Vascular fellow and resident experience performing infrapopliteal revascularization with endovascular procedures and vein bypass during training

Objective: Endovascularaneurysmrepairhas ledtoasignificantreductioninvascular traineeexperienceinthesurgical treatment of aortic aneurysms. We sought to evaluate whether the vascular training paradigmor the "endovascular first" approach to lower extremity vasculardisease hashada similar effecton trainee experiencewithinfrapopliteal endovascular therapyandveinbypass. Methods: Deidentified data were provided by the Vascular Surgery Board on the number of procedures performed by each 2014 fellowship and residency (0 thorn 5) graduate during training. Data were analyzed using parametric and nonparametric methods, where appropriate. Results: Of 125 trainees (109 fellows, 16 residents), 33 (27%) performed 10 or fewer infrapopliteal vein bypasses and 37 (29%) performed 10 or fewer infrapopliteal endovascular procedures during their training. Eleven trainees (9%) performed 10 or fewer of both procedures. There was a positive correlation between number of infrapopliteal vein bypass and endovascular procedures performed (r = 0.19; P = .03). There was no difference between fellows and residents in the mean number of bypass operations performed during training (17.3 vs 19.1; P = .50; range, 0-53). However, residents performed more infrapopliteal endovascular procedures than fellows did (median, 29 vs 16; P = .03; range, 0-128). Conclusions: More than one in four graduates of both training paradigms finish with a low number of infrapopliteal bypasses and endovascular interventions. The number of these procedures needed for proficiency is not known. Vascular surgery training programs should critically evaluate the number of infrapopliteal procedures required to achieve proficiency.