DOCSLIB.ORG

Change in Practice Patterns of an Academic Division of Vascular Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Change in Practice Patterns of an Academic Division of Vascular Surgery PAPER Change in Practice Patterns of an Academic Division of Vascular Surgery Houman Solomon, MD; Alexander B. Chao, MD; Fred A. Weaver, MD; Steven G. Katz, MD Hypothesis: Technological advances have required that Results: In 2000, 453 open and 44 endovascular index faculty of academic divisions of vascular surgery ac- procedures were performed. In contrast, by 2005, open quire new technical skills and significantly alter their past index cases had decreased by 47.0% (239) and endovas- clinical practice patterns. cular index cases had increased by 679.5% (299). Open abdominal aortic aneurysm repairs had decreased by 54.5% (68 vs 31), carotid endarterectomies by 28.8% (139 Design: Retrospective medical record review. vs 99), suprainguinal arterial reconstructions by 47.5% (40 vs 21), infrainguinal arterial reconstructions by 56.5% Setting: An academic tertiary referral center and a com- (186 vs 81), and renal/visceral arterial reconstructions munity teaching hospital. by 65.0% (20 vs 7). In 2005, 62 endovascular abdomi- nal aortic aneurysm repairs and 45 carotid stents were Patients: All patients undergoing 10 specific vascular performed, whereas none were performed in 2000. In ad- procedures during a 5-year period. dition, infrainguinal PTA/S had increased by 675.0% (12 vs 81) and suprainguinal PTA/S by 20.0% (20 vs 24). Main Outcome Measures: We analyzed volumes for Conclusions: Although the total number of proce- 10 specific open and endovascular index procedures dures performed has remained relatively constant, there performed by 5 vascular surgeons during a 60-month has been a dramatic increase in the number of endovas- period. Procedures reviewed included open abdominal cular procedures as well as an associated decline in the aortic aneurysm repair, endovascular abdominal aortic number of open procedures. This change in practice pat- aneurysm repair, carotid endarterectomy, carotid artery tern has allowed the members of our division to main- stent, suprainguinal arterial reconstruction, suprain- tain a significant role in the care of patients undergoing guinal percutaneous transluminal angioplasty/stent vascular surgery, as evidenced by stable overall proce- (PTA/S), infrainguinal arterial reconstruction, infrain- dural volume. This will provide a platform for future out- guinal PTA/S, renal and visceral arterial reconstruction, come-related analyses of open vs endovascular proce- and renal and visceral PTA/S. In-hospital length of stay dures performed within a single specialty group. was compared between open procedures and their endo- vascular counterparts. Arch Surg. 2007;142(8):733-737 HE USE OF THE AORTIC HO- the 1950s made the treatment of extracra- mograft by Gross et al,1 Ou- nial carotid disease commonplace. These dot,2,3 and Dubost et al4 in procedures established open surgical tech- the mid-20th century be- niques as the gold standard for the treat- gan the modern era of vas- ment of peripheral vascular disease. cular surgery. Development of fabric grafts More than 50 years ago, Seldinger12 de- T 5 6 by Voorhees et al and DeBakey et al al- veloped the technique of femoral artery lowed abdominal aortic aneurysm (AAA) catheterization used today. In 1964, Dot- repair to become routine. The pioneering ter and Judkins13 performed the first suc- work of Dos Santos7 and Leriche8 in end- cessful arterial dilatation. Ten years later, arterectomy formed the basis for success- Gruntzig14 created the modern angio- Author Affiliations: Division of ful treatment of arterial occlusive dis- plasty catheter. In 1990, Palmaz et al15 pub- Vascular Surgery and ease. Adaptation of Carrel’s suturing lished their initial experience with the de- Endovascular Therapy, Keck 9 School of Medicine, University technique to arterial bypass by Kunlin led ployment of balloon expandable stents, of Southern California to the treatment of infrainguinal occlu- ushering in