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View, Review VAM at Home with VAM on Demand Library
The inability to be in two places at one time makes VAM On Demand an essential component of the Vascular Annual Meeting.
VAM on Demand lets people review — in depth and on their own timeline —sessions they attended and “attend” electronically the ones they couldn’t in person. VAM on Demand will include hundreds of individual presentations, with accompanying PowerPoint slides and audio. Select video sessions will be available.
The fee is $199 for attendees after the meeting ends. (Non-attendees may purchase VAM on Demand for $499.) All purchasers receive unlimited access, plus downloads to the library, for up to one year. Access begins several weeks after VAM ends and will be available on the SVS website vascular.org.
Contact education@vascularsociety.org with questions.
The inability to be in two places at one time makes VAM On Demand an essential component of the Vascular Annual Meeting.
VAM on Demand lets people review — in depth and on their own timeline —sessions they attended and “attend” electronically the ones they couldn’t in person. VAM on Demand will include hundreds of individual presentations, with accompanying PowerPoint slides and audio. Select video sessions will be available.
The fee is $199 for attendees after the meeting ends. (Non-attendees may purchase VAM on Demand for $499.) All purchasers receive unlimited access, plus downloads to the library, for up to one year. Access begins several weeks after VAM ends and will be available on the SVS website vascular.org.
Contact education@vascularsociety.org with questions.
The inability to be in two places at one time makes VAM On Demand an essential component of the Vascular Annual Meeting.
VAM on Demand lets people review — in depth and on their own timeline —sessions they attended and “attend” electronically the ones they couldn’t in person. VAM on Demand will include hundreds of individual presentations, with accompanying PowerPoint slides and audio. Select video sessions will be available.
The fee is $199 for attendees after the meeting ends. (Non-attendees may purchase VAM on Demand for $499.) All purchasers receive unlimited access, plus downloads to the library, for up to one year. Access begins several weeks after VAM ends and will be available on the SVS website vascular.org.
Contact education@vascularsociety.org with questions.
How to Earn Your CME, MOC Credits from VAM
Physician registrants can get a big boost in collecting required Continuing Medical Education (CME) and Maintenance of Certification (MOC) self-assessment credits at the Vascular Annual Meeting.
The Society for Vascular Surgery is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. SVS has designated the 2019 Vascular Annual Meeting for a maximum of 30 AMA PRA Category 1 Credits™.
Physicians should claim only the credits commensurate with the extent of their participation in the activity.
Full credit is not available for attendance at two sessions occurring simultaneously.
A number of sessions also permit earning of MOC credits.
Participants may claim credits beginning Wednesday, June 12. Credits must be claimed by Dec. 31, 2019.
Physician registrants can get a big boost in collecting required Continuing Medical Education (CME) and Maintenance of Certification (MOC) self-assessment credits at the Vascular Annual Meeting.
The Society for Vascular Surgery is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. SVS has designated the 2019 Vascular Annual Meeting for a maximum of 30 AMA PRA Category 1 Credits™.
Physicians should claim only the credits commensurate with the extent of their participation in the activity.
Full credit is not available for attendance at two sessions occurring simultaneously.
A number of sessions also permit earning of MOC credits.
Participants may claim credits beginning Wednesday, June 12. Credits must be claimed by Dec. 31, 2019.
Physician registrants can get a big boost in collecting required Continuing Medical Education (CME) and Maintenance of Certification (MOC) self-assessment credits at the Vascular Annual Meeting.
The Society for Vascular Surgery is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. SVS has designated the 2019 Vascular Annual Meeting for a maximum of 30 AMA PRA Category 1 Credits™.
Physicians should claim only the credits commensurate with the extent of their participation in the activity.
Full credit is not available for attendance at two sessions occurring simultaneously.
A number of sessions also permit earning of MOC credits.
Participants may claim credits beginning Wednesday, June 12. Credits must be claimed by Dec. 31, 2019.
‘Good Outcomes Not Good Enough’
A tradition at the Vascular Annual Meeting, the E. Stanley Crawford Critical Issues Forum is organized by the incoming SVS President and devotes itself to assessing and discussing particular challenges currently facing the society. This year’s Forum focused on how vascular surgeons could use evidence-based medicine to develop tools to improve outcomes, reduce costs, and ensure appropriate utilization of resources.
Session moderator and organizer Kim J. Hodgson, MD, SVS president-elect and chair of the division of vascular surgery at Southern Illinois University School of Medicine, outlined the problem in his introductory presentation “Why Good Outcomes Are No Longer Good Enough.”
He pointed out how there are several driving forces influencing the inappropriate use of medical procedures, resulting in diminished quality of outcomes and increased costs of health care: These comprise incorrect evaluation, incorrect treatment and planning, and improper motivation. The first two factors can be improved through education and development and promulgation of evidence-based medical practices, but the last is correctable only through enforced regulation and peer-review. This has become increasingly more difficult as procedures move from the hospital to outpatient centers, where the profit motive for performing inappropriate procedures, and the means to satisfy it, are increasingly more tempting.
He emphasized how SVS has tools such as the Vascular Quality Initiative and its registries to provide evidence-based input on the appropriateness of procedures and whether an institution is matching up to its peers in providing appropriate patient care. The importance of the VQI was also stressed by the majority of the Crawford Forum speakers.
“Unfortunately, like it or not, the reality is that some degree of regulation is inevitable, and if we don’t step up and regulate ourselves, there are plenty of other people willing to do it for us. I would say that we let the bureaucrats develop our EHRs, and you know how that worked out. So, I think it is incumbent upon us to be able to regulate ourselves.”
Dr. Hodgson turned over the discussion to Arlene Seid, MD, MPH, medical director of the quality assurance office within the Pennsylvania Department of Health. Her presentation, “The Government’s Perspective on When & Where Endovascular Interventions Should Be Performed,” detailed how her department recently became concerned about an increase in the volume of endovascular procedures, and complications thereof, mainly in outpatient settings. The department also raised questions about the procedures and discussed whether reimbursement via programs such as Medicaid should be ceased.
She pointed out how federal regulations from the Centers for Medicare & Medicaid Services (CMS) only regulate through payments and their choice of procedures to be reimbursed, the vast majority of other regulations are established at the state level and vary widely from state to state. And at the state level, such as hers, there was great difficulty finding trustworthy expert opinion, and she added how organizations like the SVS could be of tremendous use in providing guidance in developing regulations.
As an example she used Ambulatory Surgical Centers, which are defined differently from state to state and vary widely in their requirements for licensing. The state’s job is made much simpler, and more effective, when expert organizations like the SVS can provide certification programs as a firm foundation for basing such licensing efforts.
She also suggested that if individuals have problems with or disagree with state regulations, they must become knowledgeable as to what level of state organization is involved, and ideally enlist the help of groups such as SVS to provide the expert justification for change.
Anton Sidawy, MD, MPH, FACS, professor and chair of the Department of Surgery at the George Washington University Medical Center, discussed how SVS is working with the American College of Surgeons to develop certification for vascular surgery centers. He addressed the need for organizations such as SVS to take the initiative in defining quality and value for the field, in no small part because payment models are shifting from the rewarding of volume to the rewarding of value.
Defining value may come from many sources: government, private insurers, and the public. Unless SVS has a strong voice in defining value, it may find itself not pleased with the results, according to Dr. Sidawy.
Then Fred A. Weaver, MD, chair of the SVS Patient Safety Organization and professor of surgery and chief of the vascular surgery division at Keck School of Medicine of University of Southern California, described the current state of the Vascular Quality Initiative. This is an SVS database whose 12 registries have gathered demographic, clinical, procedural and outcomes data from more than 500,000 vascular procedures performed in North America in 18 regional quality groups.
Currently, the VQI is comprised of 571 centers in the United States and Canada, with one in Singapore. Of particular importance, the makeup of the practitioners involved in the VQI is very diverse in specialty training, with only 41% of the membership being vascular surgeons.
In the near future, three more VQI registries are coming, according to Dr. Weaver: An ultrasound registry (in concert with the Society of Vascular Ultrasound); Venous Stenting; and Vascular Medicine (in concert with the American Heart Association).
Dr. Weaver emphasized how tracking outcomes is crucial for both vascular surgeons and certified vascular surgery centers to assess and improve their performance and how the VQI is critical to these endeavors.
Finally, Larry Kraiss, MD, chair of the SVS Quality Council and professor and chief of the vascular surgery division at the University of Utah, presented the goals of the new SVS council and described how the council is expanding the quality mission to include appropriate use criteria in addition to the long-standing clinical practice guidelines the SVS produces.
Dr. Kraiss elaborated how Appropriate Use Criteria (AUC) perform a substantially different role than that of Clinical Practice Guidelines (CPG).
Since 2006, SVS has developed 13 active guidelines, with more on the way. Guidelines provide positive yes/no statements with regard to treatment decision-making. However, many patients fall outside the guidelines, often due to comorbidities or other confounding factors, and appropriate use criteria are vital in these cases to evaluate where on a spectrum the patient fits for making a decision with regard to performing an operation or the use of a device.
Appropriate use criteria can be developed through the use of risk assessment to determine where on the spectrum of safety and effectiveness a particular patient falls with regard to a particular procedure or device. A major role of the new SVS Quality Council is to develop appropriate use criteria using outcome tools such as VQI and to provide recommendations as to how individuals and institutions could improve their performance by taking into account risk factors and assess infrastructural needs.
“The SVS board has authorized development of AUC in particular areas,” said Dr. Kraiss. “This process with be closely tied with updating the CPG. The first commissioned AUC will be to address intermittent claudication. But I invite the membership to participate in this process, especially on the panels, which can have up to 17 members, and we envision AUC coming out in carotid intervention, AAA management, and venous disease,” he added.
A tradition at the Vascular Annual Meeting, the E. Stanley Crawford Critical Issues Forum is organized by the incoming SVS President and devotes itself to assessing and discussing particular challenges currently facing the society. This year’s Forum focused on how vascular surgeons could use evidence-based medicine to develop tools to improve outcomes, reduce costs, and ensure appropriate utilization of resources.
Session moderator and organizer Kim J. Hodgson, MD, SVS president-elect and chair of the division of vascular surgery at Southern Illinois University School of Medicine, outlined the problem in his introductory presentation “Why Good Outcomes Are No Longer Good Enough.”
He pointed out how there are several driving forces influencing the inappropriate use of medical procedures, resulting in diminished quality of outcomes and increased costs of health care: These comprise incorrect evaluation, incorrect treatment and planning, and improper motivation. The first two factors can be improved through education and development and promulgation of evidence-based medical practices, but the last is correctable only through enforced regulation and peer-review. This has become increasingly more difficult as procedures move from the hospital to outpatient centers, where the profit motive for performing inappropriate procedures, and the means to satisfy it, are increasingly more tempting.
