2018 Vascular Annual Meeting

Society for Vascular Surgery members are receiving an important email from the Mayo Clinic containing a survey from the SVS Wellness Task Force.

Nationwide Photographers

It is the second survey the task force has distributed, all aimed at ascertaining burnout and wellness statistics from SVS members.

“We need evidence,” said Malachi Sheahan, MD, who co-chairs the group with Dawn Coleman, MD. “We can’t make change without evidence.”

He issued a “Societal Call to Action” to SVS members at the end of a Friday session addressing burnout issues, “Promoting Physician Well-Being: Achieving Quadruple Aim.”

Dr. Sheahan disclosed statistics from the first task force survey, completed by 860 members. Collectively, members worked an average 73.5 hours a week, with five hours completing electronic medical records and 5.5 hours of administrative/scholarly activities added to 63 hours in the office.

“Eighty-nine percent feel burned out on occasion, everyone thinks they’re working too hard and when there are conflicts between work and personal life, they’re resolved in favor of the personal side only 8 percent of the time,” he said of the just-released data. He believes EMR will be the No. 1 conflict of vascular surgeons, with surgeons reporting they spend one hour charting for every one hour of patient time. “It’s just not working out,” he said.

Twenty percent said they had been sued for malpractice within the past two years, 37 percent reported being depressed within the month prior to completing the survey and the 8 percent who reported suicide ideation within the past year is double the national rate, Dr. Sheahan said. The second survey, launched Monday, focuses more on physical debility and should take fewer than 10 minutes to complete, he said. “Look for the survey, and please take it.”

He added that there are initiatives going forward that aim to change the environment and change the culture, including the SVS task force and the American Board of Surgery’s new lifelong learning initiative. “This is a call to action,” he said. “The main thing I want to say is that this is changeable. I don’t want you to think or say that we can’t do it. “We can. We just need evidence.” 

Society for Vascular Surgery members are receiving an important email from the Mayo Clinic containing a survey from the SVS Wellness Task Force.

Nationwide Photographers

It is the second survey the task force has distributed, all aimed at ascertaining burnout and wellness statistics from SVS members.

“We need evidence,” said Malachi Sheahan, MD, who co-chairs the group with Dawn Coleman, MD. “We can’t make change without evidence.”

He issued a “Societal Call to Action” to SVS members at the end of a Friday session addressing burnout issues, “Promoting Physician Well-Being: Achieving Quadruple Aim.”

Dr. Sheahan disclosed statistics from the first task force survey, completed by 860 members. Collectively, members worked an average 73.5 hours a week, with five hours completing electronic medical records and 5.5 hours of administrative/scholarly activities added to 63 hours in the office.

“Eighty-nine percent feel burned out on occasion, everyone thinks they’re working too hard and when there are conflicts between work and personal life, they’re resolved in favor of the personal side only 8 percent of the time,” he said of the just-released data. He believes EMR will be the No. 1 conflict of vascular surgeons, with surgeons reporting they spend one hour charting for every one hour of patient time. “It’s just not working out,” he said.

Twenty percent said they had been sued for malpractice within the past two years, 37 percent reported being depressed within the month prior to completing the survey and the 8 percent who reported suicide ideation within the past year is double the national rate, Dr. Sheahan said. The second survey, launched Monday, focuses more on physical debility and should take fewer than 10 minutes to complete, he said. “Look for the survey, and please take it.”

He added that there are initiatives going forward that aim to change the environment and change the culture, including the SVS task force and the American Board of Surgery’s new lifelong learning initiative. “This is a call to action,” he said. “The main thing I want to say is that this is changeable. I don’t want you to think or say that we can’t do it. “We can. We just need evidence.” 

Society for Vascular Surgery members are receiving an important email from the Mayo Clinic containing a survey from the SVS Wellness Task Force.

Nationwide Photographers

It is the second survey the task force has distributed, all aimed at ascertaining burnout and wellness statistics from SVS members.

“We need evidence,” said Malachi Sheahan, MD, who co-chairs the group with Dawn Coleman, MD. “We can’t make change without evidence.”

He issued a “Societal Call to Action” to SVS members at the end of a Friday session addressing burnout issues, “Promoting Physician Well-Being: Achieving Quadruple Aim.”

Dr. Sheahan disclosed statistics from the first task force survey, completed by 860 members. Collectively, members worked an average 73.5 hours a week, with five hours completing electronic medical records and 5.5 hours of administrative/scholarly activities added to 63 hours in the office.

“Eighty-nine percent feel burned out on occasion, everyone thinks they’re working too hard and when there are conflicts between work and personal life, they’re resolved in favor of the personal side only 8 percent of the time,” he said of the just-released data. He believes EMR will be the No. 1 conflict of vascular surgeons, with surgeons reporting they spend one hour charting for every one hour of patient time. “It’s just not working out,” he said.

Twenty percent said they had been sued for malpractice within the past two years, 37 percent reported being depressed within the month prior to completing the survey and the 8 percent who reported suicide ideation within the past year is double the national rate, Dr. Sheahan said. The second survey, launched Monday, focuses more on physical debility and should take fewer than 10 minutes to complete, he said. “Look for the survey, and please take it.”

He added that there are initiatives going forward that aim to change the environment and change the culture, including the SVS task force and the American Board of Surgery’s new lifelong learning initiative. “This is a call to action,” he said. “The main thing I want to say is that this is changeable. I don’t want you to think or say that we can’t do it. “We can. We just need evidence.” 

The Vascular Annual Meeting conducts important Society business at the SVS Annual Business Meeting. During Saturday’s meeting and luncheon, President R. Clement Darling III, MD, will hand over the leadership reins to President-Elect Michel S. Makaroun, MD.

The meeting is from 12 to 1:30 p.m. Saturday in Ballroom C of the Hynes Convention Center. Besides welcoming a new president, the meeting also will include acting on the 2018-2019 slate of officers.

Members also recieved updates from officers and select committees and recognized outstanding achievements and awards from the Journal of Vascular Surgery, SVS Foundation and SVS. Award winners included the first recipients of the new SVS Foundation Community Awareness and Prevention Project Practice Grant.

The following people received awards during the luncheon:

SVS Presidential Citation Award

Drs. Kellie R. Brown, for her work as Chair of the Postgraduate Education Committee; O. William Brown, Chair of the Conflict of Interest Committee; Daniel G. Clair, Chair of the Education Council; Michael C. Dalsing, Chair of the Government Relations Committee; Alan Dardik, Chair of the Research Council; Dennis R. Gable, Chair of the Public and Professional Outreach Committee; Richard J. Fowl, Chair of the Ethics and Professional Conduct Committee; Brad L. Johnson, Chair of the Quality and Performance Measures Committee; Larry Kraiss, Chair of the SVS Patient Safety Organization; Walter J. McCarthy, Chair of the History Committee; Frank B. Pomposelli, Chair of the Clinical Practice Council; Jeffrey Raines; Amy Reed, Chair of the Fellows Committee; Edith Tzeng, Chair of the Research and Education Committee; Robert Zwolak, Chair of the VA Vascular Surgeons Committee; and Roger Gregory and James S.T. Yao, for their dedicated service in capturing the history of SVS.