the modern era of endovas- University Hospital, Los sive disease using vein bypass. The land- cular management of arterial disease. Re- Angeles, and Huntington mark reconstructions of the carotid bifur- searchers such as Fogarty et al,16 Green- Hospital, Pasadena, California. cation by Eastcott et al10 and DeBakey11 in field et al,17 and Parodi et al18 have played (REPRINTED) ARCH SURG/ VOL 142 (NO. 8), AUG 2007 WWW.ARCHSURG.COM 733 ©2007 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/23/2021 Table 1. Volume and Percentage Change Table 2. Comparison of Median LOS Between Open of the Index Procedures and Endovascular Procedures Volume, Median No. of Cases Procedure LOS, d P Value Change, Procedure 2000 2005 % Carotid endarterectomy 1.0 .01 Carotid artery stent 1.0 Carotid endarterectomy 139 99 −29 Open AAA repair 7.0 Ͻ.001 Carotid artery stent 0 45 NA EVAR 1.5 Open AAA repair 68 31 −54 Suprainguinal arterial reconstruction 3.5 Ͻ.001 EVAR 0 62 NA Suprainguinal PTA/S 1.0 Suprainguinal arterial reconstruction 40 21 −47 Infrainguinal arterial reconstruction 4.0 Ͻ.001 ϩ Suprainguinal PTA/S 20 24 20 Infrainguinal PTA/S 1.0 Infrainguinal arterial reconstruction 186 81 −56 Renal and visceral arterial reconstruction 6.0 Ͻ.001 ϩ Infrainguinal PTA/S 12 81 675 Renal and visceral PTA/S 1.0 Renal and visceral arterial 20 7 −65 Total open 3.0 Ͻ.001 reconstruction Total endovascular 1.0 Renal and visceral PTA/S 12 6 −50 Total open 453 239 −47 Abbreviations: AAA, abdominal aortic aneurysm; EVAR, endovascular AAA Total endovascular 44 299 ϩ680 repair; LOS, length of stay; PTA/S, percutaneous transluminal ϩ Total 497 538 8 angioplasty/stent. Abbreviations: AAA, abdominal aortic aneurysm; EVAR, endovascular AAA repair; NA, not applicable; PTA/S, percutaneous transluminal angioplasty/stent. amination passage rates for general and vascular surgery resi- dents during the study period were noted. The Mann- Whitney test was used to determine differences between significant roles in the minimally invasive treatment of variables with continuous outcomes, and the Fisher exact test arterial embolus, pulmonary embolism, and aortic an- was used to analyze differences between the categorical vari- eurysm. However, those in disciplines other than vas- ables. Statistical significance was assumed at PϽ.05. Data cular surgery have advanced most developments in the analysis was performed using SAS statistical software (SAS Inc, endoluminal treatment of arterial disease. With the Cary, NC). ever-increasing demand for minimally invasive proce- dures, members of our vascular surgery division re- RESULTS trained to develop catheter-based skills. In 2000, we began to perform minimally invasive vascular procedures.19 This In 2000 and 2005, the University of Southern California article describes the evolution of our practice during the Division of Vascular Surgery and Endovascular Therapy ensuing 5 years. performed 1035 index procedures. Of the patients, 62.9% were male and 37.1% were female. Their ages ranged from METHODS 49 to 92 years (mean age, 76.8 years). In addition, 45.9% of the patients confirmed a history of smoking more than We reviewed the records of all patients who had undergone any 20 cigarettes per day, 40.9% had hypercholesterolemia, of 10 open or endovascular index procedures performed by the 37.0% had coronary artery disease, 20.9% had diabetes 5 members of our division during a 60-month period. Patient mellitus, 7.8% had chronic obstructive pulmonary dis- data were collected from inpatient and outpatient medical and ease, and 5.0% had renal impairment. There were no sig- billing records. Patient demographics and comorbidities were nificant differences in the demographics or comorbidi- recorded, and comparisons were made between those under- ties of patients operated on in 2000 and 2005 or in patients going minimally invasive procedures and those undergoing open undergoing open or minimally invasive repair (PϾ.16). repair. Procedures reviewed included open AAA repair (rup- In 2000, 453 open repairs and 44 minimally invasive tured AAAs were excluded), endovascular AAA