He emphasized how SVS has tools such as the Vascular Quality Initiative and its registries to provide evidence-based input on the appropriateness of procedures and whether an institution is matching up to its peers in providing appropriate patient care. The importance of the VQI was also stressed by the majority of the Crawford Forum speakers.
“Unfortunately, like it or not, the reality is that some degree of regulation is inevitable, and if we don’t step up and regulate ourselves, there are plenty of other people willing to do it for us. I would say that we let the bureaucrats develop our EHRs, and you know how that worked out. So, I think it is incumbent upon us to be able to regulate ourselves.”
Dr. Hodgson turned over the discussion to Arlene Seid, MD, MPH, medical director of the quality assurance office within the Pennsylvania Department of Health. Her presentation, “The Government’s Perspective on When & Where Endovascular Interventions Should Be Performed,” detailed how her department recently became concerned about an increase in the volume of endovascular procedures, and complications thereof, mainly in outpatient settings. The department also raised questions about the procedures and discussed whether reimbursement via programs such as Medicaid should be ceased.
She pointed out how federal regulations from the Centers for Medicare & Medicaid Services (CMS) only regulate through payments and their choice of procedures to be reimbursed, the vast majority of other regulations are established at the state level and vary widely from state to state. And at the state level, such as hers, there was great difficulty finding trustworthy expert opinion, and she added how organizations like the SVS could be of tremendous use in providing guidance in developing regulations.
As an example she used Ambulatory Surgical Centers, which are defined differently from state to state and vary widely in their requirements for licensing. The state’s job is made much simpler, and more effective, when expert organizations like the SVS can provide certification programs as a firm foundation for basing such licensing efforts.
She also suggested that if individuals have problems with or disagree with state regulations, they must become knowledgeable as to what level of state organization is involved, and ideally enlist the help of groups such as SVS to provide the expert justification for change.
Anton Sidawy, MD, MPH, FACS, professor and chair of the Department of Surgery at the George Washington University Medical Center, discussed how SVS is working with the American College of Surgeons to develop certification for vascular surgery centers. He addressed the need for organizations such as SVS to take the initiative in defining quality and value for the field, in no small part because payment models are shifting from the rewarding of volume to the rewarding of value.
Defining value may come from many sources: government, private insurers, and the public. Unless SVS has a strong voice in defining value, it may find itself not pleased with the results, according to Dr. Sidawy.
Then Fred A. Weaver, MD, chair of the SVS Patient Safety Organization and professor of surgery and chief of the vascular surgery division at Keck School of Medicine of University of Southern California, described the current state of the Vascular Quality Initiative. This is an SVS database whose 12 registries have gathered demographic, clinical, procedural and outcomes data from more than 500,000 vascular procedures performed in North America in 18 regional quality groups.
Currently, the VQI is comprised of 571 centers in the United States and Canada, with one in Singapore. Of particular importance, the makeup of the practitioners involved in the VQI is very diverse in specialty training, with only 41% of the membership being vascular surgeons.
In the near future, three more VQI registries are coming, according to Dr. Weaver: An ultrasound registry (in concert with the Society of Vascular Ultrasound); Venous Stenting; and Vascular Medicine (in concert with the American Heart Association).
Dr. Weaver emphasized how tracking outcomes is crucial for both vascular surgeons and certified vascular surgery centers to assess and improve their performance and how the VQI is critical to these endeavors.
Finally, Larry Kraiss, MD, chair of the SVS Quality Council and professor and chief of the vascular surgery division at the University of Utah, presented the goals of the new SVS council and described how the council is expanding the quality mission to include appropriate use criteria in addition to the long-standing clinical practice guidelines the SVS produces.
Dr. Kraiss elaborated how Appropriate Use Criteria (AUC) perform a substantially different role than that of Clinical Practice Guidelines (CPG).
Since 2006, SVS has developed 13 active guidelines, with more on the way. Guidelines provide positive yes/no statements with regard to treatment decision-making. However, many patients fall outside the guidelines, often due to comorbidities or other confounding factors, and appropriate use criteria are vital in these cases to evaluate where on a spectrum the patient fits for making a decision with regard to performing an operation or the use of a device.
Appropriate use criteria can be developed through the use of risk assessment to determine where on the spectrum of safety and effectiveness a particular patient falls with regard to a particular procedure or device. A major role of the new SVS Quality Council is to develop appropriate use criteria using outcome tools such as VQI and to provide recommendations as to how individuals and institutions could improve their performance by taking into account risk factors and assess infrastructural needs.
“The SVS board has authorized development of AUC in particular areas,” said Dr. Kraiss. “This process with be closely tied with updating the CPG. The first commissioned AUC will be to address intermittent claudication. But I invite the membership to participate in this process, especially on the panels, which can have up to 17 members, and we envision AUC coming out in carotid intervention, AAA management, and venous disease,” he added.
A tradition at the Vascular Annual Meeting, the E. Stanley Crawford Critical Issues Forum is organized by the incoming SVS President and devotes itself to assessing and discussing particular challenges currently facing the society. This year’s Forum focused on how vascular surgeons could use evidence-based medicine to develop tools to improve outcomes, reduce costs, and ensure appropriate utilization of resources.
Session moderator and organizer Kim J. Hodgson, MD, SVS president-elect and chair of the division of vascular surgery at Southern Illinois University School of Medicine, outlined the problem in his introductory presentation “Why Good Outcomes Are No Longer Good Enough.”
He pointed out how there are several driving forces influencing the inappropriate use of medical procedures, resulting in diminished quality of outcomes and increased costs of health care: These comprise incorrect evaluation, incorrect treatment and planning, and improper motivation. The first two factors can be improved through education and development and promulgation of evidence-based medical practices, but the last is correctable only through enforced regulation and peer-review. This has become increasingly more difficult as procedures move from the hospital to outpatient centers, where the profit motive for performing inappropriate procedures, and the means to satisfy it, are increasingly more tempting.
He emphasized how SVS has tools such as the Vascular Quality Initiative and its registries to provide evidence-based input on the appropriateness of procedures and whether an institution is matching up to its peers in providing appropriate patient care. The importance of the VQI was also stressed by the majority of the Crawford Forum speakers.
“Unfortunately, like it or not, the reality is that some degree of regulation is inevitable, and if we don’t step up and regulate ourselves, there are plenty of other people willing to do it for us. I would say that we let the bureaucrats develop our EHRs, and you know how that worked out. So, I think it is incumbent upon us to be able to regulate ourselves.”
Dr. Hodgson turned over the discussion to Arlene Seid, MD, MPH, medical director of the quality assurance office within the Pennsylvania Department of Health. Her presentation, “The Government’s Perspective on When & Where Endovascular Interventions Should Be Performed,” detailed how her department recently became concerned about an increase in the volume of endovascular procedures, and complications thereof, mainly in outpatient settings. The department also raised questions about the procedures and discussed whether reimbursement via programs such as Medicaid should be ceased.
She pointed out how federal regulations from the Centers for Medicare & Medicaid Services (CMS) only regulate through payments and their choice of procedures to be reimbursed, the vast majority of other regulations are established at the state level and vary widely from state to state. And at the state level, such as hers, there was great difficulty finding trustworthy expert opinion, and she added how organizations like the SVS could be of tremendous use in providing guidance in developing regulations.
As an example she used Ambulatory Surgical Centers, which are defined differently from state to state and vary widely in their requirements for licensing. The state’s job is made much simpler, and more effective, when expert organizations like the SVS can provide certification programs as a firm foundation for basing such licensing efforts.
She also suggested that if individuals have problems with or disagree with state regulations, they must become knowledgeable as to what level of state organization is involved, and ideally enlist the help of groups such as SVS to provide the expert justification for change.
Anton Sidawy, MD, MPH, FACS, professor and chair of the Department of Surgery at the George Washington University Medical Center, discussed how SVS is working with the American College of Surgeons to develop certification for vascular surgery centers. He addressed the need for organizations such as SVS to take the initiative in defining quality and value for the field, in no small part because payment models are shifting from the rewarding of volume to the rewarding of value.
Defining value may come from many sources: government, private insurers, and the public. Unless SVS has a strong voice in defining value, it may find itself not pleased with the results, according to Dr. Sidawy.
Then Fred A. Weaver, MD, chair of the SVS Patient Safety Organization and professor of surgery and chief of the vascular surgery division at Keck School of Medicine of University of Southern California, described the current state of the Vascular Quality Initiative. This is an SVS database whose 12 registries have gathered demographic, clinical, procedural and outcomes data from more than 500,000 vascular procedures performed in North America in 18 regional quality groups.
Currently, the VQI is comprised of 571 centers in the United States and Canada, with one in Singapore. Of particular importance, the makeup of the practitioners involved in the VQI is very diverse in specialty training, with only 41% of the membership being vascular surgeons.
In the near future, three more VQI registries are coming, according to Dr. Weaver: An ultrasound registry (in concert with the Society of Vascular Ultrasound); Venous Stenting; and Vascular Medicine (in concert with the American Heart Association).
Dr. Weaver emphasized how tracking outcomes is crucial for both vascular surgeons and certified vascular surgery centers to assess and improve their performance and how the VQI is critical to these endeavors.
Finally, Larry Kraiss, MD, chair of the SVS Quality Council and professor and chief of the vascular surgery division at the University of Utah, presented the goals of the new SVS council and described how the council is expanding the quality mission to include appropriate use criteria in addition to the long-standing clinical practice guidelines the SVS produces.
Dr. Kraiss elaborated how Appropriate Use Criteria (AUC) perform a substantially different role than that of Clinical Practice Guidelines (CPG).
Since 2006, SVS has developed 13 active guidelines, with more on the way. Guidelines provide positive yes/no statements with regard to treatment decision-making. However, many patients fall outside the guidelines, often due to comorbidities or other confounding factors, and appropriate use criteria are vital in these cases to evaluate where on a spectrum the patient fits for making a decision with regard to performing an operation or the use of a device.
Appropriate use criteria can be developed through the use of risk assessment to determine where on the spectrum of safety and effectiveness a particular patient falls with regard to a particular procedure or device. A major role of the new SVS Quality Council is to develop appropriate use criteria using outcome tools such as VQI and to provide recommendations as to how individuals and institutions could improve their performance by taking into account risk factors and assess infrastructural needs.
“The SVS board has authorized development of AUC in particular areas,” said Dr. Kraiss. “This process with be closely tied with updating the CPG. The first commissioned AUC will be to address intermittent claudication. But I invite the membership to participate in this process, especially on the panels, which can have up to 17 members, and we envision AUC coming out in carotid intervention, AAA management, and venous disease,” he added.
