared with the GS group. Both groups expressed a desire for inclusion of VL education within their preclinical years (49/55; 89.1%). Finally, two-thirds (20/30; 66.7%) of the VL group reported a significant increase in their interest in vascular surgery following the workshop. ConclusionsA two-session VL workshop significantly enhances medical student confidence in utilizing diagnostic tools for assessing vascular pathology and fosters interest in vascular surgery. Implementing such workshops during preclinical education may provide earlier exposure, more research opportunities, and potentially increase medical student interest in pursuing vascular surgery as a career. Additionally, it may improve the competence of graduating medical students in diagnosing and treating vascular patients across all specialties. These findings emphasize the importance of innovative educational approaches to address the growing demand for vascular care in the United States.

Defining quality assessment in vascular surgery training: an expert Delphi process.

A robust and reproducible way of assessing training should optimise and standardise vascular surgical training. This study describes the methodology supporting the Vascular Surgery Specialty Advisory Committee regional quality assurance reports for vascular surgery training programmes in the UK. A Delphi consensus exercise was performed to establish the domains of training that most appropriately assess the quality of a vascular surgery training programme. A total of 54 stakeholders were invited to participate, including trainees, training programme directors and members of the vascular speciality advisory committee (SAC), vascular society executive and education committees. A total of 39 stakeholders successfully completed the three-stage Delphi process over 15 weeks. The domains identified as most appropriate to assess the quality of a vascular training programme were: Joint Committee on Surgical Training (JCST) survey results, clinical experience, regional education programmes, radiology support, timetable, regional support for trainees, trainer support for trainees, opportunities for professional development, trainee-rated quality of consultant teaching and training, and trainee recommendation of the post. This study describes a method to identify and prioritise domains that are appropriate to assess the quality of a vascular training programme. The domains that were identified as appropriate to assess quality are transferable internationally and the Delphi methodology could be used by other training schemes to 'fine-tune' their own domains to review and optimise the quality of their own training programmes.

Vascular Laboratory Workshop Increases Medical Student Understanding of Vascular Diagnostic Studies and Promotes Interest in Vascular Surgery Specialty

Vascular Laboratory Workshop Increases Medical Student Understanding of Vascular Diagnostic Studies and Promotes Interest in Vascular Surgery Specialty

Characteristics of low acuity prehospital emergency patients with 48-h mortality, an observational cohort study

Every year an emergency medical technician or paramedic treats and transports up to several hundred patients. Only some patients are acutely seriously ill, and a few of these show only discrete signs and symptoms of their condition. This study aims to describe patients who died within 48h of being admitted non-emergently to hospital by ambulance, examine the extent to which critically ill patients are recognized prehospitally, and identify clinical warning signs that might be frequently overlooked. Registry based follow-up study on patients receiving an ambulance from the Copenhagen EMS in 2018. Data was included regarding the dispatch of the ambulance from the emergency services disposition system, ICD-10 hospital admission diagnoses from the National Patient Register, 48-h mortality from the Central Person Register and assessment and treatment in the ambulance by reviewing the electronic pre-hospital patient record. In 2018 2279 patients died within 48h after contact with the EMS, 435 cases met inclusion criteria. The patients' median age was 83years (IQR 75-90), and 374 (86.0%) had one or more underlying serious medical conditions. A triage category based on vitals and presentation was not assigned by the EMS in 286 (68.9%) cases, of which 38 (13.3%) would meet red and 126 (44.1%) orange criteria. For 409 (94.0%) patients, it was estimated that death within 48h could not have been avoided prehospitally, and for 26 (6.0%) patients it was uncertain. We found 27 patients with acute aortic syndrome as admission diagnosis, of these nine (33.3%) had not been admitted urgently to a hospital with vascular surgery specialty. It was estimated that death within 48h could generally not be avoided prehospitally. The patients' median age was 83years, and they often had serious comorbidity. Patients whose vital parameters met red or orange triage criteria were to a lesser degree triaged prehospitally, compared to patients in the yellow or green categories. Patients with acute aortic syndrome were not recognized by EMS 33.3% of the time.