repair (EVAR), procedures were performed for the 10 index cases. In con- carotid endarterectomy (CEA), carotid artery stent (CAS), su- prainguinal arterial reconstruction, suprainguinal percutane- trast, by 2005, 239 open repairs and 299 minimally in- ous transluminal angioplasty/stent (PTA/S), infrainguinal ar- vasive procedures were completed. By the final year of terial reconstruction, infrainguinal PTA/S, renal and visceral the study, CEAs had decreased by 28.8%, open AAA re- artery reconstruction, and renal and visceral PTA/S. pair by 54.5%, suprainguinal arterial reconstructions by The volumes of each of these procedures, as well as their 47.5%, infrainguinal arterial reconstructions by 56.5%, corresponding in-hospital lengths of stay and mortality rates, and renal and visceral arterial reconstructions by 50.0%. were recorded. Length of stay was defined as postoperative days There was a corresponding increase in the number of until discharge or completion of care by the vascular service. minimally invasive procedures performed (Table 1). Postoperative mortality was considered to occur within 30 days When compared, patients undergoing minimally in- of the procedure or during the patient’s procedural hospital- vasive procedures had significantly shorter hospital stays ization. Comparisons of case volume, length of stay, and peri- Ͻ operative mortality rates were made between the first and last than those having open repair (1 day vs 3 days; P .001). years of the study. Vascular procedures performed by the gen- This held true when all endovascular procedures were eral surgery residents in our institution in 2000 and 2005 were compared with their open counterparts (Table 2). Pa- recorded, as were the number of open and endovascular proce- tients undergoing CEA had a much greater variation in dures performed by the vascular surgery residents. Board ex- the range of their length of stay (range: 1-19 days vs 1-8 (REPRINTED) ARCH SURG/ VOL 142 (NO. 8), AUG 2007 WWW.ARCHSURG.COM 734 ©2007 American Medical Association. All rights reserved.
Load more

Recommended publications
  • Clinical Case: Post-Procedure Thrombophlebitis
    Clinical Case: Post-procedure Thrombophlebitis A 46 year old female presented with long-standing history of right lower limb fatigue and aching with prolonged standing. Symptoms –Aching, cramping, heavy, tired right lower limb –Tenderness over bulging veins –Symptoms get worse at end of the day –She feels better with lower limb elevation and application of elastic compression stockings (ECS) History Medical and Surgical history: Sjogren syndrome, mixed connective tissue disease, GERD, IBS G2P2 with C-section x2, left breast biopsy No history of venous thrombosis Social history: non-smoker Family history: HTN, CAD Allergies: None Current medications: Pantoprazole Physical exam Both lower limbs were warm and well perfused Palpable distal pulses Motor and sensory were intact Prominent varicosities Right proximal posterior-lateral thigh and medial thigh No ulcers No edema Duplex ultrasound right lower limb GSV diameter was 6.4mm and had reflux from the SFJ to the distal thigh No deep venous reflux No deep vein thrombosis Duplex ultrasound right lower limb GSV tributary diameter 4.6mm Anterior thigh varicose veins diameter 1.5mm-2.6mm with reflux No superficial vein thrombosis What is the next step? –Conservative treatment – Phlebectomies –Sclerotherapy –Thermal ablation –Thermal ablation, phlebectomies and sclerotherapy Treatment Right GSV radiofrequency ablation Right leg ultrasound guided foam sclerotherapy with 0.5% sodium tetradecyl sulfate (STS) Right leg ambulatory phlebectomies x19 A compression dressing and ECS were applied to the right lower limb after the procedure. Follow-up 1 week post-procedure –The right limb was warm and well perfused –There was mild bruising, no infection and signs of mild thrombophlebitis –Right limb venous duplex revealed no deep vein thrombosis and the GSV was occluded 2 weeks post-procedure –Tender palpable cord was found in the right thigh extending into the calf with overlying hyperpigmentation.