SVS Awards

Women’s Leadership Training Grants
Drs. Dawn Coleman, Bao-Ngoc Nguyen and Margaret Tracci

SVS Vascular Surgery Trainee Advocacy Travel Scholarship
Dr. Anahita Dua

SVS Foundation Awards

SVS Foundation and American College of Surgeons Mentored Clinical Scientist Research Career Development Award (K08)
Dr. Bao-Ngoc Nguyen

SVS Foundation E.J. Wylie Traveling Fellowship
Dr. Omid Jazaeri

SVS Foundation Clinical Research Seed Grant
Drs. Samantha D. Minc and Bjoern D. Suckow, MD, MS

SVS Foundation Resident Research Award
Dr. Kaspar M. Trocha

SVS Foundation Research Career Development Travel Award
Drs. James Brooks, Kristina Giles, and Samir Shah, MD

Vascular Cures/ SVS Foundation Wylie Scholar Award
John Byrne, MB BCh, MD (by research), FRCSI

SVS Foundation Community Awareness and Prevention Project Practice Grant
Drs. Manish Mehta, MD, MPH; Elizabeth L. Detschelt, MD; and Marcus E. Semel, MD, MPH

Vascular Research Initiatives Conference Trainee Travel Scholarship
Drs. Frank M. Davis, Catherine Go, Omar Saffaf, and Karim M. Salem

SVS Foundation Student Research Fellowship Award
Arash Fereydooni* (Yale School of Medicine), Helen Genis* (University of Toronto), Nikolai Thomas Harroun (Washington University, St.Louis), Alice Jo* (Case Western Reserve University School of Medicine), Revanth Kosaraju* (Beth Israel Deaconess Medical Center), Alexa Mordhorst* (Vancouver General Hospital/University of British Columbia), Lindsey Anne Olivere (Duke University School of Medicine), Suzannah Patterson (Brigham and Women’s Hospital/Harvard Medical School), Joel L. Ramirez* (University of California, San Francisco), Sudie Ann Robinson* (SUNY Upstate Medical University), Muzammil Hussain Syed (St. Michael’s Hospital/McMaster University), Jeffrey W. Zhao* (Northwestern Feinberg School of Medicine)

(*Awarded a Society for Vascular Surgery General Surgery Resident/Medical Student VAM Travel Scholarship)

The Vascular Annual Meeting conducts important Society business at the SVS Annual Business Meeting. During Saturday’s meeting and luncheon, President R. Clement Darling III, MD, will hand over the leadership reins to President-Elect Michel S. Makaroun, MD.

The meeting is from 12 to 1:30 p.m. Saturday in Ballroom C of the Hynes Convention Center. Besides welcoming a new president, the meeting also will include acting on the 2018-2019 slate of officers.

Members also recieved updates from officers and select committees and recognized outstanding achievements and awards from the Journal of Vascular Surgery, SVS Foundation and SVS. Award winners included the first recipients of the new SVS Foundation Community Awareness and Prevention Project Practice Grant.

The following people received awards during the luncheon:

SVS Presidential Citation Award

Drs. Kellie R. Brown, for her work as Chair of the Postgraduate Education Committee; O. William Brown, Chair of the Conflict of Interest Committee; Daniel G. Clair, Chair of the Education Council; Michael C. Dalsing, Chair of the Government Relations Committee; Alan Dardik, Chair of the Research Council; Dennis R. Gable, Chair of the Public and Professional Outreach Committee; Richard J. Fowl, Chair of the Ethics and Professional Conduct Committee; Brad L. Johnson, Chair of the Quality and Performance Measures Committee; Larry Kraiss, Chair of the SVS Patient Safety Organization; Walter J. McCarthy, Chair of the History Committee; Frank B. Pomposelli, Chair of the Clinical Practice Council; Jeffrey Raines; Amy Reed, Chair of the Fellows Committee; Edith Tzeng, Chair of the Research and Education Committee; Robert Zwolak, Chair of the VA Vascular Surgeons Committee; and Roger Gregory and James S.T. Yao, for their dedicated service in capturing the history of SVS.

SVS Awards

Women’s Leadership Training Grants
Drs. Dawn Coleman, Bao-Ngoc Nguyen and Margaret Tracci

SVS Vascular Surgery Trainee Advocacy Travel Scholarship
Dr. Anahita Dua

SVS Foundation Awards

SVS Foundation and American College of Surgeons Mentored Clinical Scientist Research Career Development Award (K08)
Dr. Bao-Ngoc Nguyen

SVS Foundation E.J. Wylie Traveling Fellowship
Dr. Omid Jazaeri

SVS Foundation Clinical Research Seed Grant
Drs. Samantha D. Minc and Bjoern D. Suckow, MD, MS

SVS Foundation Resident Research Award
Dr. Kaspar M. Trocha

SVS Foundation Research Career Development Travel Award
Drs. James Brooks, Kristina Giles, and Samir Shah, MD

Vascular Cures/ SVS Foundation Wylie Scholar Award
John Byrne, MB BCh, MD (by research), FRCSI

SVS Foundation Community Awareness and Prevention Project Practice Grant
Drs. Manish Mehta, MD, MPH; Elizabeth L. Detschelt, MD; and Marcus E. Semel, MD, MPH

Vascular Research Initiatives Conference Trainee Travel Scholarship
Drs. Frank M. Davis, Catherine Go, Omar Saffaf, and Karim M. Salem

SVS Foundation Student Research Fellowship Award
Arash Fereydooni* (Yale School of Medicine), Helen Genis* (University of Toronto), Nikolai Thomas Harroun (Washington University, St.Louis), Alice Jo* (Case Western Reserve University School of Medicine), Revanth Kosaraju* (Beth Israel Deaconess Medical Center), Alexa Mordhorst* (Vancouver General Hospital/University of British Columbia), Lindsey Anne Olivere (Duke University School of Medicine), Suzannah Patterson (Brigham and Women’s Hospital/Harvard Medical School), Joel L. Ramirez* (University of California, San Francisco), Sudie Ann Robinson* (SUNY Upstate Medical University), Muzammil Hussain Syed (St. Michael’s Hospital/McMaster University), Jeffrey W. Zhao* (Northwestern Feinberg School of Medicine)

(*Awarded a Society for Vascular Surgery General Surgery Resident/Medical Student VAM Travel Scholarship)

The Vascular Annual Meeting conducts important Society business at the SVS Annual Business Meeting. During Saturday’s meeting and luncheon, President R. Clement Darling III, MD, will hand over the leadership reins to President-Elect Michel S. Makaroun, MD.

The meeting is from 12 to 1:30 p.m. Saturday in Ballroom C of the Hynes Convention Center. Besides welcoming a new president, the meeting also will include acting on the 2018-2019 slate of officers.

Members also recieved updates from officers and select committees and recognized outstanding achievements and awards from the Journal of Vascular Surgery, SVS Foundation and SVS. Award winners included the first recipients of the new SVS Foundation Community Awareness and Prevention Project Practice Grant.

The following people received awards during the luncheon:

SVS Presidential Citation Award

Drs. Kellie R. Brown, for her work as Chair of the Postgraduate Education Committee; O. William Brown, Chair of the Conflict of Interest Committee; Daniel G. Clair, Chair of the Education Council; Michael C. Dalsing, Chair of the Government Relations Committee; Alan Dardik, Chair of the Research Council; Dennis R. Gable, Chair of the Public and Professional Outreach Committee; Richard J. Fowl, Chair of the Ethics and Professional Conduct Committee; Brad L. Johnson, Chair of the Quality and Performance Measures Committee; Larry Kraiss, Chair of the SVS Patient Safety Organization; Walter J. McCarthy, Chair of the History Committee; Frank B. Pomposelli, Chair of the Clinical Practice Council; Jeffrey Raines; Amy Reed, Chair of the Fellows Committee; Edith Tzeng, Chair of the Research and Education Committee; Robert Zwolak, Chair of the VA Vascular Surgeons Committee; and Roger Gregory and James S.T. Yao, for their dedicated service in capturing the history of SVS.