Change Doesn’t Come Easy! But Is Needed
In selecting the subject of his presidential address, SVS President Michel Makaroun, MD, decided to focus on the inadequacy of vascular manpower to meet the demands and needs of the public.
In introducing the subject, he quoted a favorite saying from Mark Twain that gave him the topic of his address, “I am in favor of progress; it’s change I don’t like.” He then proceeded to outline why changes are necessary and what the Society for Vascular Surgery is doing to help implement them.
“You are all familiar with the highlights of the problem: It is in our numbers! A problem with multiple facets, including unfilled jobs, increasing demand, maldistribution and a demographic cliff of our membership,” Dr. Makaroun said.
The manifestations of this shortage are multiple. The number of advertised jobs far exceeds the number of graduates. There is also a significant maldistribution of the workforce. “We are concentrated in the northeast, and many populous states including Texas, Florida and California are well below average,” he said.
Additionally, many community hospitals, in both suburban areas or small towns completely lack any access to vascular surgical care, even in states with seemingly adequate numbers.
The shortage problem in vascular surgery will get worse before it gets better, he added, saying “Our pipeline is simply not large enough to overcome an older retiring generation of vascular surgeons, with nearly half retiring before 65.”
“Change does not come easy!” Dr. Makaroun warned.
“We cannot ignore in the discussion of workforce issues, the major shifts, change and uncertainty we are experiencing in health care delivery, education and the generational change of our newest members,” he said.
More than 10% of vascular surgeons now practice primarily if not exclusively in ambulatory facilities. This direction is gathering steam and reduces the pool of vascular surgeons available to accept hospital practices and cover emergencies, particularly in underserved communities.
Despite this movement, nearly two-thirds of SVS members are currently employed by hospital systems that are getting larger and larger, making it essential to navigate an ever more complex decision-making process in employment, compensation and spectrum of activities. Practice environments are becoming more corporate and bureaucratic.
Dr. Makaroun pointed out that the current landscape of our manpower has a clear two tiers divided by hospital size and location. “The most pressing concern is the inability of our specialty to provide vascular surgery services to the multitude of hospitals located in smaller communities.
“The SVS established a task force to study our manpower issues last fall. The taskforce was divided into three workgroups to focus on different areas of the problem.
The first workgroup, under the leadership of Malachi Sheehan III, MD, and Jeffrey Jim, MD, focused on the obvious solution: a campaign to increase training programs and available positions. Unfortunately, this is only aspirational, since reality fails the SVS in this effort. The pool of general surgery graduates is finite, with competition from several specialties that are more analogous to modern general surgery than vascular surgery.
Increasing the number of integrated programs is less efficient because of a 5- to 6-year lag between initiation of a new program and graduation, but it can tap into an almost unlimited pool of applicants from medical school, and more recently some very qualified international medical graduates. This makes it potentially a far more effective solution for the long term, Dr. Makaroun said.
The workgroup attempted to contact all hospitals with a general surgery program and no associated vascular fellowship. Help in navigating the process of securing financing and applying for a new program was offered. A session was conducted at VAM for interested potential sites to start discussing the process, and representatives from 27 hospitals were there expressing interest.
The second workgroup, under the leadership of Rick Powell, MD, and Andy Schanzer, MD, was tasked with analyzing and understanding the entire spectrum of surgeons’ clinical activities and producing a valuation study that illustrates the economic and vital impact of vascular surgery for hospitals and patients. “The work of this group is essential to promote a healthier relationship between our specialty and our institutions, making vascular surgery more attractive for future recruits,” according to Dr. Makaroun.
The third workgroup under the leadership of Will Jordan, MD, and Tim Sarac, MD, had the toughest job, said Dr. Makaroun. It was tasked with thinking outside the box and suggesting methods to address the most glaring need: the community hospitals, where most of the advertised jobs are, jobs that are being shunned by graduates of current training programs.
Dr. Makaroun cited the difficulties of recruitment of vascular surgeons to community hospital systems in small towns and rural areas, and he reminded people that recent general surgery graduates continue to offer vascular surgery services in such communities. Unfortunately, this is without any additional vascular training and most hospitals grant privileges without a VSB certificate when the need is demonstrated. “You all appreciate that recent graduates of general surgery programs do not have the breadth or depth of exposure to modern vascular surgery that an older generation did,” he added.
The workgroup explored many options to provide relief to community hospitals. But probably the most efficient, according to Dr. Makaroun, is to consider strategies that tap into new constituencies. One consideration to be explored is to offer a 3-year vascular surgery training opportunity to the dozens of qualified candidates in preliminary surgical positions unable to locate a categorical spot to finish their training. This process will lead to VSB certification, but will take some time to establish through the ACGME structure.
The workgroup developed an outline of a proposal for a community vascular surgery training program, as a first step. It has been sketched and will be part of the task force report submitted for review by the Executive Board of the Society.
The goals of the new pathway would be to improve local vascular care in underserved communities, while increasing the referral of appropriate cases to vascular centers. It would provide stress relief to isolated vascular surgeons, and where none exist, plant the seeds of a better work environment for vascular surgery graduates to reconsider this currently undesirable career choice.
The program is designed to offer an additional year of vascular surgery training to general surgery graduates already committed to a community practice, many of whom are already planning to offer vascular services anyway. The program will individualize training but focus only on low-complexity procedures, both open and endovascular, and more importantly the clinical situations that dictate referral, said Dr. Makaroun.
To maintain quality, the program will mandate the availability of mentorship, support and real-time advice after completion of the program, through a regional “sponsoring vascular surgery service.” This service will also be responsible for retrospective peer review and root cause analysis of complications. In addition, the association with a sponsoring institution will facilitate and increase referrals of appropriate patients to higher level of care at a vascular surgery center.
“The suggested program graduates will not be board-certified and will be performing mostly general surgery and low-complexity vascular cases part- time in smaller communities. They will also require supervision by the board-certified graduates of the current training pathways, working in a regional vascular center, typically in a larger urban center. Instead of competing they will actually complement our current trainees and provide an extension of their reach.” Dr. Makaroun stated.
“We must find a way to fill the vacuum now before the reality on the ground permanently excludes our specialty from this primary level of vascular care,” Dr. Makaroun said. “It is time for another bold step to preserve the legacy of our specialty in meeting the needs of our patients and the public.
“Progress is made through change even if we don’t like it!” Dr. Makaroun concluded.
In selecting the subject of his presidential address, SVS President Michel Makaroun, MD, decided to focus on the inadequacy of vascular manpower to meet the demands and needs of the public.
In introducing the subject, he quoted a favorite saying from Mark Twain that gave him the topic of his address, “I am in favor of progress; it’s change I don’t like.” He then proceeded to outline why changes are necessary and what the Society for Vascular Surgery is doing to help implement them.
“You are all familiar with the highlights of the problem: It is in our numbers! A problem with multiple facets, including unfilled jobs, increasing demand, maldistribution and a demographic cliff of our membership,” Dr. Makaroun said.
The manifestations of this shortage are multiple. The number of advertised jobs far exceeds the number of graduates. There is also a significant maldistribution of the workforce. “We are concentrated in the northeast, and many populous states including Texas, Florida and California are well below average,” he said.
Additionally, many community hospitals, in both suburban areas or small towns completely lack any access to vascular surgical care, even in states with seemingly adequate numbers.
The shortage problem in vascular surgery will get worse before it gets better, he added, saying “Our pipeline is simply not large enough to overcome an older retiring generation of vascular surgeons, with nearly half retiring before 65.”
“Change does not come easy!” Dr. Makaroun warned.
“We cannot ignore in the discussion of workforce issues, the major shifts, change and uncertainty we are experiencing in health care delivery, education and the generational change of our newest members,” he said.
More than 10% of vascular surgeons now practice primarily if not exclusively in ambulatory facilities. This direction is gathering steam and reduces the pool of vascular surgeons available to accept hospital practices and cover emergencies, particularly in underserved communities.
Despite this movement, nearly two-thirds of SVS members are currently employed by hospital systems that are getting larger and larger, making it essential to navigate an ever more complex decision-making process in employment, compensation and spectrum of activities. Practice environments are becoming more corporate and bureaucratic.
Dr. Makaroun pointed out that the current landscape of our manpower has a clear two tiers divided by hospital size and location. “The most pressing concern is the inability of our specialty to provide vascular surgery services to the multitude of hospitals located in smaller communities.
“The SVS established a task force to study our manpower issues last fall. The taskforce was divided into three workgroups to focus on different areas of the problem.
The first workgroup, under the leadership of Malachi Sheehan III, MD, and Jeffrey Jim, MD, focused on the obvious solution: a campaign to increase training programs and available positions. Unfortunately, this is only aspirational, since reality fails the SVS in this effort. The pool of general surgery graduates is finite, with competition from several specialties that are more analogous to modern general surgery than vascular surgery.
Increasing the number of integrated programs is less efficient because of a 5- to 6-year lag between initiation of a new program and graduation, but it can tap into an almost unlimited pool of applicants from medical school, and more recently some very qualified international medical graduates. This makes it potentially a far more effective solution for the long term, Dr. Makaroun said.
The workgroup attempted to contact all hospitals with a general surgery program and no associated vascular fellowship. Help in navigating the process of securing financing and applying for a new program was offered. A session was conducted at VAM for interested potential sites to start discussing the process, and representatives from 27 hospitals were there expressing interest.
The second workgroup, under the leadership of Rick Powell, MD, and Andy Schanzer, MD, was tasked with analyzing and understanding the entire spectrum of surgeons’ clinical activities and producing a valuation study that illustrates the economic and vital impact of vascular surgery for hospitals and patients. “The work of this group is essential to promote a healthier relationship between our specialty and our institutions, making vascular surgery more attractive for future recruits,” according to Dr. Makaroun.
The third workgroup under the leadership of Will Jordan, MD, and Tim Sarac, MD, had the toughest job, said Dr. Makaroun. It was tasked with thinking outside the box and suggesting methods to address the most glaring need: the community hospitals, where most of the advertised jobs are, jobs that are being shunned by graduates of current training programs.
Dr. Makaroun cited the difficulties of recruitment of vascular surgeons to community hospital systems in small towns and rural areas, and he reminded people that recent general surgery graduates continue to offer vascular surgery services in such communities. Unfortunately, this is without any additional vascular training and most hospitals grant privileges without a VSB certificate when the need is demonstrated. “You all appreciate that recent graduates of general surgery programs do not have the breadth or depth of exposure to modern vascular surgery that an older generation did,” he added.