Systematic review of vascular surgery recruitment strategies for medical students and general surgery residents

ObjectivesRecruitment into the vascular surgery specialty is an imperative as the specialty faces significant demographic changes. Due to the changing dynamics in vascular surgery training pathways, we sought to review current literature on recruitment strategies and their effectiveness with medical students and general surgery residents. MethodsA systematic search, following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, was performed by searching MEDLINE, EMBASE, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Education Resources Information Center (ERIC) databases for studies on vascular surgery recruitment methods for medical students and general surgery residents from inception of databases to December 31, 2021. Reports in English discussing recruitment strategies were included. Reports lacking recruitment method data and those with insufficient data were excluded. ResultsTen reports met inclusion criteria and studied a total of 688 participants. Seven reports (70%) employed simulation, didactic, or online courses. The remaining 30% of studies included data on mentorship, research, or other interventions. Most of the studies (50%) reported data for medical students (MS1-MS4). Interventions specific to residents or both students and residents comprised the other 50% of studies. Simulation and didactic courses increased interest in vascular surgery by a median of 50% (interquartile range, 38%-64%) for both medical students and residents. Importantly, without reinforcement, interest was seen to decrease over time. ConclusionsRecruitment interventions are useful in increasing student interest in vascular surgery. Early exposure to simulated vascular surgery procedures and mentorship are cited as common reasons for entering the field. Further studies on recruitment strategies focused on long-term outcomes are required.

Abstract P044: A Novel Digital Therapeutic Program Is Feasible For Patients With Peripheral Artery Disease

Introduction: Patients with peripheral artery disease (PAD) are at increased risk for adverse cardiovascular and limb events and impaired quality of life. Lifestyle factors, such as patient physical activity levels and dietary habits, are known risk factors. Limited data is available on the feasibility and efficacy of tailored PAD digital therapeutic programs, focused on improving lifestyle (e.g. physical activity levels, dietary habits, sleep, stress, energy levels) and medication adherence. Hypothesis: We assessed the hypothesis that a digital therapeutic program is feasible among elderly patients with PAD. Methods: Patients were recruited from two vascular surgery specialty clinics in Sweden. Fourteen patients signed informed consent forms and started a four-week intervention based on the first weeks of the SK-111 digital program (Sidekick Health). Questionnaires were administered at baseline and at the end of the intervention. Data on in-app activity was collected throughout the intervention. Results: Out of the 14 patients (8 men, 6 women) who started the intervention, 11 stayed active within the platform from week 1 through 4. The 11 active participants performed a median of 7.1 activities in the app/day (IQR=3.4-12.9) and logged a median number of 4500 steps/day (IQR=2700-6455). The amount of physical activity logged/day went up from a mean of 21 (SD=39) min/day to 33 (SD=54) min/day from week 1 to week 4 (p=0.201). Seven participants (median age=72, IQR=69-73 years) answered both pre and post questionnaires. No changes were observed from pre to post intervention for either the walking distance domain of the Walking Impairment Questionnaire: 22.7 (SD=0.1) and 24.3 (SD=0.1), (p=0.499) or the Vascular Quality of Life Questionnaire sum score: 15.4 (SD=3.2) and 15.6 (SD=3.4), (p=0.864). For the pre-post medication adherence question (“During the last week, did you ever forget to take your PAD medication?” Rated from 0-10), ratings went down from 2.0 (SD=3.6) before to 0.1 (SD=0.4) after intervention (p=0.048). A post-program question asking whether using the platform helped them remember to take their medication, 5/7 (71%) patients considered it helpful. When asked how likely patients would be to recommend the PSP to others, the average score was 83/100. Conclusions: The findings from this feasibility study indicate that a PAD digital therapeutic program is feasible for elderly patients with PAD. A multicenter RCT is currently ongoing, where the clinical effectiveness of the full SK-111 will be further explored in this patient group.

