National Endovascular And Total Vascular Clinical Experience Of Vascular Fellows And General Surgical Residents

John Blebea, Rashad Choudry, Paul van Bemmelen, Vittorio Rotella, Krish Soundararajan, Frank Schmieder. 
Temple University, Philadelphia, PA.

OBJECTIVES: The introduction and incorporation of endovascular procedures as an integral part of the training program for vascular surgical trainees had lead to a paradigm shift both in surgical training and clinical practice. We examined, on a national level, both the endovascular and total vascular clinical experience of graduating vascular fellows and compared it with the analogous training of graduating general surgical residents in the United States.

METHODS: The Accreditation Council for Graduate Medical Education (ACGME) is responsible for the accreditation of all post-MD medical training programs within the United States. Since 2000, the ACGME has required all graduating vascular surgical trainees to identify the number and types of endovascular diagnostic and therapeutic procedures performed. A similar requirement only for therapeutic endovascular interventions has been in place since 2001 for graduating general surgical trainees. We examined and compared the aggregate data for endovascular procedures, and total vascular procedures, by graduating vascular and general surgical trainees for the five year period from 2000 to 2004. The data is reported as the mean + standard deviation of cases performed by each trainee.

RESULTS: There has been a significant and progressive increase in both the number of endovascular and total procedures performed by vascular fellows over the past five years [Table].

The number of endovascular diagnostic procedures has increased by 354%, therapeutic procedures by 200%, and total cases by 37%. Almost half (47%) of the fellows’ clinical experience in 2004 was composed of endovascular procedures. Surgical residents, on the other hand, have had a 22% decrease in the total number of vascular procedures performed, with only a small minority being endovascular therapeutic interventions.

CONCLUSIONS: There has been a rapid and progressive increase in endovascular procedures during vascular surgery fellowships such that it now is estimated to encompass more than half of their total clinical experience. General surgical residents have only a minor participation in endovascular interventions. These results indicate further differentiation of our specialty and implies a continuing need to monitor and potentially modify both our training and certification requirements.