The workgroup explored many options to provide relief to community hospitals. But probably the most efficient, according to Dr. Makaroun, is to consider strategies that tap into new constituencies. One consideration to be explored is to offer a 3-year vascular surgery training opportunity to the dozens of qualified candidates in preliminary surgical positions unable to locate a categorical spot to finish their training. This process will lead to VSB certification, but will take some time to establish through the ACGME structure.
The workgroup developed an outline of a proposal for a community vascular surgery training program, as a first step. It has been sketched and will be part of the task force report submitted for review by the Executive Board of the Society.
The goals of the new pathway would be to improve local vascular care in underserved communities, while increasing the referral of appropriate cases to vascular centers. It would provide stress relief to isolated vascular surgeons, and where none exist, plant the seeds of a better work environment for vascular surgery graduates to reconsider this currently undesirable career choice.
The program is designed to offer an additional year of vascular surgery training to general surgery graduates already committed to a community practice, many of whom are already planning to offer vascular services anyway. The program will individualize training but focus only on low-complexity procedures, both open and endovascular, and more importantly the clinical situations that dictate referral, said Dr. Makaroun.
To maintain quality, the program will mandate the availability of mentorship, support and real-time advice after completion of the program, through a regional “sponsoring vascular surgery service.” This service will also be responsible for retrospective peer review and root cause analysis of complications. In addition, the association with a sponsoring institution will facilitate and increase referrals of appropriate patients to higher level of care at a vascular surgery center.
“The suggested program graduates will not be board-certified and will be performing mostly general surgery and low-complexity vascular cases part- time in smaller communities. They will also require supervision by the board-certified graduates of the current training pathways, working in a regional vascular center, typically in a larger urban center. Instead of competing they will actually complement our current trainees and provide an extension of their reach.” Dr. Makaroun stated.
“We must find a way to fill the vacuum now before the reality on the ground permanently excludes our specialty from this primary level of vascular care,” Dr. Makaroun said. “It is time for another bold step to preserve the legacy of our specialty in meeting the needs of our patients and the public.
“Progress is made through change even if we don’t like it!” Dr. Makaroun concluded.
In selecting the subject of his presidential address, SVS President Michel Makaroun, MD, decided to focus on the inadequacy of vascular manpower to meet the demands and needs of the public.
In introducing the subject, he quoted a favorite saying from Mark Twain that gave him the topic of his address, “I am in favor of progress; it’s change I don’t like.” He then proceeded to outline why changes are necessary and what the Society for Vascular Surgery is doing to help implement them.
“You are all familiar with the highlights of the problem: It is in our numbers! A problem with multiple facets, including unfilled jobs, increasing demand, maldistribution and a demographic cliff of our membership,” Dr. Makaroun said.
The manifestations of this shortage are multiple. The number of advertised jobs far exceeds the number of graduates. There is also a significant maldistribution of the workforce. “We are concentrated in the northeast, and many populous states including Texas, Florida and California are well below average,” he said.
Additionally, many community hospitals, in both suburban areas or small towns completely lack any access to vascular surgical care, even in states with seemingly adequate numbers.
The shortage problem in vascular surgery will get worse before it gets better, he added, saying “Our pipeline is simply not large enough to overcome an older retiring generation of vascular surgeons, with nearly half retiring before 65.”
“Change does not come easy!” Dr. Makaroun warned.
“We cannot ignore in the discussion of workforce issues, the major shifts, change and uncertainty we are experiencing in health care delivery, education and the generational change of our newest members,” he said.
More than 10% of vascular surgeons now practice primarily if not exclusively in ambulatory facilities. This direction is gathering steam and reduces the pool of vascular surgeons available to accept hospital practices and cover emergencies, particularly in underserved communities.
Despite this movement, nearly two-thirds of SVS members are currently employed by hospital systems that are getting larger and larger, making it essential to navigate an ever more complex decision-making process in employment, compensation and spectrum of activities. Practice environments are becoming more corporate and bureaucratic.
Dr. Makaroun pointed out that the current landscape of our manpower has a clear two tiers divided by hospital size and location. “The most pressing concern is the inability of our specialty to provide vascular surgery services to the multitude of hospitals located in smaller communities.
“The SVS established a task force to study our manpower issues last fall. The taskforce was divided into three workgroups to focus on different areas of the problem.
The first workgroup, under the leadership of Malachi Sheehan III, MD, and Jeffrey Jim, MD, focused on the obvious solution: a campaign to increase training programs and available positions. Unfortunately, this is only aspirational, since reality fails the SVS in this effort. The pool of general surgery graduates is finite, with competition from several specialties that are more analogous to modern general surgery than vascular surgery.
Increasing the number of integrated programs is less efficient because of a 5- to 6-year lag between initiation of a new program and graduation, but it can tap into an almost unlimited pool of applicants from medical school, and more recently some very qualified international medical graduates. This makes it potentially a far more effective solution for the long term, Dr. Makaroun said.
The workgroup attempted to contact all hospitals with a general surgery program and no associated vascular fellowship. Help in navigating the process of securing financing and applying for a new program was offered. A session was conducted at VAM for interested potential sites to start discussing the process, and representatives from 27 hospitals were there expressing interest.
The second workgroup, under the leadership of Rick Powell, MD, and Andy Schanzer, MD, was tasked with analyzing and understanding the entire spectrum of surgeons’ clinical activities and producing a valuation study that illustrates the economic and vital impact of vascular surgery for hospitals and patients. “The work of this group is essential to promote a healthier relationship between our specialty and our institutions, making vascular surgery more attractive for future recruits,” according to Dr. Makaroun.
The third workgroup under the leadership of Will Jordan, MD, and Tim Sarac, MD, had the toughest job, said Dr. Makaroun. It was tasked with thinking outside the box and suggesting methods to address the most glaring need: the community hospitals, where most of the advertised jobs are, jobs that are being shunned by graduates of current training programs.
Dr. Makaroun cited the difficulties of recruitment of vascular surgeons to community hospital systems in small towns and rural areas, and he reminded people that recent general surgery graduates continue to offer vascular surgery services in such communities. Unfortunately, this is without any additional vascular training and most hospitals grant privileges without a VSB certificate when the need is demonstrated. “You all appreciate that recent graduates of general surgery programs do not have the breadth or depth of exposure to modern vascular surgery that an older generation did,” he added.
The workgroup explored many options to provide relief to community hospitals. But probably the most efficient, according to Dr. Makaroun, is to consider strategies that tap into new constituencies. One consideration to be explored is to offer a 3-year vascular surgery training opportunity to the dozens of qualified candidates in preliminary surgical positions unable to locate a categorical spot to finish their training. This process will lead to VSB certification, but will take some time to establish through the ACGME structure.
The workgroup developed an outline of a proposal for a community vascular surgery training program, as a first step. It has been sketched and will be part of the task force report submitted for review by the Executive Board of the Society.
The goals of the new pathway would be to improve local vascular care in underserved communities, while increasing the referral of appropriate cases to vascular centers. It would provide stress relief to isolated vascular surgeons, and where none exist, plant the seeds of a better work environment for vascular surgery graduates to reconsider this currently undesirable career choice.
The program is designed to offer an additional year of vascular surgery training to general surgery graduates already committed to a community practice, many of whom are already planning to offer vascular services anyway. The program will individualize training but focus only on low-complexity procedures, both open and endovascular, and more importantly the clinical situations that dictate referral, said Dr. Makaroun.
To maintain quality, the program will mandate the availability of mentorship, support and real-time advice after completion of the program, through a regional “sponsoring vascular surgery service.” This service will also be responsible for retrospective peer review and root cause analysis of complications. In addition, the association with a sponsoring institution will facilitate and increase referrals of appropriate patients to higher level of care at a vascular surgery center.
“The suggested program graduates will not be board-certified and will be performing mostly general surgery and low-complexity vascular cases part- time in smaller communities. They will also require supervision by the board-certified graduates of the current training pathways, working in a regional vascular center, typically in a larger urban center. Instead of competing they will actually complement our current trainees and provide an extension of their reach.” Dr. Makaroun stated.
“We must find a way to fill the vacuum now before the reality on the ground permanently excludes our specialty from this primary level of vascular care,” Dr. Makaroun said. “It is time for another bold step to preserve the legacy of our specialty in meeting the needs of our patients and the public.
“Progress is made through change even if we don’t like it!” Dr. Makaroun concluded.
Cardiothoracic & Vascular Surgeons Providing Alternative Perspectives
Cardiothoracic and vascular surgeons will – together – head for the top during the Aortic Summit, from 2 to 4:30 p.m. Saturday.
The event is presented in collaboration with the Society of Thoracic Surgeons. A similar summit at the 2017 VAM attracted hundreds of surgeons.
Several topics important to both groups of surgeons will be examined from both the cardiothoracic and vascular perspectives, said Ali Azizzadeh, MD, co-moderator with Keith Allen, MD, a member of both SVS and the STS. The session is recommended by the Society for Vascular Nursing.
“We do look at issues in different ways,” said Dr. Azizzadeh said of vascular and cardiothoracic surgeons. “We all have different tools and skill sets. That’s why it’s good to look at an issue from both perspectives and also look at the devices that apply to the other’s field.”
Speakers will cover the latest indications for procedures in patients with aortic dissection, which will segue into discussion of access complications and other issues that can occur with devices. Topics also will include alternative and newer methods of access.
Speakers and attendees also will discuss the newest technology currently in trials, recently approved, or in investigation, worldwide, he said.
The two groups will collaborate, for what Dr. Azizzadeh believes is the first time, on pulmonary embolism. “This is a hot area for innovation,” he said. “There are lots of new techniques and procedures to address currently unmet needs. Medical centers around the country are assembling multidisciplinary teams, referred to as Pulmonary Embolism Response Team or PERT – to be able to take care of these sick patients. It’s a trend for the future.”
Tickets are required and are available at the registration counter. An additional fee applies: $75 for SVS Candidate members-in-training, nonmember medical students and vascular and general surgery residents, and allied health professionals; $100 for SVS Candidate members; $150 for SVS members and $200 for nonmember physicians.
Topics and speakers include:
• Optimal Management of Uncomplicated Acute Type B Aortic Dissection, Faisal Bakaeen, MD.
• Optimal Management of Chronic Type B Aortic Dissection, Adam Beck, MD.
• Alternate Non-Femoral Vascular Access for Large Endovascular Devices, Keith Allen, MD.
• Managing Vascular Access Complications, Ross Milner, MD.
• Innovative Devices: Cardiothoracic, by Grayson Wheatly III, MD.
• Innovative Devices: Vascular, by Ali Azizzadeh, MD.
• Pulmonary Embolism Teams: Cardiothoracic perspective, by Lishan Aklog, MD.
• Pulmonary Embolism Teams: Vascular perspective, by Naveed Saqib, MD.