Management of Vascular Injury in a Vascular Center of a Developing Country

In surgical practice management of vascular injuries are challenging. Vascular injuries are well addressed in developed countries but there is scarcity of vascular surgeons in developing countries like us and a large number of victims fail to reach specialist in time with consequent loss of limbs or lives. To observe the pattern and outcome of management of vascular injury in a developing country this retrospective study was conducted at the department of vascular surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. All patients with vascular injury arrived alive were included in the study. Date in terms of age, sex, cause of injury, segment of vessel involved, associated injuries, time elapsed after injury, vascular procedures done and postoperative complications were taken from records of the department and were analyzed. Out of 2174 patients with vascular injury 11 patients died at resuscitation & 52 did not come back after referral to other hospitals for management of associated injuries. Most of the patients were young male & road traffic accidents was the most common cause (91.50%). Majority (53.60%) of the patients presented after 6 hours. Majority of the cases lower limb vessels were injured (64.05%). Among the associated injuries combine orthopedic & soft tissue injuries were most common (60.58%). Among the vascular procedures antilogous venous graft (42.39%) followed by end to end anastomosis (27.79%) were in majority of the cases. In case of extremity vascular injury limb amputation rate was 35.40%. This morbidity can be reduced by improvement of road safely measures, encouraging doctors to vascular surgery specialty and effective training of orthopedic & general surgeons in the management of extremity vascular injury till the availability of vascular surgeons for provision of vascular services in remote areas. Bangladesh Heart Journal 2021; 36(1) : 32-37

Vascular surgery in the most populous state in the Amazon: socio-professional profile and aspirations of the specialty.

BackgroundThere is a dearth of studies conducted to understand the socio-professional profile of the vascular surgery specialty and the population demands of specific regions, which are needed to support creation of care policies and direct infrastructure improvements in healthcare.ObjectivesThe purpose of this study was to describe the socio-professional profile of vascular surgeons in the state of Pará, Brazil, to guide creation of tools for professional improvement.MethodsA cross-sectional, self-report survey was conducted in Pará using a questionnaire comprising 30 questions covering six main topics.ResultsAll vascular surgeons actively practicing in the state participated in this study. The total number of specialists was 59, with 71.2% working in the greater Belém area and 16.9% exclusively practicing in the interior of the state. The mean age of these professionals was 48 ± 11.1 years, 86.4% of respondents were men, 64.4% of surgeons had completed medical residency, and 96.6% (n=57) of the surgeons would like to improve their skills in venous surgery, echo-guided vascular access, and endovascular surgery. The method of professional improvement of greatest interest was simulation courses (hands-on), endorsed by 93% of the participants.ConclusionsPará has 59 vascular surgeons. These professionals mainly work in the greater Belém (71.2%), in hospitals (100%) or in private clinics or offices (94.9%), performing a wide range of procedures, including venous and arterial surgery, amputations, and provision of hemodialysis access. More than 90% of these surgeons were satisfied professionally and reported that they would choose the specialty again. However, 22% had a pessimistic view of the specialty’s future. The vast majority of professionals (96.6%) consider that training or a continuing education program are necessary.

Patient injuries in the treatment of superficial venous insufficiency registered in Finland between 2004 and 2017.

This study aimed to identify the unintended incidents that led to patient injuries (PIs) in the treatment of superficial venous insufficiency (SVI). PI claims filed with the Finnish Patient Insurance Centre between 2004 and 2017 involving SVI were reviewed. Factors contributing to PI were identified and classified. Eighteen (13.2%) of 136 compensated PIs in the specialty of vascular surgery were related to SVI. Only 4.7% of 383 SVI claims were compensated. The incidence of PIs was 9.9 per 100 000 patients. Fifteen patients had open surgery (83.3%) and three (16.7%) endovenous treatment. Two (11.1%) patients had necrotising fasciitis, four (22.1%) had deep vein injuries and two (11.1%) had a permanent nerve injury. Two (11.1%) patients had retained endovenous material that required surgical removal. PIs were identifiable during all stages of care, perioperative injuries related to open surgery being the most common.

