A multi-method assessment of the vascular surgery program director experience in creating effective training environments.

Objectives: Surgical training has received significant attention in recent years with efforts to improve trainee wellness. Vascular surgery training is subject to unique challenges, and vascular program directors (PDs) are tasked with providing learning environments that produce effective and competent surgeons. The aim of this study is to examine the experience of vascular surgery PDs in promoting effective learning environments for vascular trainees.

Incidence and Risk Factors for Hemodialysis Reliable Outflow Bypass Graft Infection.

Background: Hemodialysis Reliable Outflow (HeRO) graft implantation is performed as a last-resort option for hemodialysis access in patients limited by central venous stenosis or occlusion. In this single-center series, we examined the incidence, risk factors, and long-term outcomes of patients suffering HeRO graft infection.

Methods: Institutional medical records were retrospectively reviewed for all HeRO graft procedures performed from 2014-2023.

The relationships between hospital support staff and vascular trainee educational experience and wellbeing.

Introduction: Many stakeholders contribute to effective training environments for surgical residents, including program administrators and nursing staff. This study evaluates associations of hospital support staff with trainee educational time and wellness.

Methods: Data were collected via confidential voluntary survey of vascular trainees, who were asked about support staff interactions and protected educational time.

Outcomes After Utilization of Autogenous Arm Vein Grafts for Lower Extremity Bypasses.

Background: Lower extremity bypasses performed with autogernous conduit have superior patency and limb salvage. This is often performed with single segment great saphenous vein (GSV), but other options may be required for patients without available GSV. This study presents our experience utilizing arm veins as an alternative autogenous conduit for patients undergoing lower extremity bypass procedures.

Risk Factors and Consequences of Bleeding Complications after Transcarotid Artery Revascularization in the Vascular Quality Initiative.

Background: Previous case series on postoperative bleeding complications after transcarotid artery revascularization (TCAR) have primarily been through case series. The purpose of this study is to evaluate risk factors and consequences of bleeding complications after TCAR on a national level.

Methods: The Vascular Quality Initiative database was retrospectively queried for all patients undergoing TCAR between 2017 and 2023.

Understanding the Time Investment of Program Directors and Core Faculty in Surgical Specialties.

Background: Surgical training has evolved considerably over the past decade. Both program directors (PDs) and surgical faculty have had to adapt to novel training paradigms and innovations in surgical techniques, while balancing resident education with administrative duties. The purpose of this study is to examine the time allotment of PDs and core faculty to the educational mission of surgical residency programs.

A narrative review of psychological safety in the surgical learning environment.

Psychological safety is a critical component of the medical learning environment. While multiple synthesis studies exist for psychological safety within broader medical education, few have focused specifically on surgical training paradigms. This narrative review evaluates psychological safety for surgical trainees.

Implementation of an acute care vascular surgery "Surgeon of the Week" model improves efficiency of inpatient care delivery.

Objective: Acute care vascular surgery (ACVS) comprises a significant proportion of modern vascular surgery practice. Given the burden of ACVS at our institution, we have transitioned from a traditional "on call" model to a "Surgeon of the Week" (SOW) model, in which a single surgeon covers all daytime inpatient consults and resultant operations over the course of a week. The SOW surgeon has no overnight call, outpatient clinic, and minimizes elective operations during this week, enabling dedicated care to inpatient responsibilities.

Impact of Antiplatelet and Anticoagulation Therapy on Hemodialysis Reliable Outflow Graft Patency.

Background: The Hemodialysis Reliable Outflow (HeRO) graft combines an arteriovenous graft with a central venous stent, allowing for hemodialysis access in patients with end-stage renal disease limited by central venous stenosis. The impact of anticoagulation (AC) and antiplatelet (AP) medications on HeRO graft patency is unknown.

Methods: Institutional medical records were retrospectively queried for all HeRO graft procedures performed from 2014 to 2023.

Perioperative and long-term outcomes after Hemodialysis Reliable Outflow (HeRO) graft surgery.

Objective: The Hemodialysis Reliable Outflow (HeRO) graft offers hemodialysis access options for patients who have developed central venous stenosis or occlusion. In this single-center study, we report our perioperative and long-term outcomes after HeRO graft placement, and investigate the impact of conduit type and configuration on patency rates.

Methods: We retrospectively reviewed all HeRO graft procedures performed from January 2014 to December 2023 across three hospitals.

National Trends in Trainee Operative Exposure to Upper Extremity Fasciotomy Support a Multidisciplinary Approach.

Background: Acute limb ischemia of the upper extremity is an uncommon but emergent clinical scenario, in which both revascularization and decompressive fasciotomy may be indicated to optimize patient outcomes. The purpose of this study was to examine operative exposure to upper extremity fasciotomy among surgical trainees across different specialties.

Methods: Accreditation Council for Graduate Medical Education national data reports were reviewed for operative volumes as reported by vascular surgery integrated residents (VSRs), vascular surgery fellows (VSFs), orthopedic surgery residents (OSRs), and hand surgery fellows (HSFs).

Carotid Interventions in the Community are Associated with Higher Rates of Complications.

Background: The Maintaining Internal Systems and Strengthening Integrated Outside Networks Act was a landmark legislation that expanded Veterans' ability to seek care in the community (CITC). The purpose of this study is to evaluate perioperative outcomes among Veterans receiving CITC for carotid artery stenosis (CAS).

Methods: This is a retrospective cohort study comparing carotid endarterectomy (CEA) and transcarotid revascularization (TCAR) outcomes for Veterans undergoing interventions through CITC versus at the Durham Veterans Affairs Medical Center (DVAMC).