    [Show full text]
  • Five-Year Results of a Merger Between Vascular Surgeons and Interventional Radiologists in a University Medical Center
    From the Eastern Vascular Society Five-year results of a merger between vascular surgeons and interventional radiologists in a university medical center Richard M. Green, MD, and David Waldman, MD, PhD, for the Center for Vascular Disease* Rochester, NY Objectives: We examined economic and practice trends after 5 years of a merger between vascular surgeons and interventional radiologists. Methods: In 1998 a merger between the Division of Vascular Surgery and the Section of Interventional Radiology at the University of Rochester established the Center for Vascular Disease (CVD). Business activity was administered from the offices of the vascular surgeons. Results: In 1998 the CVD included five vascular surgeons and three interventional radiologists, who generated a total income of $5,789,311 (34% from vascular surgeons, 24% from interventional radiologists, 42% from vascular laborato- ries). Vascular surgeon participation in endoluminal therapy was limited to repair of abdominal aortic aneurysms (AAAs). Income was derived from 1011 major vascular procedures, 10,510 catheter-based procedures in 3286 patients, and 1 inpatient and 3 outpatient vascular laboratory tests. In 2002 there were six vascular surgeons (five, full-time equivalent) and four interventional radiologists, and total income was $6,550,463 despite significant reductions in unit value reimbursement over the 5 years, a 4% reduction in the number of major vascular procedures, and a 13% reduction in income from vascular laboratories. In 2002 the number of endoluminal procedures increased to 16,026 in 7131 patients, and contributions to CVD income increased from 24% in 1998 to 31% in 2002. Three of the six vascular surgeons performed endoluminal procedures in 634 patients in 2002, compared with none in 1998.
    [Show full text]
  • UW HEALTH JOB DESCRIPTION Radiologic Tech - Interventional Job Code: 500006 FLSA Status: Non-Exempt Mgt
    UW HEALTH JOB DESCRIPTION Radiologic Tech - Interventional Job Code: 500006 FLSA Status: Non-Exempt Mgt. Approval: G. Greenwood Date: March 2020 C. Hassemer Department : Interventional Radiology/AFCH Hybrid HR Approval: J. Theisen Date: March 2020 OR/OR22 (80240/14930/52580) JOB SUMMARY The Radiologic Tech - Interventional functions independently as a member of the Vascular and Interventional Radiology (VIR), Neuro Endovascular Radiology and Vascular Surgery teams. Team members include registered nurses, IR imaging technologists, nurse practitioners, physician assistants, IR fellows and residents, neurosurgery fellows and residents, vascular surgery fellows and residents, and faculty physicians. This individual is responsible for helping perform a variety of complex specialized tasks operating fluoroscopy, computed tomography, laser, and ultrasonography equipment during vascular and neuroradiology angiographic and interventional procedures. This individual is responsible for helping develop and implement systems to assure the smooth and efficient flow of patients for procedures in the Interventional labs. Duties for this position include but are not limited to: circulating and scrubbing roles during procedures, patient teaching, assisting with patient care within scope of practice, inventory management and schedule coordination. This position requires the individual to be flexible in their work schedule. This individual has previous radiologic technologist work experience, or is a graduate of an accredited IR Technologist training program.