Vascular surgery's identity

Vascular surgery's identity

Surgeon specialty significantly affects outcome of asymptomatic patients after carotid endarterectomy

BackgroundThis study evaluates the impact of surgical specialty, specifically vascular surgery (VS) versus non-VS (NVS; namely, cardiac surgery, thoracic surgery, general surgery, or neurosurgery) on perioperative carotid endarterectomy (CEA) outcomes stratified by symptom status on presentation. MethodsThe National Surgical Quality Improvement Program Vascular Procedure Targeted database was queried for elective asymptomatic or symptomatic CEA (excluding concomitant CEA and cardiac surgery) from 2011 to 2016. Data were stratified by VS versus NVS and symptom presentation. Primary end points were 30-day stroke and stroke/death; secondary end points included perioperative complications. Multivariable logistic regression determined predictors of all assessed primary outcomes and propensity-weight analysis was used to confirm results. ResultsOverall, 21,060 CEA (12,671 [59%] asymptomatic) were identified with 19,687 (93%) done by VS. In the asymptomatic CEA cohort, VS had lower unadjusted stroke (1.3% vs 2.4%; P = .021) and stroke/death (1.7% vs 3.2%; P = .006) rates. In addition, VS had fewer deaths (0.6% vs 1.3%; P = .033) and pulmonary complications (1.6% vs 2.7%; P = .036). After risk adjustment, the NVS asymptomatic cohort predicted stroke (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.1; P = .032), driven by neurosurgery (OR, 3.1; 95% CI, 1.3-7.2; P = .008). This NVS cohort also predicted stroke/death (OR, 1.8; 95% CI, 1.1-2.9; P = .013), driven by neurosurgery (OR, 2.5; 95% CI, 1.1-5.7; P = .035). After propensity weighting, these differences persisted (stroke: OR, 1.9; 95% CI, 1.1-3.3; P = .030; stroke/death: OR, 1.9; 95% CI, 1.2-3.0; P = .011). Among symptomatic CEA, there was no difference between VS and NVS in unadjusted primary end points of stroke (3.1% vs 4.2%; P = .106) or stroke/death (3.8% vs 4.6%; P = .275). However, in this cohort, VS had fewer major complications (12.7% vs 15.5%; P = .029). ConclusionsThis study identifies the VS specialty as having significantly better outcomes after CEA in patients presenting with asymptomatic disease than NVS specialty, as evidenced by lower rates of stroke and stroke death, which persisted after risk adjustment and propensity weighting. This difference in stroke and stroke/death was not apparent in the symptomatic cohort; however, NVS did have increased unadjusted rates of major complications. Although this finding may reflect multiple factors, including higher operative volume, training, or technical approach, these differences in 30-day CEA outcomes may be crucial for the proper interpretation of ongoing national outcome trials such as CREST2.

Assessment of Use of Arteriovenous Graft vs Arteriovenous Fistula for First-time Permanent Hemodialysis Access

Initial hemodialysis access with arteriovenous fistula (AVF) is associated with superior clinical outcomes compared with arteriovenous graft (AVG) and should be the procedure of choice whenever possible. To address the national underuse of AVF in the United States, the Centers for Medicare & Medicaid has established an AVF goal of 66% or greater in 2009. To explore contemporary practice patterns and physician characteristics associated with high AVG use compared with AVF use. This review of 100% Medicare Carrier claims between January 1, 2016, and December 31, 2017, includes both inpatient and outpatient Medicare claims data. All patients undergoing initial permanent hemodialysis access placement with an AVF or AVG were included. All surgeons performing more than 10 hemodialysis access procedures during the study period were analyzed. Placement of an AVF or AVG for initial permanent hemodialysis access. A surgeon-level AVG (vs AVF) use rate was calculated for all included surgeons. Hierarchical logistic regression modeling was used to identify patient-level and surgeon-level factors associated with AVG use. A total of 85 320 patients (median age, 70 [range, 18-103] years; 47 370 men [55.5%]) underwent first-time hemodialysis access placement, of whom 66 489 (77.9%) had an AVF and 18 831 (22.1%) had an AVG. Among the 2397 surgeons who performed more than 10 procedures per year, the median surgeon level AVG use rate was 18.2% (range, 0.0%-96.4%). However, 498 surgeons (20.8%) had an AVG use rate greater than 34%. After accounting for patient characteristics, surgeon factors that were independently associated with AVG use included more than 30 years of clinical practice (vs 21-30 years; odds ratio, 0.85 [95% CI, 0.75-0.96]), metropolitan setting (odds ratio, 1.25 [95% CI, 1.02-1.54]), and vascular surgery specialty (vs general surgery; odds ratio, 0.77 [95% CI, 0.69-0.86]). Surgeons in the Northeast region had the lowest rate of AVG use (vs the South; odds ratio, 0.83 [95% CI, 0.73-0.96]). First-time hemodialysis access benchmarking reports for individual surgeons were created for potential distribution. In this study, one-fifth of surgeons had an AVG use rate above the recommended best practices guideline of 34%. Although some of these differences may be explained by patient referral practices, sharing benchmarked performance data with surgeons could be an actionable step in achieving more high-value care in hemodialysis access surgery.

