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Objective - Significant increases in the number of endovascular procedures and work hour restrictions during general surgical residency training limit residents’ clinical exposure to vascular bypasses and arterial anastomoses. We utilized an anastomosis simulation lab to increase residents’ technical experience and skills.
Methods - Surgical residents and acting interns were invited to a three hour anastomosis workshop. Two trainees were assigned to each station to perform a femoral-popliteal bypass using cryopreserved saphenous or femoral veins pressurized to 150 mmHg with colored normal saline to simulate clinical clamping and bleeding conditions. Each team performed both a proximal and distal end-to-side anastomosis utilizing a separate segment of cryopreserved vein. The teams were timed, patency of the bypass was assessed and the amount of anastomotic bleeding under pressure was quantified over one minute by measuring leaked saline in a graduated cylinder. A composite performance score was calculated using the time for the anastomosis and leakage volume. A lower score indicated a higher level of technical success.
Questionnaires were given to trainees and faculty. The number of prior vascular procedures performed was derived from the residents’ ACGME case logs. Student t test and Pearson correlation statistical testing was performed to analyze outcomes.
Results - There were a total of nine trainees and three faculty members that participated. There was a positive correlation with resident level and number of prior vascular operative cases, shorter periods of time to complete the anastomosis, and overall score:

Trainee Level (PGY)	Prior Vascular Cases	Liked Simulation (0-10 scale)	Anastomotic Time (min)	Bleeding (ml)	Total Score
MS IV (n=2)	0 + 0	10.0 + 0.0	111 + 0.0	42 + 0.0	153 + 0
1 (n=2)	0 + 0	9.0 + 1.0	190 + 0.0	40 + 0.0	230 + 0
3 (n=2)	30 + 6.0	9.5 + 0.5	80 + 20.0	96 + 22.0	176 + 42
4 (n=3)	96 + 4.6	8.7 + 0.7	75 + 7.7	43 + 15.3	119 + 8
Pearson Correlation (r)	0.90	-0.41	-0.64	0.24	-0.50

The PGY4 residents who had already completed their vascular rotations liked the simulation experience the least and their leakage rates were similar to that of the least experienced trainees suggesting less interest in the process.
All (100%) of the residents and faculty members recommended that the course be repeated in the future and that competition and quantitation of anastomotic time and leakage be continued.
Conclusions - We found the vascular anastamosis simulation experience to be useful for resident education. Junior residents (PGY1-3) who have not yet completed their senior vascular rotations are more likely to appreciate and benefit from such an experience.