SVS Awards

Women’s Leadership Training Grants
Drs. Dawn Coleman, Bao-Ngoc Nguyen and Margaret Tracci

SVS Vascular Surgery Trainee Advocacy Travel Scholarship
Dr. Anahita Dua

SVS Foundation Awards

SVS Foundation and American College of Surgeons Mentored Clinical Scientist Research Career Development Award (K08)
Dr. Bao-Ngoc Nguyen

SVS Foundation E.J. Wylie Traveling Fellowship
Dr. Omid Jazaeri

SVS Foundation Clinical Research Seed Grant
Drs. Samantha D. Minc and Bjoern D. Suckow, MD, MS

SVS Foundation Resident Research Award
Dr. Kaspar M. Trocha

SVS Foundation Research Career Development Travel Award
Drs. James Brooks, Kristina Giles, and Samir Shah, MD

Vascular Cures/ SVS Foundation Wylie Scholar Award
John Byrne, MB BCh, MD (by research), FRCSI

SVS Foundation Community Awareness and Prevention Project Practice Grant
Drs. Manish Mehta, MD, MPH; Elizabeth L. Detschelt, MD; and Marcus E. Semel, MD, MPH

Vascular Research Initiatives Conference Trainee Travel Scholarship
Drs. Frank M. Davis, Catherine Go, Omar Saffaf, and Karim M. Salem

SVS Foundation Student Research Fellowship Award
Arash Fereydooni* (Yale School of Medicine), Helen Genis* (University of Toronto), Nikolai Thomas Harroun (Washington University, St.Louis), Alice Jo* (Case Western Reserve University School of Medicine), Revanth Kosaraju* (Beth Israel Deaconess Medical Center), Alexa Mordhorst* (Vancouver General Hospital/University of British Columbia), Lindsey Anne Olivere (Duke University School of Medicine), Suzannah Patterson (Brigham and Women’s Hospital/Harvard Medical School), Joel L. Ramirez* (University of California, San Francisco), Sudie Ann Robinson* (SUNY Upstate Medical University), Muzammil Hussain Syed (St. Michael’s Hospital/McMaster University), Jeffrey W. Zhao* (Northwestern Feinberg School of Medicine)

(*Awarded a Society for Vascular Surgery General Surgery Resident/Medical Student VAM Travel Scholarship)

Duty hour restrictions, changing training paradigms, and diminishing open surgical case volumes have caused dramatic shifts in the vascular trainee experience, according to Malachi Sheahan, MD, and his colleagues from Louisiana State University, New Orleans.

Dr. Sheahan and his colleagues examined the benefits of simulation courses as an augment to vascular training. They performed a 6-year review of the first simulation course established for vascular trainees in the United States.

The 3-day vascular simulation course studied was conducted at a dedicated learning center from 2012 to 2017. Attendees rated their confidence pre- and postcourse on a 6-point Likert scale ranging from 1 (none) to 6 (expert) across 8 different technical and cognitive categories. Participants were also asked to rate the value of each activity, according to Dr. Sheahan.

Assessments of each trainee were completed by the course director and sent to their program director. After 6 months, program directors and participants were surveyed on the lasting usefulness of the course. Full data were available for 98 vascular trainees: 59 categorized as Junior (PGY1-2); and 39 as Senior (PGY 3).

“Our study demonstrates that a brief, intensive simulation course can have a valuable and lasting impact on vascular resident education,” said Dr. Sheahan.

Overall, the participants rated all teaching activities as useful (4) or better, with anatomic exposures (5.8) and one-on-one suturing (5.5) rated most valuable. Both groups showed significant improvement in confidence in all measures, with Juniors improving significantly more than did Seniors in anastomoses, abdominal aortic aneurysm measurements, and tibial exposures.

Six-month follow-up with program directors found that 100% reported at least one lasting skill improvement and 85% stated that they modified their trainees curriculum based on the course assessment. 

Duty hour restrictions, changing training paradigms, and diminishing open surgical case volumes have caused dramatic shifts in the vascular trainee experience, according to Malachi Sheahan, MD, and his colleagues from Louisiana State University, New Orleans.

Dr. Sheahan and his colleagues examined the benefits of simulation courses as an augment to vascular training. They performed a 6-year review of the first simulation course established for vascular trainees in the United States.

The 3-day vascular simulation course studied was conducted at a dedicated learning center from 2012 to 2017. Attendees rated their confidence pre- and postcourse on a 6-point Likert scale ranging from 1 (none) to 6 (expert) across 8 different technical and cognitive categories. Participants were also asked to rate the value of each activity, according to Dr. Sheahan.

Assessments of each trainee were completed by the course director and sent to their program director. After 6 months, program directors and participants were surveyed on the lasting usefulness of the course. Full data were available for 98 vascular trainees: 59 categorized as Junior (PGY1-2); and 39 as Senior (PGY 3).

“Our study demonstrates that a brief, intensive simulation course can have a valuable and lasting impact on vascular resident education,” said Dr. Sheahan.

Overall, the participants rated all teaching activities as useful (4) or better, with anatomic exposures (5.8) and one-on-one suturing (5.5) rated most valuable. Both groups showed significant improvement in confidence in all measures, with Juniors improving significantly more than did Seniors in anastomoses, abdominal aortic aneurysm measurements, and tibial exposures.

Six-month follow-up with program directors found that 100% reported at least one lasting skill improvement and 85% stated that they modified their trainees curriculum based on the course assessment. 

Duty hour restrictions, changing training paradigms, and diminishing open surgical case volumes have caused dramatic shifts in the vascular trainee experience, according to Malachi Sheahan, MD, and his colleagues from Louisiana State University, New Orleans.

Dr. Sheahan and his colleagues examined the benefits of simulation courses as an augment to vascular training. They performed a 6-year review of the first simulation course established for vascular trainees in the United States.

The 3-day vascular simulation course studied was conducted at a dedicated learning center from 2012 to 2017. Attendees rated their confidence pre- and postcourse on a 6-point Likert scale ranging from 1 (none) to 6 (expert) across 8 different technical and cognitive categories. Participants were also asked to rate the value of each activity, according to Dr. Sheahan.

Assessments of each trainee were completed by the course director and sent to their program director. After 6 months, program directors and participants were surveyed on the lasting usefulness of the course. Full data were available for 98 vascular trainees: 59 categorized as Junior (PGY1-2); and 39 as Senior (PGY 3).

“Our study demonstrates that a brief, intensive simulation course can have a valuable and lasting impact on vascular resident education,” said Dr. Sheahan.

Overall, the participants rated all teaching activities as useful (4) or better, with anatomic exposures (5.8) and one-on-one suturing (5.5) rated most valuable. Both groups showed significant improvement in confidence in all measures, with Juniors improving significantly more than did Seniors in anastomoses, abdominal aortic aneurysm measurements, and tibial exposures.

Six-month follow-up with program directors found that 100% reported at least one lasting skill improvement and 85% stated that they modified their trainees curriculum based on the course assessment. 

This year’s E. Stanley Crawford Critical Issues Forum addressed the current status of the vascular surgery workforce, its existing geographic distribution, the potential for a worsening shortage, and proposed solutions to ensure future vascular care delivery.

Nationwide Photographers

As is tradition, the forum was organized and moderated by the SVS president-elect, this year Michel S. Makaroun, MD, co-director of the UPMC Heart and Vascular Institute in Pittsburgh. The session began with an overview from Dr. Makaroun on the critical nature of the growing problem.

He described how the current shortage of vascular surgeons is projected to worsen for two main reasons: First, newly trained vascular surgeons are not entering the workforce in adequate numbers to meet the increased demand presented by the nation’s aging population, even with the improvements projected from the new 0-5 training program; second, there is a large percentage of vascular surgeons currently practicing who are expected to retire in the next decade, with estimates reaching 35%-45%. He detailed the results of the 2017 survey of vascular surgeons that showed this and other concerning factors.

“We do not take vacations,” he said. “We have significant overwork.” In addition, “half of the surgeons who said they would retire, said they would retire before the age of 65.” In fact, nearly 50% of those surveyed have firm retirement plans, and nearly 20% were planning on retiring within the next five years.

Nationwide Photographers

“To summarize, we have a pipeline, which at maximum would within the next five years introduce 608 new vascular resident and fellow graduates into the workforce, and at the same time we’ll be losing the same number of practicing vascular surgeons. So, at best, we will stay even,” said Dr. Makaroun.

“The Current Landscape of the Vascular Surgery Recruitment Market” was addressed by Jeremy Robinson of Merritt Hawkins. He pointed out the market evidence for a large scarcity of vascular surgeons, with a huge number of positions going unfilled, more than half of new trainees receiving more than 100 offers, and bidding wars going on among employers, including offering expansive salaries and benefits to vascular surgeons as part of recruitment efforts.

In his talk, “Where Did the Vascular Surgeons Go? Seven Years of Futile Recruitment Attempts,” Gerald Goldstein, MD, of the Western Maryland Health System, addressed the problem of attracting new vascular surgeons. His talk was key in pointing out the problems of large health care facilities in poor and rural areas. “We’re not a Band-Aid station. ... we’re a big hospital, we serve a large geographic area and a large cohort of patients,” he said. Still they have failed to recruit a single vascular surgeon. He pointed out how places such as his could not compete for vascular surgeons against more desirable urban centers with more amenities and sufficient backup surgeons to provide lower workloads and improved quality of life, which includes time off, not being on call, and collaboration and teamwork. He was not optimistic about solutions and was fighting the final solution: hospital contraction of services.