A discussion period will follow each set of presentations.
“It’s going to be a great session to review the latest topics that apply to both cardiothoracic and vascular surgery,” said Dr. Azizzadeh.
Saturday, June 15
2-4:30 p.m.
Gaylord National, National Harbor 2
Aortic Summit
Cardiothoracic and vascular surgeons will – together – head for the top during the Aortic Summit, from 2 to 4:30 p.m. Saturday.
The event is presented in collaboration with the Society of Thoracic Surgeons. A similar summit at the 2017 VAM attracted hundreds of surgeons.
Several topics important to both groups of surgeons will be examined from both the cardiothoracic and vascular perspectives, said Ali Azizzadeh, MD, co-moderator with Keith Allen, MD, a member of both SVS and the STS. The session is recommended by the Society for Vascular Nursing.
“We do look at issues in different ways,” said Dr. Azizzadeh said of vascular and cardiothoracic surgeons. “We all have different tools and skill sets. That’s why it’s good to look at an issue from both perspectives and also look at the devices that apply to the other’s field.”
Speakers will cover the latest indications for procedures in patients with aortic dissection, which will segue into discussion of access complications and other issues that can occur with devices. Topics also will include alternative and newer methods of access.
Speakers and attendees also will discuss the newest technology currently in trials, recently approved, or in investigation, worldwide, he said.
The two groups will collaborate, for what Dr. Azizzadeh believes is the first time, on pulmonary embolism. “This is a hot area for innovation,” he said. “There are lots of new techniques and procedures to address currently unmet needs. Medical centers around the country are assembling multidisciplinary teams, referred to as Pulmonary Embolism Response Team or PERT – to be able to take care of these sick patients. It’s a trend for the future.”
Tickets are required and are available at the registration counter. An additional fee applies: $75 for SVS Candidate members-in-training, nonmember medical students and vascular and general surgery residents, and allied health professionals; $100 for SVS Candidate members; $150 for SVS members and $200 for nonmember physicians.
Topics and speakers include:
• Optimal Management of Uncomplicated Acute Type B Aortic Dissection, Faisal Bakaeen, MD.
• Optimal Management of Chronic Type B Aortic Dissection, Adam Beck, MD.
• Alternate Non-Femoral Vascular Access for Large Endovascular Devices, Keith Allen, MD.
• Managing Vascular Access Complications, Ross Milner, MD.
• Innovative Devices: Cardiothoracic, by Grayson Wheatly III, MD.
• Innovative Devices: Vascular, by Ali Azizzadeh, MD.
• Pulmonary Embolism Teams: Cardiothoracic perspective, by Lishan Aklog, MD.
• Pulmonary Embolism Teams: Vascular perspective, by Naveed Saqib, MD.
A discussion period will follow each set of presentations.
“It’s going to be a great session to review the latest topics that apply to both cardiothoracic and vascular surgery,” said Dr. Azizzadeh.
Saturday, June 15
2-4:30 p.m.
Gaylord National, National Harbor 2
Aortic Summit
Cardiothoracic and vascular surgeons will – together – head for the top during the Aortic Summit, from 2 to 4:30 p.m. Saturday.
The event is presented in collaboration with the Society of Thoracic Surgeons. A similar summit at the 2017 VAM attracted hundreds of surgeons.
Several topics important to both groups of surgeons will be examined from both the cardiothoracic and vascular perspectives, said Ali Azizzadeh, MD, co-moderator with Keith Allen, MD, a member of both SVS and the STS. The session is recommended by the Society for Vascular Nursing.
“We do look at issues in different ways,” said Dr. Azizzadeh said of vascular and cardiothoracic surgeons. “We all have different tools and skill sets. That’s why it’s good to look at an issue from both perspectives and also look at the devices that apply to the other’s field.”
Speakers will cover the latest indications for procedures in patients with aortic dissection, which will segue into discussion of access complications and other issues that can occur with devices. Topics also will include alternative and newer methods of access.
Speakers and attendees also will discuss the newest technology currently in trials, recently approved, or in investigation, worldwide, he said.
The two groups will collaborate, for what Dr. Azizzadeh believes is the first time, on pulmonary embolism. “This is a hot area for innovation,” he said. “There are lots of new techniques and procedures to address currently unmet needs. Medical centers around the country are assembling multidisciplinary teams, referred to as Pulmonary Embolism Response Team or PERT – to be able to take care of these sick patients. It’s a trend for the future.”
Tickets are required and are available at the registration counter. An additional fee applies: $75 for SVS Candidate members-in-training, nonmember medical students and vascular and general surgery residents, and allied health professionals; $100 for SVS Candidate members; $150 for SVS members and $200 for nonmember physicians.
Topics and speakers include:
• Optimal Management of Uncomplicated Acute Type B Aortic Dissection, Faisal Bakaeen, MD.
• Optimal Management of Chronic Type B Aortic Dissection, Adam Beck, MD.
• Alternate Non-Femoral Vascular Access for Large Endovascular Devices, Keith Allen, MD.
• Managing Vascular Access Complications, Ross Milner, MD.
• Innovative Devices: Cardiothoracic, by Grayson Wheatly III, MD.
• Innovative Devices: Vascular, by Ali Azizzadeh, MD.
• Pulmonary Embolism Teams: Cardiothoracic perspective, by Lishan Aklog, MD.
• Pulmonary Embolism Teams: Vascular perspective, by Naveed Saqib, MD.
A discussion period will follow each set of presentations.
“It’s going to be a great session to review the latest topics that apply to both cardiothoracic and vascular surgery,” said Dr. Azizzadeh.
Saturday, June 15
2-4:30 p.m.
Gaylord National, National Harbor 2
Aortic Summit
Annual Business Meeting, for Members Only
Electing Secretary, Welcoming President, Presenting Awards
The SVS Annual Business Meeting serves a vital, mandated function, with members conducting important Society business. This year, not only will President Michel S. Makaroun, MD, hands his gavel over to President-Elect Kim Hodgson, MD, members also will elect a new secretary from among three candidates and will affirm the Nominating Committee’s selection of the candidate for vice president.
The meeting is from 12 to 1:30 p.m. Saturday, in Potomac C. Members also will receive updates from officers and select committees and recognize outstanding achievements and awards from the Journal of Vascular Surgery, SVS Foundation, and SVS.
Only Active and Senior members may vote, which will be accomplished with Audience Response System devices. Staff will be on hand to double-check membership status for those unsure of their voting status.
The following people will receive awards during the luncheon:
SVS Presidential Citation Award: Marie Rossi, RN, BS, for her leadership of the Society for Vascular Nursing and tireless work in achieving a close relationship between the SVN and the SVS; Benjamin Pearce, MD, and Tej Singh, MD, for their dedication to improve and upgrade SVS patient education materials; Sean P. Roddy, MD and Matthew Sideman, MD, for their tireless work in advocating for and protecting the interests of our specialty; Michael S. Conte, MD, John White, MD, and Joe L. Mills, MD, for their dedicated effort to complete the Global Vascular Guidelines Project; and Dawn M. Coleman, MD, and Malachi G. Sheahan III, MD, for their dedication to improving the well-being of our members and all vascular surgeons.
SVS Awards
Women’s Leadership Training Grants: Rachel Danczyk, MD, Lori Pounds, MD, and Jessica Simons, MD.
SVS Vascular Surgery Trainee Advocacy Travel Scholarship: Ian Schlieder, MD.
SVS Foundation Awards
SVS Foundation and American College of Surgeons Mentored Clinical Scientist Research Career Development Award (K08): Jean Marie Ruddy, MD.
SVS Foundation and ACS Mentored Patient-Oriented Research Career Development Award (K23): Misty D. Humphries, MD.
Bridge Grant: Wei Zhou, MD.
E.J. Wylie Traveling Fellowship: Douglas W. Jones, MD.
Clinical Research Seed Grant: Sikandar Khan, MD, Shirling Tsai, MD; and Efthymios Avgerinos, MD (winner of the Seed Grant Challenge Wednesday at VAM).
Resident Research Award: Frank Davis, MD.
Research Career Development Travel Award: Young Erben, MD, and Claire Griffin, MD.
Vascular Cures/SVS Foundation Wylie Scholar Award: Andrea Obi, MD.
Community Awareness and Prevention Project Practice Grant: Soma Brahmanandam MD, Leigh Ann O’Banion, MD, and Uwe Fisher, PhD.
Electing Secretary, Welcoming President, Presenting Awards
The SVS Annual Business Meeting serves a vital, mandated function, with members conducting important Society business. This year, not only will President Michel S. Makaroun, MD, hands his gavel over to President-Elect Kim Hodgson, MD, members also will elect a new secretary from among three candidates and will affirm the Nominating Committee’s selection of the candidate for vice president.
The meeting is from 12 to 1:30 p.m. Saturday, in Potomac C. Members also will receive updates from officers and select committees and recognize outstanding achievements and awards from the Journal of Vascular Surgery, SVS Foundation, and SVS.
Only Active and Senior members may vote, which will be accomplished with Audience Response System devices. Staff will be on hand to double-check membership status for those unsure of their voting status.
The following people will receive awards during the luncheon:
SVS Presidential Citation Award: Marie Rossi, RN, BS, for her leadership of the Society for Vascular Nursing and tireless work in achieving a close relationship between the SVN and the SVS; Benjamin Pearce, MD, and Tej Singh, MD, for their dedication to improve and upgrade SVS patient education materials; Sean P. Roddy, MD and Matthew Sideman, MD, for their tireless work in advocating for and protecting the interests of our specialty; Michael S. Conte, MD, John White, MD, and Joe L. Mills, MD, for their dedicated effort to complete the Global Vascular Guidelines Project; and Dawn M. Coleman, MD, and Malachi G. Sheahan III, MD, for their dedication to improving the well-being of our members and all vascular surgeons.
SVS Awards
Women’s Leadership Training Grants: Rachel Danczyk, MD, Lori Pounds, MD, and Jessica Simons, MD.
SVS Vascular Surgery Trainee Advocacy Travel Scholarship: Ian Schlieder, MD.
SVS Foundation Awards
SVS Foundation and American College of Surgeons Mentored Clinical Scientist Research Career Development Award (K08): Jean Marie Ruddy, MD.
SVS Foundation and ACS Mentored Patient-Oriented Research Career Development Award (K23): Misty D. Humphries, MD.
Bridge Grant: Wei Zhou, MD.
E.J. Wylie Traveling Fellowship: Douglas W. Jones, MD.
Clinical Research Seed Grant: Sikandar Khan, MD, Shirling Tsai, MD; and Efthymios Avgerinos, MD (winner of the Seed Grant Challenge Wednesday at VAM).