Effect of Mentoring on Match Rank of Integrated Vascular Surgery Residents

Mentoring relationships have been encouraged for medical students interested in surgical specialties. We investigated the role of mentoring relationships of integrated vascular surgery residents, while in medical school. We hypothesized that mentoring relationships between medical students and vascular surgeons would have a positive effect on match outcome in the integrated vascular surgery residency match. We used an online survey that respondents completed on a smartphone, tablet, or computer. This was created with Qualtrics Software. The survey was circulated to all North American Integrated Vascular Surgery residents, with the support of the Association of Program Directors in Vascular Surgery Recruitment Committee and the Society for Vascular Surgery Resident/Student Outreach Committee. Questions were posed either as Likert Scale or as multiple choice. Data were analyzed in Stata. Response rate (67 total responses of 241 polled residents) was 28%. Earlier postgraduate year residents were more likely to have had vascular surgeon mentors (P=0.033). There was no association between having a mentor and match rank; however, those with vascular surgeon mentors matched higher on their rank list (P=0.022). 50% of respondents indicated that mentoring was influential in the choice of integrated residency. Respondents with nonvascular surgeon mentors were more likely to answer negatively regarding their mentor's knowledge about other integrated (P<0.0001) and traditional programs (P<0.0001) while residents with a vascular surgeon mentor were more likely to respond positively to this question (P<0.0001). Regarding the effectiveness of mentorship, 81% indicated their mentor was accessible, 92% responded that their mentor demonstrated professional integrity, and 76% responded that their mentor prioritized their success. Integrated vascular surgery residents were generally positive about their medical school mentors. Our data indicate that surgical mentorship in medical school is effective, both in influencing medical students to choose the vascular surgery specialty and in improving match rank-vascular surgeons were more knowledgeable and mentees with vascular surgeon mentors tended to be more successful in the match.

The role of the Vascular Surgery Board in surgical education

The American Board of Surgery (ABS) has more than 80 years of both direct and indirect involvement in US surgical education, with its primary role being certification of graduates of Accreditation Council for Graduate Medical Education–approved surgical training programs. The ABS’s impact on education has been at multiple levels, including the development of the content and administration of qualifying and certifying examinations; original education research based on the Board’s unique data sets; and surgical training and education-related initiatives in partnership with multiple regulatory bodies and surgical societies. Within these efforts, by incremental steps, the specialty of vascular surgery attained recognition as a primary specialty of the ABS, and the Vascular Surgery Board of the ABS was established 20 years ago, in 1998. The 2 decades that followed have witnessed significant transformations in the evaluation and treatment of vascular disease, the paradigms for training vascular and endovascular surgeons, and the Vascular Surgery Board has partnered with stakeholder organizations to continually ensure quality education for the evolving vascular surgical workforce. Looking forward, while surgical education remains outside of its primary mission, the ABS and Vascular Surgery Board will continue as key stakeholders and leaders in the complex network of professional societies and training institutions that will guide the evolution of vascular surgery training.