“Workforce Targets: How Can We Know Whether We Have Enough Vascular Surgeons?” was discussed by Mark Friedberg, MD, of the RAND Corporation. Dr. Friedberg pointed out that it was important to define what was meant by a shortage of vascular surgeons, asking whether a surgeon/population metric was the most valuable or should it include other components, such as geographic considerations, quality of care issues, patient waiting times, and more. In addition, he asked, for any metric chosen, how was the decision made in choosing the optimal level? What is the best ratio of vascular surgeons to population, and how do you decide it?

Finally, Anton Sidawy, MD, of the George Washington University Hospital, Washington, looked at possible solutions to the problem in his talk, “Pathways to Alleviate Shortages and Maldistributions of Vascular Surgeons.” Dr. Sidawy stressed the need for a multifaceted approach, including government at the federal, state, and local levels, as well as medical schools and training programs. He particularly stressed the need for improving the distribution of vascular surgeons to underserved rural areas, such as described by Dr. Goldstein. However, this would require thinking outside the box, perhaps involving redistribution of training to more underserved areas of the country and also recruitment of more individuals from those areas. This is more likely to produce vascular surgeons willing to remain or return to such areas to practice, as has been well documented.

Another possibility is to provide incentives for older vascular surgeons to delay retirement, perhaps with lowered workload, freedom from being on-call, and other benefits.

But perhaps his most radical suggestion is the idea of rethinking the role of vascular surgeons entirely, to include the ability to perform more general surgery operations, allowing them more flexibility to take on roles in smaller communities and organizations that could not afford a narrowly defined specialist.

The forum concluded with a panel discussion in which the panelists addressed questions from the audience. 

This year’s E. Stanley Crawford Critical Issues Forum addressed the current status of the vascular surgery workforce, its existing geographic distribution, the potential for a worsening shortage, and proposed solutions to ensure future vascular care delivery.

Nationwide Photographers

As is tradition, the forum was organized and moderated by the SVS president-elect, this year Michel S. Makaroun, MD, co-director of the UPMC Heart and Vascular Institute in Pittsburgh. The session began with an overview from Dr. Makaroun on the critical nature of the growing problem.

He described how the current shortage of vascular surgeons is projected to worsen for two main reasons: First, newly trained vascular surgeons are not entering the workforce in adequate numbers to meet the increased demand presented by the nation’s aging population, even with the improvements projected from the new 0-5 training program; second, there is a large percentage of vascular surgeons currently practicing who are expected to retire in the next decade, with estimates reaching 35%-45%. He detailed the results of the 2017 survey of vascular surgeons that showed this and other concerning factors.

“We do not take vacations,” he said. “We have significant overwork.” In addition, “half of the surgeons who said they would retire, said they would retire before the age of 65.” In fact, nearly 50% of those surveyed have firm retirement plans, and nearly 20% were planning on retiring within the next five years.

Nationwide Photographers

“To summarize, we have a pipeline, which at maximum would within the next five years introduce 608 new vascular resident and fellow graduates into the workforce, and at the same time we’ll be losing the same number of practicing vascular surgeons. So, at best, we will stay even,” said Dr. Makaroun.

“The Current Landscape of the Vascular Surgery Recruitment Market” was addressed by Jeremy Robinson of Merritt Hawkins. He pointed out the market evidence for a large scarcity of vascular surgeons, with a huge number of positions going unfilled, more than half of new trainees receiving more than 100 offers, and bidding wars going on among employers, including offering expansive salaries and benefits to vascular surgeons as part of recruitment efforts.

In his talk, “Where Did the Vascular Surgeons Go? Seven Years of Futile Recruitment Attempts,” Gerald Goldstein, MD, of the Western Maryland Health System, addressed the problem of attracting new vascular surgeons. His talk was key in pointing out the problems of large health care facilities in poor and rural areas. “We’re not a Band-Aid station. ... we’re a big hospital, we serve a large geographic area and a large cohort of patients,” he said. Still they have failed to recruit a single vascular surgeon. He pointed out how places such as his could not compete for vascular surgeons against more desirable urban centers with more amenities and sufficient backup surgeons to provide lower workloads and improved quality of life, which includes time off, not being on call, and collaboration and teamwork. He was not optimistic about solutions and was fighting the final solution: hospital contraction of services.

“Workforce Targets: How Can We Know Whether We Have Enough Vascular Surgeons?” was discussed by Mark Friedberg, MD, of the RAND Corporation. Dr. Friedberg pointed out that it was important to define what was meant by a shortage of vascular surgeons, asking whether a surgeon/population metric was the most valuable or should it include other components, such as geographic considerations, quality of care issues, patient waiting times, and more. In addition, he asked, for any metric chosen, how was the decision made in choosing the optimal level? What is the best ratio of vascular surgeons to population, and how do you decide it?

Finally, Anton Sidawy, MD, of the George Washington University Hospital, Washington, looked at possible solutions to the problem in his talk, “Pathways to Alleviate Shortages and Maldistributions of Vascular Surgeons.” Dr. Sidawy stressed the need for a multifaceted approach, including government at the federal, state, and local levels, as well as medical schools and training programs. He particularly stressed the need for improving the distribution of vascular surgeons to underserved rural areas, such as described by Dr. Goldstein. However, this would require thinking outside the box, perhaps involving redistribution of training to more underserved areas of the country and also recruitment of more individuals from those areas. This is more likely to produce vascular surgeons willing to remain or return to such areas to practice, as has been well documented.

Another possibility is to provide incentives for older vascular surgeons to delay retirement, perhaps with lowered workload, freedom from being on-call, and other benefits.

But perhaps his most radical suggestion is the idea of rethinking the role of vascular surgeons entirely, to include the ability to perform more general surgery operations, allowing them more flexibility to take on roles in smaller communities and organizations that could not afford a narrowly defined specialist.

The forum concluded with a panel discussion in which the panelists addressed questions from the audience. 

This year’s E. Stanley Crawford Critical Issues Forum addressed the current status of the vascular surgery workforce, its existing geographic distribution, the potential for a worsening shortage, and proposed solutions to ensure future vascular care delivery.

Nationwide Photographers

As is tradition, the forum was organized and moderated by the SVS president-elect, this year Michel S. Makaroun, MD, co-director of the UPMC Heart and Vascular Institute in Pittsburgh. The session began with an overview from Dr. Makaroun on the critical nature of the growing problem.

He described how the current shortage of vascular surgeons is projected to worsen for two main reasons: First, newly trained vascular surgeons are not entering the workforce in adequate numbers to meet the increased demand presented by the nation’s aging population, even with the improvements projected from the new 0-5 training program; second, there is a large percentage of vascular surgeons currently practicing who are expected to retire in the next decade, with estimates reaching 35%-45%. He detailed the results of the 2017 survey of vascular surgeons that showed this and other concerning factors.

“We do not take vacations,” he said. “We have significant overwork.” In addition, “half of the surgeons who said they would retire, said they would retire before the age of 65.” In fact, nearly 50% of those surveyed have firm retirement plans, and nearly 20% were planning on retiring within the next five years.

Nationwide Photographers

“To summarize, we have a pipeline, which at maximum would within the next five years introduce 608 new vascular resident and fellow graduates into the workforce, and at the same time we’ll be losing the same number of practicing vascular surgeons. So, at best, we will stay even,” said Dr. Makaroun.

“The Current Landscape of the Vascular Surgery Recruitment Market” was addressed by Jeremy Robinson of Merritt Hawkins. He pointed out the market evidence for a large scarcity of vascular surgeons, with a huge number of positions going unfilled, more than half of new trainees receiving more than 100 offers, and bidding wars going on among employers, including offering expansive salaries and benefits to vascular surgeons as part of recruitment efforts.