    [Show full text]
  • Our Vascular Surgery Capabilities Include Treatment for the Following
    Vascular and EXPERIENCE MATTERS Endovascular The vascular and endovascular surgeons at LVI are highly experienced at performing vascular surgery and Surgery minimally invasive vascular therapies, and they are leading national experts in limb salvage. We invite you to consult with us, and allow us the opportunity to share our experience and discuss the appropriateness of one Our vascular surgery or more of our procedures for your patients. capabilities include treatment for the following conditions: Abdominal Aortic Peripheral Aneurysm Aneurysm Peripheral Artery Aortic Dissection Disease Aortoiliac Occlusive Portal Hypertension Disease Pulmonary Embolism Ritu Aparajita, MD Tushar Barot, MD Atherosclerosis Renovascular Vascular Surgeon Vascular Surgeon Carotid Artery Disease Conditions Chronic Venous Stroke Insufficiency Thoracic Aortic Deep Vein Aneurysm Thrombosis Vascular Infections Fibromuscular Vascular Trauma Disease Medicine Vasculitis Giant Cell Arteritis Visceral Artery Lawrence Sowka, MD Mesenteric Ischemia without limits Aneurysm Vascular Surgeon 1305 Lakeland Hills Blvd. Lakeland, FL 33805 lakelandvascular.com P: 863.577.0316 F: 1.888.668.7528 PROCEDURES WE PERFORM Minimally Angiogram and Arteriogram Endovascular treatment These vascular imaging tests allow our vascular Performed inside the blood vessel, endovascular specialists to assess blood flow through the arteries treatments are minimally invasive procedures to treat invasive and and check for blockages. In some cases, treatments peripheral artery disease. may be performed during one of these tests. Hybrid Procedures for Vascular Blockage surgical Angioplasty and Vascular Stenting Combines traditional open surgery with endovascular Angioplasty uses a balloon-tipped catheter to open a therapy to repair vessels or place stents, when an blocked blood vessel. Sometimes, the placement of endovascular procedure by itself is not possible for treatment a mesh tube inside the artery is required to keep the the patient.
    [Show full text]
  • Predictors of Cardiac Events After Major Vascular Surgery Role of Clinical Characteristics, Dobutamine Echocardiography, and ␤-Blocker Therapy
    ORIGINAL CONTRIBUTION Predictors of Cardiac Events After Major Vascular Surgery Role of Clinical Characteristics, Dobutamine Echocardiography, and b-Blocker Therapy Eric Boersma, PhD Context Patients who undergo major vascular surgery are at increased risk of peri- Don Poldermans, MD, PhD operative cardiac complications. High-risk patients can be identified by clinical factors and noninvasive cardiac testing, such as dobutamine stress echocardiography (DSE); Jeroen J. Bax, MD, PhD however, such noninvasive imaging techniques carry significant disadvantages. A re- Ewout W. Steyerberg, MD, PhD cent study found that perioperative b-blocker therapy reduces complication rates in Ian R. Thomson, MD high-risk individuals. Objective To examine the relationship of clinical characteristics, DSE results, b-blocker Jan D. Banga, MD, PhD therapy, and cardiac events in patients undergoing major vascular surgery. Louis L. M. van de Ven, MD, PhD Design and Setting Cohort study conducted in 1996-1999 in the following 8 cen- Hero van Urk, MD, PhD ters: Erasmus Medical Centre and Sint Clara Ziekenhuis, Rotterdam, Twee Steden Ziek- enhuis, Tilburg, Academisch Ziekenhuis Utrecht, Utrecht, and Medisch Centrum Alkmaar, Jos R. T. C. Roelandt, MD, PhD Alkmaar, the Netherlands; Ziekenhuis Middelheim, Antwerp, Belgium; and San Gerardo for the DECREASE Study Group Hospital, Monza, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy. ATIENTS WITH SEVERE PERIPH- Patients A total of 1351 consecutive patients scheduled for major vascular surgery; eral vascular disease frequently b have underlying coronary artery DSE was performed in 1097 patients (81%), and 360 (27%) received -blocker therapy. disease. Hence, patients under- Main Outcome Measure Cardiac death or nonfatal myocardial infarction within 30 b Pgoing major vascular surgery are at days after surgery, compared by clinical characteristics, DSE results, and -blocker use.