Factors relating to the publication rate of abstracts presented from 2012 to 2015 at the Society for Vascular Surgery Annual Meeting

ObjectiveThe Society for Vascular Surgery's Annual Meeting acts as a means of disseminating research findings among vascular surgeons through the presentation of research abstracts. Following presentation at the meeting, research is often compiled into a full-text manuscript and submitted to a peer-reviewed journal. However, not all abstracts accepted to the Vascular Annual Meeting (VAM) eventually have a corresponding full-text publication. The objectives of this study were to establish the publication rate of abstracts presented between 2012 and 2015 to the VAM and to identify factors correlating with publication status. MethodsAbstracts presented at the VAM were available through the Journal of Vascular Surgery. Data extracted from eligible abstracts included level of evidence according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence scheme, type of study (prognostic, therapeutic/harm, diagnostic), sample size, and status of outcome (positive, negative, or descriptive findings). Publication status of the abstracts was determined through a comprehensive literature review of PubMed (MEDLINE), Ovid (MEDLINE), and Embase. A multivariable logistic regression was conducted to determine factors correlating with publication status. ResultsThe publication rate during the study period was 43.0% with a median time to publication of 9 months, with 412 of the 958 abstracts having a corresponding full-text publication in 48 journals with weighted mean impact factor of 3.40. Eleven journals collectively published 372 (90.3%) of the articles, with the Journal of Vascular Surgery publishing 280 (68.0%) of the manuscripts. Our logistic regression model demonstrated that factors positively affecting publication status were a positive status of outcome (odds ratio, 2.59; 95% confidence interval, 1.56-4.28) and a logarithmic increase in the sample size of the study (odds ratio, 1.35; 95% confidence interval, 1.13-1.60). In addition, studies with a corresponding full-text publication had a greater median sample size (250) compared with those without one (143; P < .001). ConclusionsFrom 2012 to 2015, 43.0% of VAM abstracts had a corresponding full-text publication, with greater sample size and a positive status of outcome positively correlating with likelihood of publication. Studies with negative findings made up a small proportion of conference abstracts (9.6%) and were the least likely to be published. Given the relatively small size of the specialty of vascular surgery, it may be particularly important to be mindful of publication bias. It may be worthwhile to give additional consideration to acceptance of abstracts or publication of studies with negative results that meaningfully contribute to the literature.

Enfermeras Vasculares y Técnicos de Ultrasonidos Europeos

El grupo Enfermeras Vasculares y Técnicos de Ultraso-nidos Europeos (ESVS) es un comité de reciente forma-ción que representa los intereses de estos dos grupos profesionales que trabajan en el ámbito de la cirugía vascular en toda Europa.A partir del congreso de Oslo, Noruega, de 2009, en las reuniones anuales de la Sociedad Europea de Ciruja-nos Vasculares (ESVS) ha habido programas específicos para enfermeras y técnicos de ultrasonidos. Dichos pro-gramas fueron organizados por profesionales de cada país bajo el auspicio de la ESVS. Pero debido a la variabi-lidad en los roles que estos profesionales desempeñan en cada país no ha habido siempre grupos dispuestos a organizar el programa para enfermeras y técnicos de ultrasonidos en el congreso anual de la ESVS.Tras el congreso anual de la ESVS de 2016 en Copen-hague, Dinamarca, se realizó una propuesta formal a la Junta Directiva de la ESVS para crear la EVNS y asegurar un programa educacional para enfermeras y técnicos de ultrasonidos. Los objetivos de este comité son:• Ofrecer a las enfermeras y técnicos de ultraso-nidos de Europa un foro de encuentro.• Homogeneizar la provisión de servicios en Europa.• Homogeneizar las competencias profesionales en Europa.• Apoyar a la ESVS en su intento de convertirse en una sociedad integradora del equipo multidisci-plinar.• Hacernos socios de la ESVS y constituir un sub-comité dentro de esa sociedad.Esta idea inicial ha seguido evolucionando a lo largo de los dos últimos años, y se espera que a principios de 2019 haya una sección de socios específica para enfer-meras y técnicos de ultrasonidos dentro de la ESVS. También hemos elevado una propuesta solicitando que la EVNS se convierta en un comité oficial de la ESVS.Agradeceríamos mucho un apoyo continuado a la EVNS. Se puede encontrar información adicional sobre la EVNS y sobre cómo hacerse socio de la ESVS en la página web http://www.esvs.org/