In his talk, “Where Did the Vascular Surgeons Go? Seven Years of Futile Recruitment Attempts,” Gerald Goldstein, MD, of the Western Maryland Health System, addressed the problem of attracting new vascular surgeons. His talk was key in pointing out the problems of large health care facilities in poor and rural areas. “We’re not a Band-Aid station. ... we’re a big hospital, we serve a large geographic area and a large cohort of patients,” he said. Still they have failed to recruit a single vascular surgeon. He pointed out how places such as his could not compete for vascular surgeons against more desirable urban centers with more amenities and sufficient backup surgeons to provide lower workloads and improved quality of life, which includes time off, not being on call, and collaboration and teamwork. He was not optimistic about solutions and was fighting the final solution: hospital contraction of services.

“Workforce Targets: How Can We Know Whether We Have Enough Vascular Surgeons?” was discussed by Mark Friedberg, MD, of the RAND Corporation. Dr. Friedberg pointed out that it was important to define what was meant by a shortage of vascular surgeons, asking whether a surgeon/population metric was the most valuable or should it include other components, such as geographic considerations, quality of care issues, patient waiting times, and more. In addition, he asked, for any metric chosen, how was the decision made in choosing the optimal level? What is the best ratio of vascular surgeons to population, and how do you decide it?

Finally, Anton Sidawy, MD, of the George Washington University Hospital, Washington, looked at possible solutions to the problem in his talk, “Pathways to Alleviate Shortages and Maldistributions of Vascular Surgeons.” Dr. Sidawy stressed the need for a multifaceted approach, including government at the federal, state, and local levels, as well as medical schools and training programs. He particularly stressed the need for improving the distribution of vascular surgeons to underserved rural areas, such as described by Dr. Goldstein. However, this would require thinking outside the box, perhaps involving redistribution of training to more underserved areas of the country and also recruitment of more individuals from those areas. This is more likely to produce vascular surgeons willing to remain or return to such areas to practice, as has been well documented.

Another possibility is to provide incentives for older vascular surgeons to delay retirement, perhaps with lowered workload, freedom from being on-call, and other benefits.

But perhaps his most radical suggestion is the idea of rethinking the role of vascular surgeons entirely, to include the ability to perform more general surgery operations, allowing them more flexibility to take on roles in smaller communities and organizations that could not afford a narrowly defined specialist.

The forum concluded with a panel discussion in which the panelists addressed questions from the audience. 

When R. Clement Darling III, MD, took to the podium at the Vascular Annual Meeting to present his presidential address, he highlighted the importance of teamwork and collaboration in training, in maintaining personal well-being, and most importantly, in patient care.

Nationwide Photographers

His talk, titled, “Looking Forward Through the Past: Changing Me to We in the Evolution of Team-based Vascular Care,” addressed these issues through a very personal lens. To make his point, Dr. Darling outlined four key take-home concepts that he had found useful “over five decades of working in an operating room as a technologist, a student and a surgeon,” and as chief of the division of vascular surgery at Albany Medical Center Hospital (N.Y.). These formed the basis of his entire address:

1. “None of us is as smart as all of us.” We learn from each other which is the foundation of team-based training.

2. The key to resilience, healing and health, whether for our patients or for ourselves, is caring and supporting each other more.

3. Failure is not an end result. It is the path to success through learning.

4. Remember the past but look to the future. The best predictor of future behavior is the past, but the future we are experiencing now, is like no other!”

Dr. Darling spoke from the heart about the importance of his colleagues and his parents, especially the role of his father as a pioneer in vascular surgery, and of the women in his life as role models.

He stressed how “one of the invaluable things I have learned is the value of failure, evaluating the past to avoid the same mistakes and the benefit of the TEAM in providing support and care.”

“Every day we’re asked to do the impossible and every day we get up, go to work. We do the best we can. We can make the best plans, treat the sickest patients and get a tremendous fulfillment for what we do in what we do. We do the right thing for the patient,” Dr. Darling explained, in summarizing the passion that he feels for vascular surgery.

“We are always willing to do and try the impossible. We’re always willing to be the last person to call when things look bleak. It brings me great glee whenever we get called to the operating room and people look around and go, ‘oh thank God, the vascular surgeon’s here.’ Our colleagues in other specialties are often afraid of blood vessels, afraid of death, afraid of complications. We thrust ourselves every day into situations where nobody else will go,” he added.

“As vascular surgeons we face failure and roadblocks daily yet still persist where others are scared to tread. Many of you have faced far worse barriers of discrimination and unreasonable arbitrary barriers, and I am constantly humbled by your ability to overcome them,” Dr. Darling said. He pointed out that: “This innate ability to focus on the problem is what makes vascular surgeons great. No problem is too complex, no detail is too small. We do the right thing despite the odds against us. We do right by the patient.”

After telling some of his own stories of “failure,” to illustrate its importance as a learning tool, Dr. Darling spoke of one person’s reception of his application to join the SVS: “When I applied for membership to the Society for Vascular Surgery, someone had written a note saying that ‘I should never be considered, nor was I deserving to be a member of the SVS, and never should I be admitted into this austere society.’”

Throughout his address, Dr. Darling re-emphasized the importance of teams and the collaborative nature of patient care. “The SVS has developed strong partnerships with the Society for Vascular Nursing, The American Venous Forum, The Society for Vascular Ultrasound, and is seeking to strengthen relationships with the regional vascular societies, VESS, the Society for Clinical Vascular Surgery, The Society for Vascular Medicine, the American Heart Association, and many others.

“The SVS is developing these relationships with the patient at the center, and with purpose, focusing on ‘shared vision,’ of specific advancements, programs, and initiatives that will advance quality of care. By tapping into this vast array of talent Vascular Surgery will become more agile, intelligent and thoughtful in our care of vascular patients,” Dr. Darling predicted.

But vascular surgeons must become comfortable with moving from the concept of “captain of the ship” to the role of team leadership, he emphasized, if they are to truly succeed in their careers and in providing optimal patient care.

“Currently, each patient coming to your service touches over 100 staff during their experience. This includes your office, vascular lab, angio suite, recovery room, hospital floor, ICU, CT scanner to name a few.” This is part of the need for the evolution from ‘captain’ to ‘leader,’ he added.

“If you have not had any formal training in leadership or team development, I strongly suggest you add this to your learning portfolio,” Dr. Darling counseled. “The SVS is addressing this through its Leadership and Diversity Committee, and you will see an expanding array of learning opportunities in the future.”

With regard to his own tenure as SVS President: “I am proud that during my year as president, the SVS has invested in several new Task Forces to address critical future issues including: Alternative Payment Models for vascular surgery; a national inpatient and outpatient vascular certification program; a focus on our own health, wellness, and potential ways to mitigate potential burnout; and Dr. Makaroun will be taking on the issues of vascular surgery valuation and workforce in the new Task Force on the Future of Vascular Surgery.”

He further discussed the role SVS is playing in helping to define the future of vascular surgery.

“As we work to strengthen our brand and identity, the SVS Executive Board has supported, and thanks, Amy Reed and Will Jordan for their leadership in the APDVS [Association of Program Directors of Vascular Surgery], and for taking the first step toward attaining a separate Vascular Residency Review Committee or RRC.” In addition, he described how “SVS is also working closely, and collaboratively, with the American Board of Surgery, and the Vascular Surgery Board, to complete the work that was begun a decade ago, and achieve an autonomous vascular surgery board that is an equal partner and stakeholder in the ABS.”

Dr. Darling then outlined one of his major concerns and interests: the exit path of senior vascular surgeons, and how this is often a tremendous waste of talent and expertise. “In the last decade of work when senior surgeons are trying to transition to non-clinical work, I think we throw away much of their intellectual skill and experience in dealing with vascular surgery problems,” he said. He urged that “as our senior surgeons leave clinical practice, we need to use their intellectual expertise and experience in a more productive way.”

The Society for Vascular Surgery is establishing pathways for leadership and pathways to train people in administration, he added.

Turning back to the extreme importance of teamwork, Dr. Darling addressed the future.

“We, physicians, nurses, PAs, technologists, staff, and administrators, need to work together, think together, to grow together, not only for our patients, but for our partners and our families. We are all part of the vascular team,” Dr. Darling said. 

