Portuguese Society of Angiology and Vascular Surgery (SPACV) Abstracts abstracts

Objective: In the past decade, treatment of abdominal aortic aneurysm (AAA) has shifted dramatically from open aneurysm repair (OAR) to an endovascular approach (EVAR). The decreasing number OARs has raised concerns regarding future vascular surgeons' competence to perform this complex and high risk procedure. The main goal of this study was to evaluate AAA repair trends among vascular surgery residents over the last 15 years on a national level. Methods: After identifying the physicians who completed the Angiology and Vascular Surgery Residency between 2007 and 2017 at a national level, all data were collected retrospectively, by examination of the curriculum vitae presented for the final speciality exam. The total number of AAA procedures was counted, categorised by the type of surgery performed (OAR vs. EVAR) and accounting for those performed as first or assistant surgeon. The evolutionary trends on AAA repair over time were evaluated. Trends were assessed using Spearman's correlation coefficient. Results: From 2002 to 2017 there was no variability in the total exposure to OAR, but there was a marked decrease in procedures performed as first surgeon (rho = -0.363; p < .02). By the end of their residency, a vascular surgery resident in 2007 would have completed, on average, 15 OAR cases compared with only seven cases in 2017. On the other hand, there was a marked increase in the total exposure to endovascular procedures (rho = 0.478; p < .02) as well as those performed as first surgeon (rho = 0.540; p < .01). Conclusion: This study demonstrates that vascular surgical residents are being exposed to progressively fewer open aneurysm cases, and that those cases are increasingly complex and often perceived as being too difficult for many residents. The variable and diminishing OAR exposure within the vascular surgery training programme highlights growing concerns surrounding competence in complex open repair and suggests that only a small proportion of current trainees have sufficient opportunity to develop confidence and proficiency in this high risk operation. In conjunction with decreasing trainee confidence completing OAR and increased malpractice litigation in this area, a new paradigm in vascular surgery education will be necessary to maintain high standards for patients who undergo OAR. In all likelihood, training programmes will need to consider supplemental open AAA training, such as simulation or travelling to high volume centres to achieve competence in open AAA surgery.