Resident Research Award: Frank Davis, MD.
Research Career Development Travel Award: Young Erben, MD, and Claire Griffin, MD.
Vascular Cures/SVS Foundation Wylie Scholar Award: Andrea Obi, MD.
Community Awareness and Prevention Project Practice Grant: Soma Brahmanandam MD, Leigh Ann O’Banion, MD, and Uwe Fisher, PhD.
Electing Secretary, Welcoming President, Presenting Awards
The SVS Annual Business Meeting serves a vital, mandated function, with members conducting important Society business. This year, not only will President Michel S. Makaroun, MD, hands his gavel over to President-Elect Kim Hodgson, MD, members also will elect a new secretary from among three candidates and will affirm the Nominating Committee’s selection of the candidate for vice president.
The meeting is from 12 to 1:30 p.m. Saturday, in Potomac C. Members also will receive updates from officers and select committees and recognize outstanding achievements and awards from the Journal of Vascular Surgery, SVS Foundation, and SVS.
Only Active and Senior members may vote, which will be accomplished with Audience Response System devices. Staff will be on hand to double-check membership status for those unsure of their voting status.
The following people will receive awards during the luncheon:
SVS Presidential Citation Award: Marie Rossi, RN, BS, for her leadership of the Society for Vascular Nursing and tireless work in achieving a close relationship between the SVN and the SVS; Benjamin Pearce, MD, and Tej Singh, MD, for their dedication to improve and upgrade SVS patient education materials; Sean P. Roddy, MD and Matthew Sideman, MD, for their tireless work in advocating for and protecting the interests of our specialty; Michael S. Conte, MD, John White, MD, and Joe L. Mills, MD, for their dedicated effort to complete the Global Vascular Guidelines Project; and Dawn M. Coleman, MD, and Malachi G. Sheahan III, MD, for their dedication to improving the well-being of our members and all vascular surgeons.
SVS Awards
Women’s Leadership Training Grants: Rachel Danczyk, MD, Lori Pounds, MD, and Jessica Simons, MD.
SVS Vascular Surgery Trainee Advocacy Travel Scholarship: Ian Schlieder, MD.
SVS Foundation Awards
SVS Foundation and American College of Surgeons Mentored Clinical Scientist Research Career Development Award (K08): Jean Marie Ruddy, MD.
SVS Foundation and ACS Mentored Patient-Oriented Research Career Development Award (K23): Misty D. Humphries, MD.
Bridge Grant: Wei Zhou, MD.
E.J. Wylie Traveling Fellowship: Douglas W. Jones, MD.
Clinical Research Seed Grant: Sikandar Khan, MD, Shirling Tsai, MD; and Efthymios Avgerinos, MD (winner of the Seed Grant Challenge Wednesday at VAM).
Resident Research Award: Frank Davis, MD.
Research Career Development Travel Award: Young Erben, MD, and Claire Griffin, MD.
Vascular Cures/SVS Foundation Wylie Scholar Award: Andrea Obi, MD.
Community Awareness and Prevention Project Practice Grant: Soma Brahmanandam MD, Leigh Ann O’Banion, MD, and Uwe Fisher, PhD.
Is Surveillance Futile for Small AAAs in the Very Elderly?
To determine the necessity of permanent monitoring of small aortic aneurysms in the elderly, Mark Rockley, MD, of the Ottawa Hospital and his colleagues investigated the yield of ultrasound surveillance for small abdominal aortic aneurysms (AAAs) in octogenarians, as compared with a younger population. Their goal was to detect the frequency of AAA growth reaching the threshold size for repair. Secondary objectives included analysis of the incidence of AAA repair, and the cost-effectiveness of surveillance.
In Saturday’s Scientific Session 8, Dr. Rockley will report on their retrospective cohort study performed on all patients undergoing AAA surveillance in Ottawa during 2007-2017. The patients were split into two groups by enrollment age (those younger and those equal to or older than 80 years of age) with cross-over to prevent lead-time bias, and stratification by enrollment AAA size.
The two cohorts were cross-referenced with the Ottawa Surgical Database, leveraging the common health region to assure complete data capture, according to Dr. Rockley.
The threshold size for repair was sex specific (women at 5.0cm, men at 5.5 cm) and the factors influencing AAA growth rate were assessed using multiple linear regression. Analyses with Cox proportional hazards and multiple regression models adjusted for sex and enrollment aneurysm size, and cost-effectiveness were analyzed by referencing Ontario billing codes.
The researchers found that 1,231 patients underwent serial ultrasound surveillance, of which 460 (37.4%) were octogenarians at the time of enrollment. Multiple linear regression demonstrated that old age, male sex, and smaller enrollment aneurysm size were significantly protective against AAA growth.
Overall, 355 (28.8%) subjects reached the AAA size threshold for repair, and 313 (25.4%) underwent AAA repair. Octogenarians were half as likely to reach the AAA threshold size for repair when compared with their younger counterparts, and of the 355 subjects whose AAA reached the threshold size for repair, octogenarians were half as likely to undergo elective AAA repair).
Repair of ruptured AAA was rare (0.94%) and age differences were insignificant. The cost of ultrasound surveillance alone to identify one patient who ultimately received elective AAA repair was more than four times more expensive for octogenarians with 3.0-3.9–cm enrollment aneurysms, when compared with the rest of the study sample ($12,080 vs. $2,915, in Canadian dollars, respectively), said Dr. Rockley.
“Our study showed that octogenarians are half as likely as their younger counterparts to experience aortic growth reaching th.e repair threshold size Furthermore, in the event of reaching the size threshold, octogenarians are half as likely to undergo repair, without a significantly increased risk of requiring repair for AAA rupture. In the context of patient-specific factors and wishes, surveillance of AAA less than 4cm in octogenarians is costly and unlikely to be beneficial.” Dr. Rockley concluded.
Saturday, June 15
8-9:30 a.m.
Gaylord National, Potomac A/B
S8: Scientific Session 8: SS29
To determine the necessity of permanent monitoring of small aortic aneurysms in the elderly, Mark Rockley, MD, of the Ottawa Hospital and his colleagues investigated the yield of ultrasound surveillance for small abdominal aortic aneurysms (AAAs) in octogenarians, as compared with a younger population. Their goal was to detect the frequency of AAA growth reaching the threshold size for repair. Secondary objectives included analysis of the incidence of AAA repair, and the cost-effectiveness of surveillance.
In Saturday’s Scientific Session 8, Dr. Rockley will report on their retrospective cohort study performed on all patients undergoing AAA surveillance in Ottawa during 2007-2017. The patients were split into two groups by enrollment age (those younger and those equal to or older than 80 years of age) with cross-over to prevent lead-time bias, and stratification by enrollment AAA size.
The two cohorts were cross-referenced with the Ottawa Surgical Database, leveraging the common health region to assure complete data capture, according to Dr. Rockley.
The threshold size for repair was sex specific (women at 5.0cm, men at 5.5 cm) and the factors influencing AAA growth rate were assessed using multiple linear regression. Analyses with Cox proportional hazards and multiple regression models adjusted for sex and enrollment aneurysm size, and cost-effectiveness were analyzed by referencing Ontario billing codes.
The researchers found that 1,231 patients underwent serial ultrasound surveillance, of which 460 (37.4%) were octogenarians at the time of enrollment. Multiple linear regression demonstrated that old age, male sex, and smaller enrollment aneurysm size were significantly protective against AAA growth.
Overall, 355 (28.8%) subjects reached the AAA size threshold for repair, and 313 (25.4%) underwent AAA repair. Octogenarians were half as likely to reach the AAA threshold size for repair when compared with their younger counterparts, and of the 355 subjects whose AAA reached the threshold size for repair, octogenarians were half as likely to undergo elective AAA repair).
Repair of ruptured AAA was rare (0.94%) and age differences were insignificant. The cost of ultrasound surveillance alone to identify one patient who ultimately received elective AAA repair was more than four times more expensive for octogenarians with 3.0-3.9–cm enrollment aneurysms, when compared with the rest of the study sample ($12,080 vs. $2,915, in Canadian dollars, respectively), said Dr. Rockley.
“Our study showed that octogenarians are half as likely as their younger counterparts to experience aortic growth reaching th.e repair threshold size Furthermore, in the event of reaching the size threshold, octogenarians are half as likely to undergo repair, without a significantly increased risk of requiring repair for AAA rupture. In the context of patient-specific factors and wishes, surveillance of AAA less than 4cm in octogenarians is costly and unlikely to be beneficial.” Dr. Rockley concluded.
Saturday, June 15
8-9:30 a.m.
Gaylord National, Potomac A/B
S8: Scientific Session 8: SS29
To determine the necessity of permanent monitoring of small aortic aneurysms in the elderly, Mark Rockley, MD, of the Ottawa Hospital and his colleagues investigated the yield of ultrasound surveillance for small abdominal aortic aneurysms (AAAs) in octogenarians, as compared with a younger population. Their goal was to detect the frequency of AAA growth reaching the threshold size for repair. Secondary objectives included analysis of the incidence of AAA repair, and the cost-effectiveness of surveillance.
In Saturday’s Scientific Session 8, Dr. Rockley will report on their retrospective cohort study performed on all patients undergoing AAA surveillance in Ottawa during 2007-2017. The patients were split into two groups by enrollment age (those younger and those equal to or older than 80 years of age) with cross-over to prevent lead-time bias, and stratification by enrollment AAA size.
The two cohorts were cross-referenced with the Ottawa Surgical Database, leveraging the common health region to assure complete data capture, according to Dr. Rockley.
The threshold size for repair was sex specific (women at 5.0cm, men at 5.5 cm) and the factors influencing AAA growth rate were assessed using multiple linear regression. Analyses with Cox proportional hazards and multiple regression models adjusted for sex and enrollment aneurysm size, and cost-effectiveness were analyzed by referencing Ontario billing codes.
The researchers found that 1,231 patients underwent serial ultrasound surveillance, of which 460 (37.4%) were octogenarians at the time of enrollment. Multiple linear regression demonstrated that old age, male sex, and smaller enrollment aneurysm size were significantly protective against AAA growth.
Overall, 355 (28.8%) subjects reached the AAA size threshold for repair, and 313 (25.4%) underwent AAA repair. Octogenarians were half as likely to reach the AAA threshold size for repair when compared with their younger counterparts, and of the 355 subjects whose AAA reached the threshold size for repair, octogenarians were half as likely to undergo elective AAA repair).
Repair of ruptured AAA was rare (0.94%) and age differences were insignificant. The cost of ultrasound surveillance alone to identify one patient who ultimately received elective AAA repair was more than four times more expensive for octogenarians with 3.0-3.9–cm enrollment aneurysms, when compared with the rest of the study sample ($12,080 vs. $2,915, in Canadian dollars, respectively), said Dr. Rockley.