When R. Clement Darling III, MD, took to the podium at the Vascular Annual Meeting to present his presidential address, he highlighted the importance of teamwork and collaboration in training, in maintaining personal well-being, and most importantly, in patient care.

Nationwide Photographers

His talk, titled, “Looking Forward Through the Past: Changing Me to We in the Evolution of Team-based Vascular Care,” addressed these issues through a very personal lens. To make his point, Dr. Darling outlined four key take-home concepts that he had found useful “over five decades of working in an operating room as a technologist, a student and a surgeon,” and as chief of the division of vascular surgery at Albany Medical Center Hospital (N.Y.). These formed the basis of his entire address:

1. “None of us is as smart as all of us.” We learn from each other which is the foundation of team-based training.

2. The key to resilience, healing and health, whether for our patients or for ourselves, is caring and supporting each other more.

3. Failure is not an end result. It is the path to success through learning.

4. Remember the past but look to the future. The best predictor of future behavior is the past, but the future we are experiencing now, is like no other!”

Dr. Darling spoke from the heart about the importance of his colleagues and his parents, especially the role of his father as a pioneer in vascular surgery, and of the women in his life as role models.

He stressed how “one of the invaluable things I have learned is the value of failure, evaluating the past to avoid the same mistakes and the benefit of the TEAM in providing support and care.”

“Every day we’re asked to do the impossible and every day we get up, go to work. We do the best we can. We can make the best plans, treat the sickest patients and get a tremendous fulfillment for what we do in what we do. We do the right thing for the patient,” Dr. Darling explained, in summarizing the passion that he feels for vascular surgery.

“We are always willing to do and try the impossible. We’re always willing to be the last person to call when things look bleak. It brings me great glee whenever we get called to the operating room and people look around and go, ‘oh thank God, the vascular surgeon’s here.’ Our colleagues in other specialties are often afraid of blood vessels, afraid of death, afraid of complications. We thrust ourselves every day into situations where nobody else will go,” he added.

“As vascular surgeons we face failure and roadblocks daily yet still persist where others are scared to tread. Many of you have faced far worse barriers of discrimination and unreasonable arbitrary barriers, and I am constantly humbled by your ability to overcome them,” Dr. Darling said. He pointed out that: “This innate ability to focus on the problem is what makes vascular surgeons great. No problem is too complex, no detail is too small. We do the right thing despite the odds against us. We do right by the patient.”

After telling some of his own stories of “failure,” to illustrate its importance as a learning tool, Dr. Darling spoke of one person’s reception of his application to join the SVS: “When I applied for membership to the Society for Vascular Surgery, someone had written a note saying that ‘I should never be considered, nor was I deserving to be a member of the SVS, and never should I be admitted into this austere society.’”

Throughout his address, Dr. Darling re-emphasized the importance of teams and the collaborative nature of patient care. “The SVS has developed strong partnerships with the Society for Vascular Nursing, The American Venous Forum, The Society for Vascular Ultrasound, and is seeking to strengthen relationships with the regional vascular societies, VESS, the Society for Clinical Vascular Surgery, The Society for Vascular Medicine, the American Heart Association, and many others.

“The SVS is developing these relationships with the patient at the center, and with purpose, focusing on ‘shared vision,’ of specific advancements, programs, and initiatives that will advance quality of care. By tapping into this vast array of talent Vascular Surgery will become more agile, intelligent and thoughtful in our care of vascular patients,” Dr. Darling predicted.

But vascular surgeons must become comfortable with moving from the concept of “captain of the ship” to the role of team leadership, he emphasized, if they are to truly succeed in their careers and in providing optimal patient care.

“Currently, each patient coming to your service touches over 100 staff during their experience. This includes your office, vascular lab, angio suite, recovery room, hospital floor, ICU, CT scanner to name a few.” This is part of the need for the evolution from ‘captain’ to ‘leader,’ he added.

“If you have not had any formal training in leadership or team development, I strongly suggest you add this to your learning portfolio,” Dr. Darling counseled. “The SVS is addressing this through its Leadership and Diversity Committee, and you will see an expanding array of learning opportunities in the future.”

With regard to his own tenure as SVS President: “I am proud that during my year as president, the SVS has invested in several new Task Forces to address critical future issues including: Alternative Payment Models for vascular surgery; a national inpatient and outpatient vascular certification program; a focus on our own health, wellness, and potential ways to mitigate potential burnout; and Dr. Makaroun will be taking on the issues of vascular surgery valuation and workforce in the new Task Force on the Future of Vascular Surgery.”

He further discussed the role SVS is playing in helping to define the future of vascular surgery.

“As we work to strengthen our brand and identity, the SVS Executive Board has supported, and thanks, Amy Reed and Will Jordan for their leadership in the APDVS [Association of Program Directors of Vascular Surgery], and for taking the first step toward attaining a separate Vascular Residency Review Committee or RRC.” In addition, he described how “SVS is also working closely, and collaboratively, with the American Board of Surgery, and the Vascular Surgery Board, to complete the work that was begun a decade ago, and achieve an autonomous vascular surgery board that is an equal partner and stakeholder in the ABS.”

Dr. Darling then outlined one of his major concerns and interests: the exit path of senior vascular surgeons, and how this is often a tremendous waste of talent and expertise. “In the last decade of work when senior surgeons are trying to transition to non-clinical work, I think we throw away much of their intellectual skill and experience in dealing with vascular surgery problems,” he said. He urged that “as our senior surgeons leave clinical practice, we need to use their intellectual expertise and experience in a more productive way.”

The Society for Vascular Surgery is establishing pathways for leadership and pathways to train people in administration, he added.

Turning back to the extreme importance of teamwork, Dr. Darling addressed the future.

“We, physicians, nurses, PAs, technologists, staff, and administrators, need to work together, think together, to grow together, not only for our patients, but for our partners and our families. We are all part of the vascular team,” Dr. Darling said. 

When R. Clement Darling III, MD, took to the podium at the Vascular Annual Meeting to present his presidential address, he highlighted the importance of teamwork and collaboration in training, in maintaining personal well-being, and most importantly, in patient care.

Nationwide Photographers

His talk, titled, “Looking Forward Through the Past: Changing Me to We in the Evolution of Team-based Vascular Care,” addressed these issues through a very personal lens. To make his point, Dr. Darling outlined four key take-home concepts that he had found useful “over five decades of working in an operating room as a technologist, a student and a surgeon,” and as chief of the division of vascular surgery at Albany Medical Center Hospital (N.Y.). These formed the basis of his entire address:

1. “None of us is as smart as all of us.” We learn from each other which is the foundation of team-based training.

2. The key to resilience, healing and health, whether for our patients or for ourselves, is caring and supporting each other more.

3. Failure is not an end result. It is the path to success through learning.

4. Remember the past but look to the future. The best predictor of future behavior is the past, but the future we are experiencing now, is like no other!”

Dr. Darling spoke from the heart about the importance of his colleagues and his parents, especially the role of his father as a pioneer in vascular surgery, and of the women in his life as role models.

He stressed how “one of the invaluable things I have learned is the value of failure, evaluating the past to avoid the same mistakes and the benefit of the TEAM in providing support and care.”

“Every day we’re asked to do the impossible and every day we get up, go to work. We do the best we can. We can make the best plans, treat the sickest patients and get a tremendous fulfillment for what we do in what we do. We do the right thing for the patient,” Dr. Darling explained, in summarizing the passion that he feels for vascular surgery.

“We are always willing to do and try the impossible. We’re always willing to be the last person to call when things look bleak. It brings me great glee whenever we get called to the operating room and people look around and go, ‘oh thank God, the vascular surgeon’s here.’ Our colleagues in other specialties are often afraid of blood vessels, afraid of death, afraid of complications. We thrust ourselves every day into situations where nobody else will go,” he added.

“As vascular surgeons we face failure and roadblocks daily yet still persist where others are scared to tread. Many of you have faced far worse barriers of discrimination and unreasonable arbitrary barriers, and I am constantly humbled by your ability to overcome them,” Dr. Darling said. He pointed out that: “This innate ability to focus on the problem is what makes vascular surgeons great. No problem is too complex, no detail is too small. We do the right thing despite the odds against us. We do right by the patient.”

