Progressive shortfall in open aneurysm experience for vascular surgery trainees with the impact of fenestrated and branched endovascular technology

• Published in: Journal of vascular surgery 2017-01, Vol.65 (1), p.257-261
• Main Authors: Dua, Anahita, MD, MS, MBA, Koprowski, Steven, BS, Upchurch, Gilbert, MD, Lee, Cheong J., MD, Desai, Sapan S., MD, PhD, MBA
• Format: Article
• Language: English
• Subjects: Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - education; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - trends; Clinical Competence; Curriculum; Databases, Factual; Diffusion of Innovation; Education, Medical, Graduate - methods; Education, Medical, Graduate - trends; Endovascular Procedures - adverse effects; Endovascular Procedures - education; Endovascular Procedures - instrumentation; Endovascular Procedures - trends; Hospitals, Teaching; Humans; Internship and Residency - trends; Learning Curve; Logistic Models; Prosthesis Design; Retrospective Studies; Stents; Surgeons - education; Surgeons - trends; Surgery; Time Factors; United States
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2016.08.075

Abstract Background In 2014, we published a series of articles in the Journal of Vascular Surgery that detailed the decrease in volume of open aneurysm repair (OAR) completed for abdominal aortic aneurysm (AAA) by vascular surgery trainees. At that time, only data points from 2000 through 2011 were available, and reliable predictions could only be made through 2015. Lack of data on endovascular aneurysm repair (EVAR) using fenestrated (FEVAR) and branched (BrEVAR) endografts also affected our findings. Despite these limitations, our predictions for OAR completed by vascular trainees were accurate for 2012 to 2014. This report uses updated data points through 2014 in conjunction with data on FEVAR and BrEVAR obtained from industry to predict trends in OAR and how it will affect vascular surgery training through 2020. Methods An S-curve modified logistic function was used to model the effect of introducing new technologies (EVAR, FEVAR, BrEVAR) on the standard management of AAA with OAR starting in the year 2000, similar to the technique that we have previously described. Weighted samples and data from the United States Census Bureau were used in conjunction with volume estimates derived from the National Inpatient Sample, State Inpatient Databases, and industry sources to determine trends in OAR and EVAR. The number of cases completed at teaching hospitals was calculated using the National Inpatient Sample, and Accreditation Council for Graduate Medical Education case logs were used to forecast the number of cases completed by vascular surgery trainees through 2020. Sensitivity analysis and trend analysis were completed. Results Approximately 45,000 AAA repairs are completed annually in the United States, but only 15% of these are now completed using OAR compared with >50% just a decade ago. Further, with the accelerating adoption of FEVAR and BrEVAR, and expanding indications for standard EVAR, our model predicts that