“Our study showed that octogenarians are half as likely as their younger counterparts to experience aortic growth reaching th.e repair threshold size Furthermore, in the event of reaching the size threshold, octogenarians are half as likely to undergo repair, without a significantly increased risk of requiring repair for AAA rupture. In the context of patient-specific factors and wishes, surveillance of AAA less than 4cm in octogenarians is costly and unlikely to be beneficial.” Dr. Rockley concluded.
Saturday, June 15
8-9:30 a.m.
Gaylord National, Potomac A/B
S8: Scientific Session 8: SS29
Early Outcomes To Be Presented From ROADSTER 2
Vikram S. Kashyap, MD, of the University Hospitals Cleveland Medical Center, will present results from ROADSTER 2, a prospective, multicenter, postapproval registry for patients undergoing transcarotid artery revascularization (TCAR). This technique involves carotid artery stenting with cerebral protection via reversal of carotid arterial flow. The aim of the study was to evaluate the real- world safety and efficacy of TCAR.
Dr. Kashyap and his colleagues enrolled 623 patients who were considered at high risk for complications from carotid endarterectomy (CEA) and who had symptomatic stenosis equal to or greater than 50% or asymptomatic stenosis equal to or greater than 80%. The primary endpoint was procedural success, which encompassed technical success plus the absence of stroke, myocardial infarction, or death within the 30-day postoperative period. Secondary endpoints were acute device success (delivery of device, establishment of flow reversal, and retrieval), technical success (acute device success plus introduction of interventional tools), stroke, death, and the composite of stroke, death, or myocardial infarction (S/D/MI), according to Dr. Kashyap.
A total of 599 of the patients completed 30-day follow-up. The cohort included 67.0% men, 42% older than 75 years, and 26.8% with symptoms Overall, 68.2% of the patients had anatomic-related high-risk factors, 56.5% had physiologic high-risk factors, and 24.7% had both. The majority (81.2%) of the operators in this study were new to TCAR and did not participate in the ROADSTER 1 trial.
The early postoperative outcomes included five patients (0.8%) suffering a stroke, one patient (0.2%) dying from a ruptured AAA two weeks post-procedure, and six (1.0%) having an MI. The composite stroke/death/MI rate was 1.9%.
“TCAR results in excellent early outcomes with a combined stroke/death rate of 1.0%. Broader, longer- term, comparative studies are needed in this area. But if these results can be confirmed, I believe TCAR may become a favorable alternative to transfemoral carotid artery stenting, and even rival carotid endarterectomy,” Dr. Kashyap concluded.
Saturday, June 15
1:30-2:30 p.m.
Gaylord National, Potomac 4-6
S10: Scientific Session 10/Late-Breaking: LB2
Vikram S. Kashyap, MD, of the University Hospitals Cleveland Medical Center, will present results from ROADSTER 2, a prospective, multicenter, postapproval registry for patients undergoing transcarotid artery revascularization (TCAR). This technique involves carotid artery stenting with cerebral protection via reversal of carotid arterial flow. The aim of the study was to evaluate the real- world safety and efficacy of TCAR.
Dr. Kashyap and his colleagues enrolled 623 patients who were considered at high risk for complications from carotid endarterectomy (CEA) and who had symptomatic stenosis equal to or greater than 50% or asymptomatic stenosis equal to or greater than 80%. The primary endpoint was procedural success, which encompassed technical success plus the absence of stroke, myocardial infarction, or death within the 30-day postoperative period. Secondary endpoints were acute device success (delivery of device, establishment of flow reversal, and retrieval), technical success (acute device success plus introduction of interventional tools), stroke, death, and the composite of stroke, death, or myocardial infarction (S/D/MI), according to Dr. Kashyap.
A total of 599 of the patients completed 30-day follow-up. The cohort included 67.0% men, 42% older than 75 years, and 26.8% with symptoms Overall, 68.2% of the patients had anatomic-related high-risk factors, 56.5% had physiologic high-risk factors, and 24.7% had both. The majority (81.2%) of the operators in this study were new to TCAR and did not participate in the ROADSTER 1 trial.
The early postoperative outcomes included five patients (0.8%) suffering a stroke, one patient (0.2%) dying from a ruptured AAA two weeks post-procedure, and six (1.0%) having an MI. The composite stroke/death/MI rate was 1.9%.
“TCAR results in excellent early outcomes with a combined stroke/death rate of 1.0%. Broader, longer- term, comparative studies are needed in this area. But if these results can be confirmed, I believe TCAR may become a favorable alternative to transfemoral carotid artery stenting, and even rival carotid endarterectomy,” Dr. Kashyap concluded.
Saturday, June 15
1:30-2:30 p.m.
Gaylord National, Potomac 4-6
S10: Scientific Session 10/Late-Breaking: LB2
Vikram S. Kashyap, MD, of the University Hospitals Cleveland Medical Center, will present results from ROADSTER 2, a prospective, multicenter, postapproval registry for patients undergoing transcarotid artery revascularization (TCAR). This technique involves carotid artery stenting with cerebral protection via reversal of carotid arterial flow. The aim of the study was to evaluate the real- world safety and efficacy of TCAR.
Dr. Kashyap and his colleagues enrolled 623 patients who were considered at high risk for complications from carotid endarterectomy (CEA) and who had symptomatic stenosis equal to or greater than 50% or asymptomatic stenosis equal to or greater than 80%. The primary endpoint was procedural success, which encompassed technical success plus the absence of stroke, myocardial infarction, or death within the 30-day postoperative period. Secondary endpoints were acute device success (delivery of device, establishment of flow reversal, and retrieval), technical success (acute device success plus introduction of interventional tools), stroke, death, and the composite of stroke, death, or myocardial infarction (S/D/MI), according to Dr. Kashyap.
A total of 599 of the patients completed 30-day follow-up. The cohort included 67.0% men, 42% older than 75 years, and 26.8% with symptoms Overall, 68.2% of the patients had anatomic-related high-risk factors, 56.5% had physiologic high-risk factors, and 24.7% had both. The majority (81.2%) of the operators in this study were new to TCAR and did not participate in the ROADSTER 1 trial.
The early postoperative outcomes included five patients (0.8%) suffering a stroke, one patient (0.2%) dying from a ruptured AAA two weeks post-procedure, and six (1.0%) having an MI. The composite stroke/death/MI rate was 1.9%.
“TCAR results in excellent early outcomes with a combined stroke/death rate of 1.0%. Broader, longer- term, comparative studies are needed in this area. But if these results can be confirmed, I believe TCAR may become a favorable alternative to transfemoral carotid artery stenting, and even rival carotid endarterectomy,” Dr. Kashyap concluded.
Saturday, June 15
1:30-2:30 p.m.
Gaylord National, Potomac 4-6
S10: Scientific Session 10/Late-Breaking: LB2
Lifetime Achievement, Innovation Award On Tap
Three of the Vascular Annual Meeting’s signature events – celebrations along with distinguished lectures – occur on Saturday, VAM’s closing day. All conveniently occur in the morning, shortly before the start of the SVS Annual Business Meeting and luncheon and take place in Potomac A/B.
The John Homans Lecture, 9:30 to 10 a.m.: Jack Cronenwett, MD, Dartmouth-Hitchcock Medical Center, Lebanon, N.H., will present the lecture, “Why Should I Join the Vascular Quality Initiative?” Dr. Cronenwett spearheaded a regional quality outcomes registry, the eventual model for VQI. He later helped launch the SVS-Patient Safety Organization, which operates VQI and served as medical director until 2016. Dr. Cronenwett will discuss the VQI’s benefits for vascular practitioners and examine the VQI’s research and quality improvement opportunities.
The Roy Greenberg Distinguished Lecture, 10:15 to 10:45 a.m.: Michael Dake, MD, professor at Stanford (Calif.) University, will present “The Vision Beyond the Vision: Same as it Ever Was, but Different.” Dr. Dake is an internationally recognized pioneer of image-guided therapies whose contributions have changed the treatment of both common and complex vascular disease issues. His groundbreaking research with CT angiography, endovascular stents and stent-grafts has forever altered the interventional landscape and his publications have dramatically influenced several fields, including vascular imaging.
Awards Ceremony, 10 to 10:15 a.m.: Who will win two of the SVS’s top honors? Attendees will find out at the Awards Ceremony, during which the Lifetime Achievement Award AND the Medal for Innovation in Vascular Surgery will be presented.
The Lifetime Achievement Award recognizes an individual’s outstanding and sustained contributions to the profession and SVS, and his or her exemplary professional practice and leadership. The 2018 recipient was Gregorio Sicard, MD.
The Medal for Innovation is not an annual award; it recognizes individual whose contributions have had a transforming impact on the practice or science of vascular surgery. Past recipients include Juan Parodi, MD (2006); Timothy Chuter, MD (2008); Thomas Fogarty, MD (2010); Roy Greenberg, MD (2012); and, most recently, Edward Diethrich, MD (2013).
The identities of these two recipients are a closely guarded secret until the presentation. Be part of the unveiling and celebration.
Three of the Vascular Annual Meeting’s signature events – celebrations along with distinguished lectures – occur on Saturday, VAM’s closing day. All conveniently occur in the morning, shortly before the start of the SVS Annual Business Meeting and luncheon and take place in Potomac A/B.
The John Homans Lecture, 9:30 to 10 a.m.: Jack Cronenwett, MD, Dartmouth-Hitchcock Medical Center, Lebanon, N.H., will present the lecture, “Why Should I Join the Vascular Quality Initiative?” Dr. Cronenwett spearheaded a regional quality outcomes registry, the eventual model for VQI. He later helped launch the SVS-Patient Safety Organization, which operates VQI and served as medical director until 2016. Dr. Cronenwett will discuss the VQI’s benefits for vascular practitioners and examine the VQI’s research and quality improvement opportunities.
The Roy Greenberg Distinguished Lecture, 10:15 to 10:45 a.m.: Michael Dake, MD, professor at Stanford (Calif.) University, will present “The Vision Beyond the Vision: Same as it Ever Was, but Different.” Dr. Dake is an internationally recognized pioneer of image-guided therapies whose contributions have changed the treatment of both common and complex vascular disease issues. His groundbreaking research with CT angiography, endovascular stents and stent-grafts has forever altered the interventional landscape and his publications have dramatically influenced several fields, including vascular imaging.
Awards Ceremony, 10 to 10:15 a.m.: Who will win two of the SVS’s top honors? Attendees will find out at the Awards Ceremony, during which the Lifetime Achievement Award AND the Medal for Innovation in Vascular Surgery will be presented.