After telling some of his own stories of “failure,” to illustrate its importance as a learning tool, Dr. Darling spoke of one person’s reception of his application to join the SVS: “When I applied for membership to the Society for Vascular Surgery, someone had written a note saying that ‘I should never be considered, nor was I deserving to be a member of the SVS, and never should I be admitted into this austere society.’”

Throughout his address, Dr. Darling re-emphasized the importance of teams and the collaborative nature of patient care. “The SVS has developed strong partnerships with the Society for Vascular Nursing, The American Venous Forum, The Society for Vascular Ultrasound, and is seeking to strengthen relationships with the regional vascular societies, VESS, the Society for Clinical Vascular Surgery, The Society for Vascular Medicine, the American Heart Association, and many others.

“The SVS is developing these relationships with the patient at the center, and with purpose, focusing on ‘shared vision,’ of specific advancements, programs, and initiatives that will advance quality of care. By tapping into this vast array of talent Vascular Surgery will become more agile, intelligent and thoughtful in our care of vascular patients,” Dr. Darling predicted.

But vascular surgeons must become comfortable with moving from the concept of “captain of the ship” to the role of team leadership, he emphasized, if they are to truly succeed in their careers and in providing optimal patient care.

“Currently, each patient coming to your service touches over 100 staff during their experience. This includes your office, vascular lab, angio suite, recovery room, hospital floor, ICU, CT scanner to name a few.” This is part of the need for the evolution from ‘captain’ to ‘leader,’ he added.

“If you have not had any formal training in leadership or team development, I strongly suggest you add this to your learning portfolio,” Dr. Darling counseled. “The SVS is addressing this through its Leadership and Diversity Committee, and you will see an expanding array of learning opportunities in the future.”

With regard to his own tenure as SVS President: “I am proud that during my year as president, the SVS has invested in several new Task Forces to address critical future issues including: Alternative Payment Models for vascular surgery; a national inpatient and outpatient vascular certification program; a focus on our own health, wellness, and potential ways to mitigate potential burnout; and Dr. Makaroun will be taking on the issues of vascular surgery valuation and workforce in the new Task Force on the Future of Vascular Surgery.”

He further discussed the role SVS is playing in helping to define the future of vascular surgery.

“As we work to strengthen our brand and identity, the SVS Executive Board has supported, and thanks, Amy Reed and Will Jordan for their leadership in the APDVS [Association of Program Directors of Vascular Surgery], and for taking the first step toward attaining a separate Vascular Residency Review Committee or RRC.” In addition, he described how “SVS is also working closely, and collaboratively, with the American Board of Surgery, and the Vascular Surgery Board, to complete the work that was begun a decade ago, and achieve an autonomous vascular surgery board that is an equal partner and stakeholder in the ABS.”

Dr. Darling then outlined one of his major concerns and interests: the exit path of senior vascular surgeons, and how this is often a tremendous waste of talent and expertise. “In the last decade of work when senior surgeons are trying to transition to non-clinical work, I think we throw away much of their intellectual skill and experience in dealing with vascular surgery problems,” he said. He urged that “as our senior surgeons leave clinical practice, we need to use their intellectual expertise and experience in a more productive way.”

The Society for Vascular Surgery is establishing pathways for leadership and pathways to train people in administration, he added.

Turning back to the extreme importance of teamwork, Dr. Darling addressed the future.

“We, physicians, nurses, PAs, technologists, staff, and administrators, need to work together, think together, to grow together, not only for our patients, but for our partners and our families. We are all part of the vascular team,” Dr. Darling said. 

Postoperative delirium has a high prevalence among vascular surgery patients, increasing morbidity, mortality and length of stay (LOS),according to Rima G. Styra, MD, and her colleagues at the University of Toronto (Canada).

In Friday’s Scientific Session 5, Dr. Styra will present their prospective study, which found that there were preop risk factors for delirium that can be determined by a surgical team in order to identify high risk patients; their study also looked at the impacts of delirium on hospital costs.

She and her colleagues preoperatively assessed 173 elective vascular surgery patients for cognitive function using the Montreal Cognitive Assessment Scale (MoCA) and the Confusion Assessment Method (CAM) for postoperative delirium, which was verified by chart and clinical review.

Friday, June 22

3:30–5 p.m.

HCC, Ballroom A/B

SS26: The Impact of Pre-Operative Cognitive Impairment and Type of Vascular Surgery on Postoperative Delirium and Cost Implications

Postoperative delirium has a high prevalence among vascular surgery patients, increasing morbidity, mortality and length of stay (LOS),according to Rima G. Styra, MD, and her colleagues at the University of Toronto (Canada).

In Friday’s Scientific Session 5, Dr. Styra will present their prospective study, which found that there were preop risk factors for delirium that can be determined by a surgical team in order to identify high risk patients; their study also looked at the impacts of delirium on hospital costs.

She and her colleagues preoperatively assessed 173 elective vascular surgery patients for cognitive function using the Montreal Cognitive Assessment Scale (MoCA) and the Confusion Assessment Method (CAM) for postoperative delirium, which was verified by chart and clinical review.

Friday, June 22

3:30–5 p.m.

HCC, Ballroom A/B

SS26: The Impact of Pre-Operative Cognitive Impairment and Type of Vascular Surgery on Postoperative Delirium and Cost Implications

Postoperative delirium has a high prevalence among vascular surgery patients, increasing morbidity, mortality and length of stay (LOS),according to Rima G. Styra, MD, and her colleagues at the University of Toronto (Canada).

In Friday’s Scientific Session 5, Dr. Styra will present their prospective study, which found that there were preop risk factors for delirium that can be determined by a surgical team in order to identify high risk patients; their study also looked at the impacts of delirium on hospital costs.

She and her colleagues preoperatively assessed 173 elective vascular surgery patients for cognitive function using the Montreal Cognitive Assessment Scale (MoCA) and the Confusion Assessment Method (CAM) for postoperative delirium, which was verified by chart and clinical review.

Friday, June 22

3:30–5 p.m.

HCC, Ballroom A/B

SS26: The Impact of Pre-Operative Cognitive Impairment and Type of Vascular Surgery on Postoperative Delirium and Cost Implications

The Safety and Efficacy Study for Reverse Flow Used during Carotid Artery Stenting Procedure (ROADSTER) multicenter trial reported the lowest stroke rate in high-risk patients compared with any prospective trial of TFCAS, according to Mahmoud B. Malas, MD, of the Johns Hopkins Hospital and his colleagues. However, clinical trials have selection criteria that exclude many patients, and are highly selective of operators performing the procedures, which limit generalizability. Dr. Malas will present a study in Scientific Session S4 that he and his colleagues did to compare in-hospital outcomes after TCAR and TFCAS as reported in VQI.

They analyzed data from the initial 646 patients enrolled in the SVS VQI TCAR Surveillance Project (TSP) and compared it with that of patients who underwent TFCAS between 2005 and 2017. Patients with tandem, traumatic, or dissection lesions were excluded. They used multivariable logistic regression and 1:1 coarsened exact matching (CEM) to analyze neurologic adverse events [stroke and transient ischemic attacks (TIAs)] and in-hospital mortality. Patients in the two procedures were matched on age, race, coronary artery disease, congestive heart failure, prior CABG/PCI, chronic kidney disease, diabetes, ASA class, symptomatic status, restenosis, anatomical and medical risk, emergency status, and preoperative medication use.

Compared with more than 10,000 patients undergoing TFCAS, the 638 undergoing TCAR were significantly older and had more cardiac comorbidities. In contrast, patients in the TFCAS group were more likely to be symptomatic and to have a restenotic lesion. There was no significant change in the odds of stroke/death in TFCAS over the study period.

The rates of in-hospital TIA/stroke as well as TIA/stroke/death were significantly higher in TFCAS compared with TCAR (3.3% vs.1.9% and 3.8% vs.2.2%, respectively; both P = .04). In both procedures, symptomatic patients had higher rates of TIA/stroke/death compared with asymptomatic patients; however, the difference was significant only in the TFCAS (5.3% vs. 2.7%, P less than .001). On multivariable analysis, TFCAS was associated with twice the odds of in-hospital neurologic events and TIA/stroke/death compared with TCAR, independent of symptomatic status. CEM showed similar results.