    [Show full text]
  • Microvascular Disease in Chronic Thromboembolic Pulmonary Hypertension: a Role for Pulmonary Veins and Systemic Vasculature
    ERJ Express. Published on August 19, 2014 as doi: 10.1183/09031936.00169113 ORIGINAL ARTICLE IN PRESS | CORRECTED PROOF Microvascular disease in chronic thromboembolic pulmonary hypertension: a role for pulmonary veins and systemic vasculature Peter Dorfmu¨ller1,2,3,8, Sven Gu¨nther1,3,4,8, Maria-Rosa Ghigna1,2,3, Vincent Thomas de Montpre´ville2, David Boulate5, Jean-Franc¸ois Paul6, Xavier Jaı¨s1,3,4, Benoit Decante5,Ge´rald Simonneau1,3,4, Philippe Dartevelle1,3,7, Marc Humbert1,3,4, Elie Fadel1,3,5,7 and Olaf Mercier1,3,5,7 Affiliations: 1Paris-South University, Faculty of Medicine, Kremlin-Biceˆtre, France. 2Dept of Pathology, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France. 3INSERM U999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France. 4National Reference Center of Pulmonary Hypertension, Dept of Pulmonology and Intensive Care Unit for Respiratory Diseases, Hoˆpital Biceˆtre, AP-HP, Kremlin-Biceˆtre, France. 5Surgical Research Lab, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France. 6Dept of Radiology, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France. 7Dept of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France. 8Both authors contributed equally to this study. Correspondence: Peter Dorfmu¨ller, Service d’Anatomie et de Cytologie Pathologiques, Centre Chirurgical Marie Lannelongue, 133 Avenue de la Re´sistance, 92350 Le Plessis-Robinson, France. E-mail: [email protected] ABSTRACT Limited numbers of operated patients with chronic thromboembolic pulmonary hyperten- sion (CTEPH) are refractory to pulmonary endarterectomy (PEA) and experience persistent pulmonary hypertension (PH). We retrospectively assessed lung histology available from nine patients with persistent PH (ineffective PEA (inPEA) group) and from eight patients transplanted for distal CTEPH inaccessible by PEA (noPEA group).
    [Show full text]
  • Can an Interventional Radiologist Survive in Today's Turf War?
    UNIVERSITYUNIVERSITY OF WISCONSIN–MADISON OF WISCONSIN–MADISON Can An Interventional Radiologist Survive In Today’s Turf War? John Swietlik, MD, Paul H Yi, MD, Nathan Kim, MD & Jie Nguyen, MD, MS Department of Diagnostic Radiology University of Wisconsin-Madison UNIVERSITY OF WISCONSIN–MADISON Disclosures The authors have no financial disclosures relevant to this electronic exhibit. University of Wisconsin–Madison 2 UNIVERSITY OF WISCONSIN–MADISON Introduction • Increasing numbers of imaging-assisted endovascular and cardiac procedures are being performed by non-Interventional Radiologists. “Between 1997 and 2002, procedure volume in percutaneous peripheral arterial interventions grew at faster rates among cardiologists, vascular surgeons, and other physicians than it did among radiologists.” • This trend has raised concerns amongst Interventional Radiology (IR) physicians regarding the financial viability of the field. University of Wisconsin–Madison 3 UNIVERSITY OF WISCONSIN–MADISON Let the Turf Wars Begin • As a result, there has been concern about turf wars between IR and other endovascular and cardiac procedure-oriented fields for decades. University of Wisconsin–Madison 4 UNIVERSITY OF WISCONSIN–MADISON Goals & Objectives • The purpose of this study was to assess the differences in maximum Medicare reimbursements to IR, VS, and Cardiology physicians. In other words… Can the field of IR remain financially viable in today's healthcare market? University of Wisconsin–Madison 5 UNIVERSITY OF WISCONSIN–MADISON Methods • The Medicare Provider Utilization and Payment Database is a publicly available database provided by the Centers for Medicare & Medicaid services (US Government organization) that discloses all Medicare payments by dollar amount to physicians from 2012 to the present. • This database was queried for all IR, VS, and Cardiology physicians who received Medicare reimbursements in 2014.
