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The Clinical Practice Council of the Society for Vascular Surgery (SVS) was charged with providing an updated consensus on guidelines for hospital privileges in vascular and endovascular surgery. One compelling reason to update these recommendations is that vascular surgery as a specialty has continued to evolve with a significant shift towards endovascular therapies. The Society for Vascular Surgery is making the following four recommendations concerning guidelines for hospital privileges for vascular and endovascular surgery. First, anyone applying for new hospital privileges to perform vascular surgery should have completed an Accreditation Council for Graduate Medical-accredited vascular surgery residency and should obtain American Board of Surgery certification in vascular surgery within 3 years of completion of their training. Second, we reaffirm and provide updated recommendations concerning previous established guidelines for peripheral endovascular procedures, thoracic and abdominal aortic endograft replacements, and carotid artery balloon angioplasty and stenting for trainees and already credentialed physicians who are adding these new procedures to their hospital credentials. Third, we endorse the Residency Review Committee for Surgery recommendations regarding open and endovascular cases during vascular residency training. Fourth, we endorse the Inter-societal Commission for Accreditation of Vascular Laboratories (ICAVL) recommendations for noninvasive vascular laboratory interpretations and examinations to become a registered physician in vascular interpretation (RPVI) or a registered vascular technologist (RVT).

Purpose: Under the direction of the Association of Program Directors in Vascular Surgery, a survey was mailed to vascular surgery residents (VSRs), general surgery chief residents (GS-CRs), and fourth-year medical students (MSs) to better define reasons why trainees do and do not choose vascular surgery as a career., Methods: Questionnaires were mailed to all accredited VSR programs and their associated GS programs in the United States and Canada in 2001 (survey 1) and in 2003 (survey 2) and to 2 medical schools with VSR programs in 2001. A total of 197 VSRs, 169 GS-CRs, and 78 MSs responded (overall program response rate of 78% for VSRs, 46% for GSRs, 20% for MSs). A scoring system was assigned, with 1.0 the least important and 5.0 the most important reasons to choose or not choose vascular surgery., Results: Technical aspects, role of mentors, and complex decision making involved in vascular surgery were the most important reasons that VSRs, GS-CRs, and MSs would choose vascular surgery as a specialty (average scores > or =4.0 for VSRs and GS-CRs; > or =3.5 for MSs). Responses of GS-CRs and VSRs did not vary significantly between surveys 1 and 2, except endovascular capabilities of vascular surgeons had a more important role in choosing vascular surgery, and future loss of patients to other interventionalists had a more important role in not choosing this specialty in the more recent survey of GS-CRs and VSRs. MSs identified lifestyle as a surgical resident (4.3) and as a surgeon (4.2) as the most important negative factors. A training paradigm consisting of 4 years general surgery + 2 years vascular surgery with a GS certificate was favored by 64% of GS-CRs and 48% of VSRs, compared with a paradigm of 5 years + 2 years with a general surgery certificate, which was favored by 29% of GS-CRs and 25% of VSRs, or 3 years + 3 years without a general surgery certificate, favored by 7% of GS-CRs and 27% of VSRs. Of note, 86% of MSs favored 3 years general surgery + 3 years vascular surgery or 2 years general surgery + 4 years vascular surgery compared with longer general surgery training periods., Conclusion: These findings may help vascular surgery program directors devise strategies to attract future trainees. The importance of mentorship to general surgery junior residents and medical students in choosing vascular surgery cannot be overestimated. Endovascular capabilities of vascular surgeons have an increasingly positive role in career choice by GS-CRs and VSRs, but these residents express increasing concerns about potential loss of patients to other specialists. Lifestyle concerns are the most important reasons why medical students do not choose vascular surgery as a career.

Clinical Experience Level III training in vascular medicine should provide the knowledge and skills to function as a vascular specialist, including the ability to interpret patients' clinical presentation, plan diagnostic testing, apply clinical and laboratory information, and develop appropriate management plans for patients across the entire range of vascular diseases. For patients with atherosclerotic cerebrovascular disease, trainees should define and apply appropriate risk stratification and medical therapies to reduce risk of stroke, including managing the most common risk factors for development and progression of cerebrovascular disease (e.g., smoking, diabetes, hypertension, hypercholesterolemia). They should know the diagnostic and management strategies relevant to specific patient populations, such as pregnant women, patients with cancer, patients with severe obesity, and patients with chronic kidney disease. They should be able to initiate compression therapy, refer to a physical therapist specialized in manual lymphatic therapy and multimodal lymphedema therapy, and determine if a patient would benefit from advanced therapies such as compression pumps or referral for surgery. [Extracted from the article]

Objective: Traditionally, vascular surgery fellows (VSFs) have learned to perform peripheral arterial endovascular procedures in a hospital setting. Many vascular surgeons currently perform these procedures in an "outpatient" non-hospital-based setting. Loss of these cases from the hospital setting may impact vascular surgery fellowship endovascular volume. We assessed the safety of first-year VSFs performing peripheral endovascular procedures under the supervision of vascular surgery attending surgeons in a non-hospital-based facility. Methods: Between January 1, 2012, and December 31, 2016, 166 patients underwent 193 endovascular procedures in a non-hospital-based ambulatory facility: 136 interventions (65 femoral, 40 iliac, 13 popliteal, and 9 infrapopliteal arteries) and 31 diagnostic arteriograms for claudication (57.8%; 85), rest pain (11.6%; 17), tissue loss (12.9%; 19), and failing grafts (17.7%; 26). Interventions included balloon angioplasty alone in 8.8% (12/136) of cases, stents in 16.9% (23/136), covered stents in 14% (19/136), atherectomy in 60.3% (82/136), and mechanical thrombolysis in 0.7% (1/136). Results: First-year VSFs performed an increasing percentage of these procedures during this interval: academic year 2012 to 2013 = 0% (0/49), 2013 to 2014 = 31% (17/54), 2014 to 2015 = 93% (56/60), and 2015 to 2016 = 82% (57/70). All but 5 (3%) patients having 167 procedures were discharged home after 2 to 6 hours of bed rest without any 30-day adverse outcomes. Four patients were immediately transferred to our hospital after the intervention: 2 for respiratory issues (hypoxia), 1 for groin hematoma (observation only), and 1 for arterial occlusion (required tibial stent not available at outpatient center). One patient returned to our hospital with rest pain due to treatment site occlusion the following day. Conclusion: Our results demonstrate that complex peripheral arterial endovascular procedures can be performed safely by first-year VSFs under vascular attending supervision in an outpatient, non-hospital-based setting. [ABSTRACT FROM AUTHOR]