A rare case of hemorrhage from spontaneous disconnection of super-HeRO adapter and early-cannulation graft: A case report.

To overcome the limitations of central venous occlusion or stenosis (CVO) in complex chronic hemodialysis patients, the Hemodialysis Reliable Outflow (HeRO) vascular access graft was created as an alternative means of vascular access that bypasses the CVO and provides an additional upper extremity access option. The super-HeRO adapter was created to allow for the use of early cannulation grafts in the HeRO graft thereby enabling early cannulation and reducing tunneled dialysis catheter dependence time. Some complications have been previously reported for the traditional HeRO and the modified HeRO grafts.

Trainee Perception of Virtual Interviews and Associations of Virtual Engagement with Vascular Surgery Culture and Community.

Background: In recent years, the vascular surgery community has increased the utilization of virtual interviews and virtual engagement or use of online technologies for educational, networking, and mentorship activities. This study evaluates trainee preferences of virtual interviews and associations of virtual engagement with wellness.

Methods: Deidentified data were collected from a confidential, voluntary survey of residents and fellows in vascular surgery programs administered following the 2023 Vascular Surgery In-Training Examination (VSITE).

Impact of COVID-19 pandemic on surgical training in the United States.

The impact of the coronavirus disease COVID-19 pandemic on surgical training in the United States remains a controversial topic. In this study, we examined resident and fellow operative volumes in the pre-COVID-19 and COVID-19 periods across ten different surgical specialties. Accreditation Council for Graduate Medical Education (ACGME) national data reports were collected for ten surgical specialties, including general surgery, neurological surgery, ophthalmology, orthopedic surgery, pediatric surgery, plastic surgery (independent), thoracic surgery, urology, vascular surgery (integrated), and vascular surgery (traditional).

Alternatives for exhausted dialysis access.

Hemodialysis (HD) access failure is a frequent problem encountered by vascular surgeons. As treatment of end-stage renal disease improves and patients live longer on HD, eventual exhaustion of traditional upper extremity HD access is common. Efforts to preserve and maintain these accesses are essential.

Effectiveness of Negative Pressure Wound Therapy on Groin Surgical Site Infection After Lower Extremity Bypass for Chronic Limb-Threatening Ischemia.

Background: Surgical site infections (SSIs) are a common cause of patient morbidity, hospital readmission, and reoperation after lower extremity bypass (LEBs) surgery for chronic limb-threatening ischemia (CLTI). Recent studies on the use of incisional negative pressure wound therapy (NPWT) in LEB surgery have reported conflicting results. In this single-center study, we examined our experience on the impact of NPWT on groin SSI rates after LEB surgery.

Characterizing Early-Onset Surgical Site Infection After Lower Extremity Bypass Surgery.

Background: Surgical site infections (SSI) are the most common complication following lower extremity bypass (LEB) surgery. SSIs contribute to significant patient morbidity and healthcare expenditure, and accurate detection of SSIs remains an important step in reduction efforts. In this study, we aimed to characterize early-onset SSIs among patients undergoing LEB surgery.

Prophylactic Sartorius Flap Reconstruction Is Associated With Reduced Vascular Graft Infection.

Introduction: Complications in the femoral area following vascular surgery are frequent and linked to considerable morbidity, including the risk of underlying graft infection. Sartorius muscle flaps are an important adjunct for the treatment of wound complications. In this study, we examined our experience with prophylactic sartorius muscle flap coverage and its association with prosthetic vascular graft infection.

A multi-institutional study from the United States Resident OPerative Experience Consortium examining factors influencing vascular surgery specialization among general surgery residents.

Objective: There remains a progressive projected deficit in the vascular surgery (VS) workforce for decades. Despite the expanding integrated VS residency pathway, the fellowship training model remains critical in supporting our future workforce. Therefore, it is imperative to understand the resident and program-specific factors that influence VS specialization among general surgery (GS) residents.

Postoperative Bleeding Complications are Common among Patients Undergoing Transcarotid Artery Revascularization.

Background: Current practice guidelines recommend dual antiplatelet therapy for at least 30 days postoperatively after transcarotid artery revascularization (TCAR) to promote stent patency. However, many patients are already taking other antithrombotic medications. The optimal pharmacologic regimen in this patient population remains unclear, especially as it pertains to postoperative bleeding complications.

Burnout is not associated with trainee performance on the Vascular Surgery In-Training Exam.

Objective: The Vascular Surgery In-Training Examination (VSITE) is a yearly exam evaluating vascular trainees' knowledge base. Although multiple studies have evaluated variables associated with exam outcomes, few have incorporated training program-specific metrics. The purpose of this study is to evaluate the impact of the learning environment and burnout on VSITE performance.

Predicting the future caretakers of traumatic vascular injury management via operative exposure among surgical trainees.

Background: The management of vascular trauma requires specialized training and expertise. Although traumatic vascular injury is treated currently by both vascular and trauma surgeons in modern practice, it remains unclear who will inherit the role of managing vascular trauma in the coming decades. In this study, we examined disparities in operative experience in vascular trauma among surgical trainees across different surgical specialties.

Impact of Wound Closure Technique on Surgical Site Infection After Lower Extremity Bypass Surgery.

Background: Surgical site infections (SSIs) are among the most common complications after lower extremity bypass (LEB). Both patient and hospital-related factors have been associated with SSI after LEB; however, the impact of surgical closure technique on SSI incidence remains unclear.

Methods: Institutional electronic medical records (EMRs) were retrospectively queried for all LEB procedures performed from 2018 to 2022.