The Lifetime Achievement Award recognizes an individual’s outstanding and sustained contributions to the profession and SVS, and his or her exemplary professional practice and leadership. The 2018 recipient was Gregorio Sicard, MD.
The Medal for Innovation is not an annual award; it recognizes individual whose contributions have had a transforming impact on the practice or science of vascular surgery. Past recipients include Juan Parodi, MD (2006); Timothy Chuter, MD (2008); Thomas Fogarty, MD (2010); Roy Greenberg, MD (2012); and, most recently, Edward Diethrich, MD (2013).
The identities of these two recipients are a closely guarded secret until the presentation. Be part of the unveiling and celebration.
Three of the Vascular Annual Meeting’s signature events – celebrations along with distinguished lectures – occur on Saturday, VAM’s closing day. All conveniently occur in the morning, shortly before the start of the SVS Annual Business Meeting and luncheon and take place in Potomac A/B.
The John Homans Lecture, 9:30 to 10 a.m.: Jack Cronenwett, MD, Dartmouth-Hitchcock Medical Center, Lebanon, N.H., will present the lecture, “Why Should I Join the Vascular Quality Initiative?” Dr. Cronenwett spearheaded a regional quality outcomes registry, the eventual model for VQI. He later helped launch the SVS-Patient Safety Organization, which operates VQI and served as medical director until 2016. Dr. Cronenwett will discuss the VQI’s benefits for vascular practitioners and examine the VQI’s research and quality improvement opportunities.
The Roy Greenberg Distinguished Lecture, 10:15 to 10:45 a.m.: Michael Dake, MD, professor at Stanford (Calif.) University, will present “The Vision Beyond the Vision: Same as it Ever Was, but Different.” Dr. Dake is an internationally recognized pioneer of image-guided therapies whose contributions have changed the treatment of both common and complex vascular disease issues. His groundbreaking research with CT angiography, endovascular stents and stent-grafts has forever altered the interventional landscape and his publications have dramatically influenced several fields, including vascular imaging.
Awards Ceremony, 10 to 10:15 a.m.: Who will win two of the SVS’s top honors? Attendees will find out at the Awards Ceremony, during which the Lifetime Achievement Award AND the Medal for Innovation in Vascular Surgery will be presented.
The Lifetime Achievement Award recognizes an individual’s outstanding and sustained contributions to the profession and SVS, and his or her exemplary professional practice and leadership. The 2018 recipient was Gregorio Sicard, MD.
The Medal for Innovation is not an annual award; it recognizes individual whose contributions have had a transforming impact on the practice or science of vascular surgery. Past recipients include Juan Parodi, MD (2006); Timothy Chuter, MD (2008); Thomas Fogarty, MD (2010); Roy Greenberg, MD (2012); and, most recently, Edward Diethrich, MD (2013).
The identities of these two recipients are a closely guarded secret until the presentation. Be part of the unveiling and celebration.
Malnutrition Exacerbated Outcomes in Frail Elderly Patients Treated for PAD
Frailty increasingly has been seen as a factor in procedural outcomes, including vascular surgery. Nutrition factors among older adults have also become an issue of concern, and older adults undergoing interventions for peripheral arterial disease (PAD) may be at risk for malnutrition. In Friday’s Scientific Session 6, Laura Drudi, MD, of McGill University, Montreal, will report on a study that she and her colleagues performed to determine the association between preprocedural nutritional status and all-cause mortality in patients being treated for PAD.
Dr. Drudi will report on their post hoc analysis of the FRAILED (Frailty Assessment in Lower Extremity arterial Disease) prospective cohort, which comprised two centers recruiting patients during July 1, 2015–Oct.1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled.
Trained observers used the Mini Nutritional Assessment (MNA)–Short Form to assess the patients before their procedures. Scores less than or equal to 7 on a 14-point scale were considered malnourished, with scores of 8-11 indicated that patients were at risk for malnutrition.
The modified Essential Frailty Toolset (mEFT) was simultaneously used to measure frailty, with scores of 3 or less on a 5-point scale considered frail. The primary endpoint of the study was all-cause mortality at 12 months after the procedure. Dr. Drudi will report on the results of the cohort of 148 patients (39.2% women) with a mean age of 70 years, and a mean body mass index of 26.7 kg/m2. Among these patients, 59 (40%) had claudication and 89 (60%) had chronic limb-threatening ischemia. A total of 98 (66%) patients underwent endovascular revascularization and 50 (34%) underwent open or hybrid revascularization.
Overall, 3% of subjects were classified as malnourished and 33% were at risk for malnutrition. There were 9 (6%) deaths at 12 months. Mini Nutritional Assessment–Short Form scores were modestly but significantly correlated with the mEFT scores (Pearson’s R = –0.48; P less than .001).
”We found that patients with malnourishment or at risk of malnourishment had a 2.5-fold higher crude 1-year mortality, compared with those with normal nutritional status,” said Dr. Drudi.
In the 41% of patients deemed frail, malnutrition was associated with all-cause mortality (adjusted odds ratio, 2.08 per point decrease in MNA scores); whereas in the nonfrail patients, MNA scores had little or no effect on mortality (adjusted OR, 1.05).
“Preprocedural nutritional status is associated with mortality in frail older adults undergoing interventions for PAD. Clinical trials are needed to determine whether pre- and postprocedural nutritional interventions can improve clinical outcomes in these vulnerable individuals,” Dr. Drudi concluded.
Friday, June 21
1:30-3:00 p.m.
Gaylord National, Potomac A/B
S6: Scientific Session 6: RS16
Frailty increasingly has been seen as a factor in procedural outcomes, including vascular surgery. Nutrition factors among older adults have also become an issue of concern, and older adults undergoing interventions for peripheral arterial disease (PAD) may be at risk for malnutrition. In Friday’s Scientific Session 6, Laura Drudi, MD, of McGill University, Montreal, will report on a study that she and her colleagues performed to determine the association between preprocedural nutritional status and all-cause mortality in patients being treated for PAD.
Dr. Drudi will report on their post hoc analysis of the FRAILED (Frailty Assessment in Lower Extremity arterial Disease) prospective cohort, which comprised two centers recruiting patients during July 1, 2015–Oct.1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled.
Trained observers used the Mini Nutritional Assessment (MNA)–Short Form to assess the patients before their procedures. Scores less than or equal to 7 on a 14-point scale were considered malnourished, with scores of 8-11 indicated that patients were at risk for malnutrition.
The modified Essential Frailty Toolset (mEFT) was simultaneously used to measure frailty, with scores of 3 or less on a 5-point scale considered frail. The primary endpoint of the study was all-cause mortality at 12 months after the procedure. Dr. Drudi will report on the results of the cohort of 148 patients (39.2% women) with a mean age of 70 years, and a mean body mass index of 26.7 kg/m2. Among these patients, 59 (40%) had claudication and 89 (60%) had chronic limb-threatening ischemia. A total of 98 (66%) patients underwent endovascular revascularization and 50 (34%) underwent open or hybrid revascularization.
Overall, 3% of subjects were classified as malnourished and 33% were at risk for malnutrition. There were 9 (6%) deaths at 12 months. Mini Nutritional Assessment–Short Form scores were modestly but significantly correlated with the mEFT scores (Pearson’s R = –0.48; P less than .001).
”We found that patients with malnourishment or at risk of malnourishment had a 2.5-fold higher crude 1-year mortality, compared with those with normal nutritional status,” said Dr. Drudi.
In the 41% of patients deemed frail, malnutrition was associated with all-cause mortality (adjusted odds ratio, 2.08 per point decrease in MNA scores); whereas in the nonfrail patients, MNA scores had little or no effect on mortality (adjusted OR, 1.05).
“Preprocedural nutritional status is associated with mortality in frail older adults undergoing interventions for PAD. Clinical trials are needed to determine whether pre- and postprocedural nutritional interventions can improve clinical outcomes in these vulnerable individuals,” Dr. Drudi concluded.
Friday, June 21
1:30-3:00 p.m.
Gaylord National, Potomac A/B
S6: Scientific Session 6: RS16
Frailty increasingly has been seen as a factor in procedural outcomes, including vascular surgery. Nutrition factors among older adults have also become an issue of concern, and older adults undergoing interventions for peripheral arterial disease (PAD) may be at risk for malnutrition. In Friday’s Scientific Session 6, Laura Drudi, MD, of McGill University, Montreal, will report on a study that she and her colleagues performed to determine the association between preprocedural nutritional status and all-cause mortality in patients being treated for PAD.
Dr. Drudi will report on their post hoc analysis of the FRAILED (Frailty Assessment in Lower Extremity arterial Disease) prospective cohort, which comprised two centers recruiting patients during July 1, 2015–Oct.1, 2016. Individuals who underwent vascular interventions for Rutherford class 3 or higher PAD were enrolled.
Trained observers used the Mini Nutritional Assessment (MNA)–Short Form to assess the patients before their procedures. Scores less than or equal to 7 on a 14-point scale were considered malnourished, with scores of 8-11 indicated that patients were at risk for malnutrition.
The modified Essential Frailty Toolset (mEFT) was simultaneously used to measure frailty, with scores of 3 or less on a 5-point scale considered frail. The primary endpoint of the study was all-cause mortality at 12 months after the procedure. Dr. Drudi will report on the results of the cohort of 148 patients (39.2% women) with a mean age of 70 years, and a mean body mass index of 26.7 kg/m2. Among these patients, 59 (40%) had claudication and 89 (60%) had chronic limb-threatening ischemia. A total of 98 (66%) patients underwent endovascular revascularization and 50 (34%) underwent open or hybrid revascularization.
Overall, 3% of subjects were classified as malnourished and 33% were at risk for malnutrition. There were 9 (6%) deaths at 12 months. Mini Nutritional Assessment–Short Form scores were modestly but significantly correlated with the mEFT scores (Pearson’s R = –0.48; P less than .001).
”We found that patients with malnourishment or at risk of malnourishment had a 2.5-fold higher crude 1-year mortality, compared with those with normal nutritional status,” said Dr. Drudi.
In the 41% of patients deemed frail, malnutrition was associated with all-cause mortality (adjusted odds ratio, 2.08 per point decrease in MNA scores); whereas in the nonfrail patients, MNA scores had little or no effect on mortality (adjusted OR, 1.05).
“Preprocedural nutritional status is associated with mortality in frail older adults undergoing interventions for PAD. Clinical trials are needed to determine whether pre- and postprocedural nutritional interventions can improve clinical outcomes in these vulnerable individuals,” Dr. Drudi concluded.
Friday, June 21
1:30-3:00 p.m.
Gaylord National, Potomac A/B
S6: Scientific Session 6: RS16