Vascular Surgery Trainees’ Open Lower Extremity Revascularization Experience in an Endo-First Era

We investigated trends in open vs endovascular lower extremity revascularization case volumes among graduating vascular fellows (5+2) and integrated vascular residents (0+5) to determine the impact of adoption of endovascular-first therapies on trainees’ experience with open bypass. We reviewed the Accreditation Council for Graduate Medical Education 2012-2021 case log data for graduating vascular surgery fellows (5+2) and integrated residents (0+5). We retrieved the mean number of femoropopliteal and infrapopliteal revascularization procedures carried out by each group, both open and endovascular. The means were plotted against time. A Mann-Kendall test was conducted to detect trends in the average number of cases performed by vascular graduates. Between 2012 and 2021, integrated vascular residents graduated with an average of 21.9 femoropopliteal and 22.5 infrapopliteal bypasses, surpassing vascular surgery fellows by 4.4 ± 1.4 and 3.0 ± 1.9, respectively. For both trainee groups, the mean number of open procedures—femoropopliteal or infrapopliteal—was consistent over the course of the years with no statistically significant trend observed (Figure). Integrated vascular residents graduated with an average of 47.9 femoropopliteal and 22.7 infrapopliteal endovascular procedures, surpassing vascular surgery fellows by 6.2 ± 2.9 and 3.1 ± 1.7, respectively. We observed a statistically significant increase in the mean number of femoropopliteal and infrapopliteal endovascular procedures in this time period –in both trainee groups. The mean number of femoropopliteal endovascular cases increased by 105.5% (31.1 to 63.9; P < .001) for integrated residents and 110.3% (26.2 to 55.1; P < .001) for vascular fellows. The mean number of infrapopliteal endovascular cases increased by 120.3% (14.3 to 31.5; P < .001) for integrated residents and 94.1% (13.6 to 26.4; P < .001) for vascular fellows. The overall case volume of femoropopliteal and infrapopliteal procedures, combining open and endovascular techniques, increased for both trainee groups mainly due to a significant increase in peripheral vascular intervention volume. The total case volume of lower extremity revascularization has increased for all vascular trainees but graduates of integrated residency programs have a more robust experience. Despite a significant rise in endovascular case volume, the average number of open bypass procedures performed by graduating vascular surgery trainees has remained stable.