    [Show full text]
  • How to Prepare for an Appointment with a Vascular Surgeon
    Protect Your Vascular Health How to Prepare for an Appointment with a Vascular Surgeon Who needs to see a vascular surgeon? TA vascular surgeon is a highly trained physician who manages patients with all forms of vascular disease, so almost any patient might have occasion to see such a specialist. This includes: • Patients with aneurysms in almost • any location in the chest, abdomen, or extremities. • Patients with peripheral arterial disease (PAD), whether symptoms are minor or more threatening to the leg. • Many patients with carotid disease or blockage will see a vascular surgeon for stroke prevention and treatment. • Patients with kidney failure require dialysis access procedures, also provided by vascular surgeons. • Patients with varicose veins, spider veins, or leg ulcers caused by venous disease. Vascular surgeons are the only professionals who can offer all forms of treatment to this wide-ranging group of patients. What testing might have led to a recommendation to visit a vascular surgeon? Your primary care physician may have identified vascular disease with one of many different examinations. • Bruit, or sound heard in the neck. • History of stroke-like symptoms may prompt a carotid ultrasound (duplex scan), a CT scan, or MR scan may lead to a consultation with a vascular surgeon. • An ultrasound or CT scan may identify an aneurysm to be evaluated by a vascular surgeon. • An examination of the pulses in the legs or a Doppler study (ABI) could demonstrate PAD prompting further evaluation and treatment provided by a vascular surgeon. Please call with any questions: For more information visit VascularWeb.org ® Copyright © 2012, Society for Vascular Surgery®.
    [Show full text]
  • Treatment of Cavernous Sinus Aneurysms with Flow Diversion: Results in 44 Patients
    ORIGINAL RESEARCH INTERVENTIONAL Treatment of Cavernous Sinus Aneurysms with Flow Diversion: Results in 44 Patients R.C. Puffer, M. Piano, G. Lanzino, L. Valvassori, D.F. Kallmes, L. Quilici, H.J. Cloft, and E. Boccardi ABSTRACT BACKGROUND AND PURPOSE: Aneurysms of the cavernous segment of the ICA are difficult to treat with standard endovascular techniques, and ICA sacrifice achieves a high rate of occlusion but carries an elevated level of surgical complications and risk of de novo aneurysm formation. We report rates of occlusion and treatment-related data in 44 patients with cavernous sinus aneurysms treated with flow diversion. MATERIALS AND METHODS: Patients with cavernous segment aneurysms treated with flow diversion were selected from a prospec- tively maintained data base of patients from 2009 to the present. Demographic information, treatment indications, number/type of flow diverters placed, outcome, complications (technical or clinical), and clinical/imaging follow-up data were analyzed. RESULTS: We identified 44 patients (37 females, 7 males) who had a flow diverter placed for treatment of a cavernous ICA aneurysm (mean age, 57.2; mean aneurysm size, 20.9 mm). The mean number of devices placed per patient was 2.2. At final angiographic follow-up (mean, 10.9 months), 71% had complete occlusion, and of those with incomplete occlusion, 40% had minimal remnants (Ͻ3 mm). In symptomatic patients, complete resolution or significant improvement in symptoms was noted in 90% at follow-up. Technical complications (which included, among others, vessel perforation in 4 patients, groin hematoma in 2, and asymptomatic carotid occlusion in 1) occurred in approximately 36% of patients but did not result in any clinical sequelae immediately or at follow-up.
