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The New Golden Age Of Aortic Training
Sarah Lauve, MD, Kathryn DiLosa, MD, Marie Unruh, MD, Amit Chawla, MD, Claudie Sheahan, MD, Malachi G. Sheahan, III, MD.
LSU, New Orleans, LA, USA.
OBJECTIVES - Following the development of endovascular aortic repair (EVAR), publications reported a decline in open aortic repairs (OAR) amongst vascular surgery trainees (VST; fellows VSF, integrated residents VSR), increasing scrutiny over aortic case volume. In recent studies including aortoiliac occlusive disease (AIOD), OAR volume remains stable. We sought to evaluate the VST aortic experience and compare it to the experience in a similar training paradigm, modern cardiothoracic surgery trainees (CTST; fellows CTSF, integrated residents CTSR).
METHODS - Accreditation Council for Graduate Medical Education (ACGME) reports were reviewed for VSR, VSF, CTSR, and CTSF from 2021-2024 and for VSF from 2007-2010 for comparison to historic training experience. Cases included for analysis for VST were open abdominal aortic aneurysm repair (AAA), complex AAA, aortic endarterectomy, aortobifemoral bypass (ABF), open mesenteric intervention, spine exposure, aortoiliac trauma, EVAR, and thoracic EVAR (TEVAR). Open AAA included ruptures and elective infrarenal repairs, complex AAA included descending thoracic aortic (TAA), thoracoabdominal (TAAA), and juxta-renal aneurysms. Cases included for CTST were ascending TAA, descending TAA, TAAA, aortic trauma, and total aortic endovascular experience.
RESULTS - The mean open aortic volume for VSR and VSF from 2021-2024 was 52.3 and 48.6 cases, respectively (Table 1). The mean open aortic volume for the historic VSF cohort was 47.7 cases. The mean total aortic volume from 2021-2024 for VSR and VSF was 114.3 and 102.5 cases, respectively. The mean total aortic volume for the historic VSF cohort was similar at 103.5 cases. While modern day VSR and VSF performed less OAR for aneurysms than the historic fellow cohort, the modern VST performed more aortic endarterectomies, ABF, spine exposures, and aortoiliac traumas with similar volumes for open mesenteric and endovascular cases. Compared to CTST, VST consistently had higher open and endovascular aortic volume despite CTST performing more OAR for aneurysms.
CONCLUSIONS - Between 2021-2024, the mean open aortic case volume amongst our VST remained stable and comparable to recent studies including AIOD. When comparing modern VST to historic VSF, we observed no change in total aortic volume. And when comparing vascular to CTS training, VST experienced more open and endovascular aortic cases.
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