Managing claudication in the community setting

Advances made in medical management and treatment options in addressing lower extremity claudication and vascular disease have skyrocketed during the last decade. Given the recent advances in treatment options, there is often the perception within the medical community and general community that to get the most “cutting edge” treatment, one must go to an academic center or practitioner. The goal of this portion of the discussion is to explore the question of what differences in treatment options there are between a community practice and an academic practice within those members of the vascular surgery specialty. Are there really any differences in the types of treatments offered or availability of the different modalities, and what drives us as practitioners to one over the other?

Evolução e tendências formativas em angiologia e cirurgia vascular: a experiência de uma instituição

IntroductionThe constant advances in Angiology and Vascular Surgery specialty has brought to us a great variety in the training during the residency. The main purpose of this study was to show the distinct trends in training during Angiology and Vascular Surgery residency over time, particularly in the field of surgical exposure and scientific activity. MethodsAfter identifying the physicians who completed the Angiology and Vascular Surgery residency between January 2001 and March 2014 in the institution, a retrospective analysis was performed and all data collected from the final curriculum was reviewed. The results were obtained using the Spearman correlation coefficient. ResultsFrom 2001 to 2014, 13 subjects concluded Angiology and Vascular Surgery residency in the Institution, with a mean age 35±5.7 and 4 subjects (31%) were female. The average exposure to surgical procedures was 2518±310, which 2026±291 were vascular procedures. The mean of scientific presentations as first author was 9.7±5.7 and the mean of publications as first author was 4.5±5.9. Although surgical exposure has remained approximately constant, there was a marked variability in the proportion of endovascular procedures. It was observed a marked correlation between the number of endovascular procedures and time (rho=0.869, p<0.001). There was no correlation between the number of endovascular procedures in respect to age or gender. Regarding scientific activity, variability was also large, there has also been an association between time and number of publications (rho=0.879, p<0.001) and presentations (rho=0.753, p<0.001). In a similar way, no correlation was found between the scientific activity and age or gender. ConclusionIn overall the surgical exposure during the residency has remained stable; there was an evolution of the proportion of endovascular procedures, a growing concern with the scientific activity; also the gender or age did not affect surgical exposure and adoption of new technical or scientific activity.

The Vascular Surgery Workforce: A Survey of Consultant Vascular Surgeons in the UK, 2014

The purpose of this study was to describe the demographics, training, and practice characteristics of consultant vascular surgeons across the UK to provide an assessment of current, and inform future prediction of workforce needs. A questionnaire was developed using a modified Delphi process to generate questionnaire items. The questionnaire was emailed to all consultant vascular surgeons (n=450) in the UK who were members of the Vascular Society of Great Britain & Ireland. 352 consultant vascular surgeons from 95 hospital trusts across the UK completed the survey (78%response rate). The mean age was 50.6 years old, the majority (62%) were mid-career, but 24% were above the age of 55. Currently, 92% are men and only 8% women. 93% work full-time, with 60% working >50 hours, and 21% working >60 hours per week. The average team was 5 to 6 (range 2-10) vascular surgeons, with 23% working in a large team of ≥8. 17% still work in small teams of ≤3. Over 90% of consultant vascular surgeons perform the major index vascular surgery procedures (aneurysm repair, carotid endarterectomy, infra-inguinal bypass, amputation). While 84% perform standard endovascular abdominal aortic aneurysm repair (EVAR), <50% perform more complex endovascular aortic therapy. The majority of vascular surgeons "like their job" (85%) and are "satisfied" (69%) with their job. 34% of consultant vascular surgeons indicated they were "extremely likely" to retire within the next 10 years. This study provides the first detailed analysis of the new specialty of vascular surgery as practiced in the UK. There is a need to plan for a significant expansion in the consultant vascular surgeon workforce in the UK over the next 10 years to maintain the status quo.