Society For Clinical Vascular Surgery

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Trends in the Number of Cases Performed by Vascular Fellows and Integrated Vascular Residents for the Treatment of Peripheral Arterial Occlusive Disease
Victoria Greenwood, BS, Bing Shue, MD, Brian Shames, MD, Jeffrey Indes, MD.
University of Connecticut, Farmington, CT, USA.

Objectives: In current integrated vascular residency, the primary focus on the vascular patient occurs in the final 2 years of training. Vascular trainees need to be proficient in both endovascular and open procedures for the treatment of peripheral arterial occlusive disease. This retrospective study evaluates trends in case numbers for integrated vascular surgery residents in their chief years compared to their 5+2 counterparts, for the treatment of peripheral arterial occlusive disease.
Methods: The Accredited Council for Graduate Medical Education case logs between 2012 and 2016 were collected from a pool of 577 residents and fellows from 123 programs. Trainees were grouped into 2 categories: integrated vascular residency (0+5) and vascular surgery fellowship (5+2) in the United States. Inclusion criteria were specific to open and endovascular cases for the treatment of peripheral arterial occlusive disease performed by the "surgeon chief" for integrated vascular surgery programs and "surgeon fellow" for vascular surgery fellowships.
Results: Vascular surgery fellows consistently performed over 1.5 fold more total peripheral cases and nearly 2 fold more peripheral endovascular cases than their 0+5 counterparts per year, respectively (152.7 vs 89.5 and 83.5 vs.44.2, p<0.05). When analyzing these cases further with respect to endovascular treatment for aortoiliac (AI), femoropopliteal (FP) and infra-pop (IP), we found AI and FP case numbers increased between 2012 - 2016 and IP cases decreased, while at the same time VSF’s were performing many more of these cases per year than the 0+5 residents, respectively (AI: 12.2-27.8 vs. 6.1-16.1 p<0.05, FP: 26.2-43 vs. 15.3-22.9 p<0.05, IP: 42.7-20.7 vs. 19.8-13.3 ) p<0.05. When looking at 3 index open procedures, aortobifemoral bypass (ABF), femoropopliteal bypass with vein (FPBv) and infra-popliteal bypass with vein (IPBv), in the most recent academic year of 2016, and the VSF’s performed more cases than the 0+5 residents, respectively (ABF: 8.5 vs. 6.3, FPBv: 10.3 vs. 6.9, IPBv: 16.3 vs. 9.2 ).
Conclusions: Vascular trainees are performing considerably more endovascular than open procedures for peripheral artery occlusive disease. VSF’s are performing more endovascular and open cases than their 0+5 counterparts. This increase in case numbers among VSF’s seems much more pronounced for endovascular than open cases. These findings may have implications for and be contradictory to established thoughts about the 5+2 and 0+5 vascular training pathways.

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