A national analysis of vascular surgery resident operative experience in peripheral artery disease

Abstract

Background: Endovascular and hybrid interventions have played an increasingly prominent role in the treatment of peripheral arterial disease (PAD) in the past decade. This shift has prompted concerns about the adequacy of open surgical training for current surgical residents. Moreover, the recent Best Surgical Therapy in Patients With Critical Limb Ischemia trial has further emphasized the importance of open surgical techniques in the treatment of peripheral arterial disease. The purpose of this study was to examine national temporal trends in peripheral operative volume among integrated vascular surgery residents.

Methods: Data was obtained from the Accreditation Council for Graduate Medical Education national data reports for integrated vascular surgery residents. Case volumes for surgeon chief or surgeon junior cases were collected from academic years 2012 to 2013 and 2021 to 2022. Trends in case-mix and volume were evaluated using linear regression analysis.

Results: The mean total vascular operative volume increased from 851.2 to 914.3 cases among graduating chief residents, with an annual growth of 8.5 ± 1.7 cases/year (R² = 0.77; P < .0001). Major vascular case volume also increased at a rate of 5.7 ± 1.2 cases/year (R² = 0.74; P < .001). Among operative categories, peripheral cases were the most frequent (n = 232.2 [26.6%]) and demonstrated the greatest annual growth (+8.0 ± 0.8 cases/year, R² = 0.93; P < .001). No changes were seen in volume of open peripheral cases, including suprainguinal bypass (+0.1 ± 0.2 cases/year; R² = 0.08; P = .40) or femoropopliteal bypass procedures (-0.1 ± 0.2 cases/year; R² = 0.17; P = .20). Infrapopliteal bypass (+0.4 ± 0.1 cases/year; R² = 0.48; P = .006), iliac/femoral endarterectomy (+1.3 ± 0.2 cases/year; R² = 0.82; P < .001), and leg thromboembolectomy (+0.4 ± 0.1 cases/year; R² = 0.64; P < .001) all demonstrated annual growth. For endovascular peripheral cases, aortoiliac revascularization (+3.4 ± 0.3 cases/year; R² = 0.94; P < .001), femoropopliteal revascularization (+5.4 ± 0.2 cases/year; R² = 0.98; P < .001), and tibioperoneal revascularization (+2.0 ± 0.2 cases/year; R² = 0.92; P < .001) all increased in volume. Lower extremity amputations, including above-knee amputation (+0.6 ± 0.2 cases/year; R² = 0.65; P < .001) and below-knee amputation (+0.9 ± 0.2 cases/year; R² = 0.72; P < .001) also demonstrated an increase in volume.

Conclusions: Current graduating residents have higher open and endovascular case volumes for peripheral artery disease on a national level, despite the increasing popularity of endovascular techniques. Further studies are needed to identify how these trends may impact current vascular surgery milestones. These trends may also influence the rising interest in competency-based training programs.

Keywords: Peripheral artery disease; Residency; Surgical education.