    [Show full text]
  • How Vascular Surgery Programs Differ from Interventional Radiology and Interventional Cardiology Programs
    How Vascular Surgery Programs Differ From Interventional Radiology and Interventional Cardiology Programs Dawn M. Coleman, MD Handleman Research Professor Program Director – UM Vascular Surgery Disclosures • I’m a vascular surgeon • I’m a program director How do you train to be a vascular surgeon? • Independent fellowship (5+2 pathway) • Integrated Residency (0+5 pathway) • Alternative pathways – Early specialization (4+2) – Independent (3+3) Vascular Surgery Training– Independent Fellowship (5+2 pathway) • 5 years of general surgery residency (+/- ADT) • Followed by a 2 year vascular surgery fellowship • Previously, the most common training pathway • Vast majority of VS trained this way • 2018 - 96 fellowship programs (121 spots) • Allows for ABS certification in both: • General Surgery (primary certificate) • Vascular Surgery (CAQ - certificate of added qualification) 4 Vascular Surgery Training – Integrated Residency (0+5 pathway) • VS made a primary certificate in 2006 (ABS) – General Surgery ABS certification no longer required for VS certification – Cannot be General Surgery “board certified” • In 2007 the first THREE vascular residencies appeared – 2018 - 54 integrated programs • 24 months of “core” General Surgery • Remainder = Vascular Surgery Training (open and endovascular) 5 Vascular Surgery Training– 4+2, 3+3 • Early Specialization (4+2) - ESP – Must be done at a single institution – 4 years of general surgery training (-1 year) – Basically followed by a traditional VS fellowship – Allows for ABS Certification in both GS and
    [Show full text]
  • Collaboration Between Vascular Surgeons and Interventional Radiologists: Reflections After Two Years
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Collaboration between vascular surgeons and interventional radiologists: Reflections after two years Richard M. Green, MD, Rochester, NY Like the subject of Shel Silverstein’s provocative after previous efforts at collaboration broke down. children’s story, The Missing Piece,1 vascular sur- The Society for Vascular Medicine and Biology was geons think a piece is missing, that they are incom- invited to participate, and the program was orga- plete. They are not happy, and they are not alone. nized by Barry Katzen, MD (SCVIR), Alan Hirsch, There could not be any better evidence for this than MD (Society for Vascular Medicine and Biology), the unexpectedly large and broad-based attendance and me. The intent was to identify ways to collabo- at the Vascular Centers of Excellence Conference in rate more effectively. Every effort was made to bal- Chicago from April 30 to May 1, 1999. Vascular ance the program, and the premise that all the issues surgeons, along with many other people, came in should be discussed even if the participants walked search of their missing pieces. This story is an alle- away and agreed to disagree was accepted. goric rendition of the current rage for synergy that Conference organizers anticipated 200 attendees pervades the management of most large industries.2 and got 714 attendees (24% vascular surgery, 35% None of this would be occurring in the absence interventional radiology, 2% vascular medicine, 5% of the emerging technologies that transcend any one cardiology, and 15% hospital administration).
    [Show full text]
  • Vascular Surgery Career Resource
    The American Journal of Surgery (2011) 201, 269–271 Editorial Opinion Vascular surgery career resource KEYWORDS: Abstract. Vascular surgery has undergone a minimally invasive revolution in the past 15 years. The Vascular surgery; subspecialty emerged with many changes to its training paradigms that have made this field more Surgical subspecialty attractive to both medical student and general surgery resident candidates. Commitment to diagnosis training; and treatment of arterial, venous, and lymphatic systems disorders remains the cornerstone of this Career resource profession, but an entirely new generation of endovascular treatments has been added to the staple of open surgical procedures used to treat these diseases. A wide variety of practice options are available, ranging from high-stress, technologically demanding complex arterial repairs to low-risk, outpatient, venous insufficiency treatment and all combinations in-between. Many online resources are available to allow an interested candidate to stay current with all the exciting changes in the field. This information is maintained by strong national organizations of vascular surgeons. Published by Elsevier Inc. Vascular surgery is a subspecialty devoted to the diag- include significant experience in vascular ultrasound, noninva- nosis and treatment of diseases of the arteries, veins, and sive arterial testing, and catheter-based imaging (angiography lymphatics. This allows the surgeon a wide variety of prac- and venography). Knowledge of cross-sectional imaging tech- tice options. Some surgeons focus on complex aneurysms, niques (computed tomography and magnetic resonance) is also requiring a hospital-based practice, a high level of skill, and very important. significant technological support. Some surgeons focus only Vascular surgery formed in the middle of the last century.
    [Show full text]