Training Of Vascular Surgeons Research Articles

Commentary to ‘Trends in Treatments of Abdominal Aortic- and Iliac Aneurysm Repairs in Norway from 2001 to 2013’: Mapping of Clinical Practice: A Mirror for Clinicians and Decision Makers

number of vascular centers has decreased over the years, and the proportion of endovascular procedures has increased, although to a variable degree throughout the country, and to a lesser degree than in many other European countries.They tell a story of challenges that are not distinct for Norway, including: the conflict of need for sufficient volume of a procedure to ensure quality, versus the need for health services close to where patients live; the introduction of a new technique requiring collaboration of highly skilled experts from several specialties and the political demand for equitable health care; and the third aspect, can we rely on the data from our clinical databases and administrative registries? Regarding the political goal of equitable health care,Norway has a challenging geography. Only 5 million people live in the country, of whom about 50% live in the area of the SouthEastern Regional Health Authority. In some regions, travel distances to even a small hospital are several hours.Vascular surgery has been a subspecialty of general surgery since 1986, and endovascular proceduresareperformedincollaborationwithinterventionalradiologists. Since the first report from the Norwegian association for vascular surgery in 2001 regarding the structure of vascular surgical healthcare services, there has been an ongoing debate about where vascular surgery should be performed. 2 Should all hospitals perform vascular surgery? Should there be one regional center where, for instance, endovascular aortic repairs should be performed, while peripheral vascular surgery could be performed more widely? How many procedures need to be performed to ensure quality for the patients and quality in the training of vascular surgeons? There was an understanding that vascular centers ought to serve a large enough population to acquire excellence in both open and endovascular repair of aortic aneurysms. Publications regarding feasibility of endovascular repair of acute aneurysms, with lower mortality, and the emerging practice of this in the larger centers, also influenced the discussion. This led to processes and heated discussions in all health regions. The importance and interdependence of vascular surgery with trauma care and other acute surgical care were issues e if vascular surgery was not offered, could the hospital still be an acute service surgical hospital? What about travelling times in acute cases? The threats to the hospitals’ future existence were obvious. This involved discussion far beyond the vascular surgical community. To guide the policy debates, the knowledge base for the relationship between volume and quality was at the same time sought through a systematic review of the literature. 3 Although there was fairly strong evidence regarding a positive correlation between

Impact of Carotid Artery Stent Trials on the Education and Training of Vascular Surgeons

Clinical trials directed at evaluating the efficacy and safety of carotid artery stenting (CAS) have accelerated development of didactic and technical training programs for both newly trained and experienced vascular surgeons. This report reviews the current status of guidelines for CAS and the evolution of related educational programs necessary to impart the clinical, cognitive, and technical skills required for the optimal care of patients with this new technology.

The American Association for Vascular Surgery: Advocate for independence

The American Association for Vascular Surgery: Advocate for independence

The American Association for Vascular Surgery: Advocate for independence

The American Association for Vascular Surgery: Advocate for independence

Presidential address: Practice patterns in vascular surgery—Implications for the certification and training of vascular surgeons

It is a privilege for me to welcome you to the Eleventh Annual Meeting of the Eastern Vascular Society (EVS). Serving as President of your Society during this past year has been a great pleasure and distinct honor for me. As I contemplated the traditional obligation for this address, I was impressed with the emergence of our specialty of vascular surgery to a position of independence, as well as the gravity of decisions and crossroads we face movingtoward the next century. Today, I have chosen to review a body of data that impacts on the practice of vascular surgery and the training of vascular surgeons. In preparing for this presentation, I have used data previously collected for the Association of Program Directors in Vascular Surgery (APDVS; Manpower survey. Hobson RW, unpublished data; 199596.). I have been urged by many colleagues to publish this information, and I trust that it will interest you as well as constitute a useful review for those of you in the audience who attended recent meetings of the APDVS. In my opinion, these data reflect ongoing changes in the practice of vascular surgery and have important implications for the certification and future training of vascular surgeons.