“Our results show that patients undergoing TCAR had significantly higher medical comorbidities, but half the risk of in-hospital TIA/stroke/death compared to patients undergoing TFCAS. This initial evaluation of VQI TSP demonstrates the ability to rapidly monitor new devices/procedures in real world practice. While preliminary, this is the first study to confirm the benefit of TCAR compared to TFCAS in real-world practice,” Dr. Malas concluded. 

Friday, June 22

3:30 - 5 p.m.

HCC, Ballroom A/B

SS24: Transcarotid Artery Revascularization (TCAR) vs. Transfemoral Carotid Artery Stenting (TFCAS) in the SVS Vascular Quality Initiative

The Safety and Efficacy Study for Reverse Flow Used during Carotid Artery Stenting Procedure (ROADSTER) multicenter trial reported the lowest stroke rate in high-risk patients compared with any prospective trial of TFCAS, according to Mahmoud B. Malas, MD, of the Johns Hopkins Hospital and his colleagues. However, clinical trials have selection criteria that exclude many patients, and are highly selective of operators performing the procedures, which limit generalizability. Dr. Malas will present a study in Scientific Session S4 that he and his colleagues did to compare in-hospital outcomes after TCAR and TFCAS as reported in VQI.

They analyzed data from the initial 646 patients enrolled in the SVS VQI TCAR Surveillance Project (TSP) and compared it with that of patients who underwent TFCAS between 2005 and 2017. Patients with tandem, traumatic, or dissection lesions were excluded. They used multivariable logistic regression and 1:1 coarsened exact matching (CEM) to analyze neurologic adverse events [stroke and transient ischemic attacks (TIAs)] and in-hospital mortality. Patients in the two procedures were matched on age, race, coronary artery disease, congestive heart failure, prior CABG/PCI, chronic kidney disease, diabetes, ASA class, symptomatic status, restenosis, anatomical and medical risk, emergency status, and preoperative medication use.

Compared with more than 10,000 patients undergoing TFCAS, the 638 undergoing TCAR were significantly older and had more cardiac comorbidities. In contrast, patients in the TFCAS group were more likely to be symptomatic and to have a restenotic lesion. There was no significant change in the odds of stroke/death in TFCAS over the study period.

The rates of in-hospital TIA/stroke as well as TIA/stroke/death were significantly higher in TFCAS compared with TCAR (3.3% vs.1.9% and 3.8% vs.2.2%, respectively; both P = .04). In both procedures, symptomatic patients had higher rates of TIA/stroke/death compared with asymptomatic patients; however, the difference was significant only in the TFCAS (5.3% vs. 2.7%, P less than .001). On multivariable analysis, TFCAS was associated with twice the odds of in-hospital neurologic events and TIA/stroke/death compared with TCAR, independent of symptomatic status. CEM showed similar results.

“Our results show that patients undergoing TCAR had significantly higher medical comorbidities, but half the risk of in-hospital TIA/stroke/death compared to patients undergoing TFCAS. This initial evaluation of VQI TSP demonstrates the ability to rapidly monitor new devices/procedures in real world practice. While preliminary, this is the first study to confirm the benefit of TCAR compared to TFCAS in real-world practice,” Dr. Malas concluded. 

Friday, June 22

3:30 - 5 p.m.

HCC, Ballroom A/B

SS24: Transcarotid Artery Revascularization (TCAR) vs. Transfemoral Carotid Artery Stenting (TFCAS) in the SVS Vascular Quality Initiative

The Safety and Efficacy Study for Reverse Flow Used during Carotid Artery Stenting Procedure (ROADSTER) multicenter trial reported the lowest stroke rate in high-risk patients compared with any prospective trial of TFCAS, according to Mahmoud B. Malas, MD, of the Johns Hopkins Hospital and his colleagues. However, clinical trials have selection criteria that exclude many patients, and are highly selective of operators performing the procedures, which limit generalizability. Dr. Malas will present a study in Scientific Session S4 that he and his colleagues did to compare in-hospital outcomes after TCAR and TFCAS as reported in VQI.

They analyzed data from the initial 646 patients enrolled in the SVS VQI TCAR Surveillance Project (TSP) and compared it with that of patients who underwent TFCAS between 2005 and 2017. Patients with tandem, traumatic, or dissection lesions were excluded. They used multivariable logistic regression and 1:1 coarsened exact matching (CEM) to analyze neurologic adverse events [stroke and transient ischemic attacks (TIAs)] and in-hospital mortality. Patients in the two procedures were matched on age, race, coronary artery disease, congestive heart failure, prior CABG/PCI, chronic kidney disease, diabetes, ASA class, symptomatic status, restenosis, anatomical and medical risk, emergency status, and preoperative medication use.

Compared with more than 10,000 patients undergoing TFCAS, the 638 undergoing TCAR were significantly older and had more cardiac comorbidities. In contrast, patients in the TFCAS group were more likely to be symptomatic and to have a restenotic lesion. There was no significant change in the odds of stroke/death in TFCAS over the study period.

The rates of in-hospital TIA/stroke as well as TIA/stroke/death were significantly higher in TFCAS compared with TCAR (3.3% vs.1.9% and 3.8% vs.2.2%, respectively; both P = .04). In both procedures, symptomatic patients had higher rates of TIA/stroke/death compared with asymptomatic patients; however, the difference was significant only in the TFCAS (5.3% vs. 2.7%, P less than .001). On multivariable analysis, TFCAS was associated with twice the odds of in-hospital neurologic events and TIA/stroke/death compared with TCAR, independent of symptomatic status. CEM showed similar results.

“Our results show that patients undergoing TCAR had significantly higher medical comorbidities, but half the risk of in-hospital TIA/stroke/death compared to patients undergoing TFCAS. This initial evaluation of VQI TSP demonstrates the ability to rapidly monitor new devices/procedures in real world practice. While preliminary, this is the first study to confirm the benefit of TCAR compared to TFCAS in real-world practice,” Dr. Malas concluded. 

Friday, June 22

3:30 - 5 p.m.

HCC, Ballroom A/B

SS24: Transcarotid Artery Revascularization (TCAR) vs. Transfemoral Carotid Artery Stenting (TFCAS) in the SVS Vascular Quality Initiative

Young vascular surgeons looking to make their marks and balance their lives, as well as more experienced surgeons seeking tips for more effective practice and career management, should consider the session led by Jeffrey Siracuse, MD, of Boston Medical Center, and Courtney Warner, MD, of Albany Medical College, Saratoga Springs, N.Y.

“This will be a great and informative session that, although geared toward young surgeons, will be highly useful for surgeons of all experience levels,” Dr. Siracuse said of the session.

Friday, June 22

1:30 – 3:00 p.m.

HCC, Room 311

C5: Practice Management Tips and Tricks for Young Vascular Surgeons

Young vascular surgeons looking to make their marks and balance their lives, as well as more experienced surgeons seeking tips for more effective practice and career management, should consider the session led by Jeffrey Siracuse, MD, of Boston Medical Center, and Courtney Warner, MD, of Albany Medical College, Saratoga Springs, N.Y.

“This will be a great and informative session that, although geared toward young surgeons, will be highly useful for surgeons of all experience levels,” Dr. Siracuse said of the session.

Friday, June 22

1:30 – 3:00 p.m.

HCC, Room 311

C5: Practice Management Tips and Tricks for Young Vascular Surgeons

Young vascular surgeons looking to make their marks and balance their lives, as well as more experienced surgeons seeking tips for more effective practice and career management, should consider the session led by Jeffrey Siracuse, MD, of Boston Medical Center, and Courtney Warner, MD, of Albany Medical College, Saratoga Springs, N.Y.

“This will be a great and informative session that, although geared toward young surgeons, will be highly useful for surgeons of all experience levels,” Dr. Siracuse said of the session.

Friday, June 22

1:30 – 3:00 p.m.

HCC, Room 311

C5: Practice Management Tips and Tricks for Young Vascular Surgeons