A program of operative angioplasty: Endovascular intervention and the vascular surgeon

Vascular surgeons are ideally suited to select and perform endovascular interventions either as primary therapy or as an adjunct to bypass surgery. Attaining proficiency in endovascular techniques is an important goal in the training of vascular surgeons. We report our initial experience with a program of endovascular intervention performed in the operating room by vascular surgeons. During the previous three years, we performed 109 angioplasty procedures, 60 aortoiliac (55%), 32 femoropopliteal (29%), and 17 popliteal/tibial (16%), using guidewires and angioplasty balloons directed by intraoperative digital subtraction C-arm arteriography with road-mapping capabilities. Indications for angioplasty included disabling claudication in 59 patients (54%), rest pain in 18 (17%), and tissue loss in 32 (29%). Angioplasty was accompanied by stent placement in 39 of 60 aortoiliac procedures (65%) and in two of 32 femoral procedures (6%). In 16 cases (15%), the endovascular procedure was performed in conjunction with a bypass procedure. In selected cases (15, 14%), duplex scanning was the sole diagnostic method used before surgery to identify the lesion, eliminating the need for preoperative arteriographic scans. Segmental pressure measurements, duplex ultrasound scans, and treadmill exercise testing as indicated were performed before and after surgery. The efficacy of the endovascular intervention was assessed at 3-month intervals during the first year and at 6-month intervals thereafter. A successful results was defined using criteria recommended by the Ad Hoc Subcommittee on Reporting Standards for Endovascular Procedures from the Society for Vascular Surgery/International Society for Cardiovascular Surgery. This included the combination of symptomatic improvement, obtaining an anatomically successful result with < 30% residual lumen stenosis, and elimination of the translesion gradient with an improvement in high thigh-brachial index or ankle-brachial index greater than 0.15. Initial success was achieved in 55 of 60 aortoiliac (92%), 28 of 32 femoropopliteal (88%), and 16 of 17 popliteal/tibial (94%) angioplasty procedures. Clinical follow-up has been achieved in all cases, with continued clinical success rates of 80%, 75%, and 82% for aortoiliac, femoropopliteal, and popliteal/tibial angioplasty procedures, respectively, with a mean follow-up of 15.7 months. These results confirm the value of a program in which C-arm technology was used by vascular surgeons in the performance of angioplasty and stenting procedures in the operating room. This experience in therapeutic endovascular intervention will facilitate the credentialing process for future vascular surgeons.

The development of the E. Stanley Crawford Critical Issues Forum

The development of the E. Stanley Crawford Critical Issues Forum

Accreditation of vascular training programs and certification of vascular surgeons

Accreditation of vascular training programs and certification of vascular surgeons

The residency review committee for surgery and the training of vascular surgeons

Purpose: This article reviews the activities and actions of the Residency Review Committee (RRC) for Surgery in the accreditation process of of vascular surgery training programs since 1983.Methods: The substantial changes of the Special Requirements for Graduate Education in General Vascular Surgery are discussed for 1983, 1987, 1989, and 1992. The rank-ordered list of RRC citations is reviewed. The national resident operative statistics for the past 4 years are reported for both general and vascular surgery residents.Results: Changes in the Special Requirements have included deletion of two of the four types of programs, elimination of the need for institutional programs in specialties other than core general or thoracic surgery, and relaxation of the restriction against concurrent resident assignment. The most common citation continues to be the negative impact on general surgery residents. Nevertheless national operative statistics show a favorable increase in case load for both general and vascular surgery residents.Conclusions: Future challenges to surgical education and practice are summarized; the solutions to these challenges will require cooperative efforts of the RRC, the American Board of Surgery, and a number of specialty societies and credentialling or regulatory bodies.

Training of vascular surgeons in france: Ten years of the french college of vascular surgery

Training of vascular surgeons in france: Ten years of the french college of vascular surgery

Training of Vascular Surgeons in France: Ten Years of the French College of Vascular Surgery

The French College of Vascular Surgeons serves several functions including the organization of vascular surgery training nationwide, overseeing the practical aspects of institutional training, providing motivation for trainees by creating final exams, and bringing surgeons together to update their knowledge. This article details the results of their programs, the demographic changes in vascular surgical practice over the last ten years, and the problems to be solved in the near future. These challenges include: maintenance of autonomy in the surgical world, enlargement of the fields of action, clarification of indications for vascular procedures, demographic control, and recognition of training programs on the wider, European level.