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IP165. Faculty Gender Differences in Vascular Surgery Departments
Journal of Vascular Surgery
Abstracts
99S
Volume 65, Number 6S Table II. Intervention and outcomes by age decile Variable Patients, No.
20-29 30-39 40-49 50-59 60-69 70-79 80-89 9
Rate of intervention, % 37.5 Overall maturation rate, %
68
Overall stenosis rate, %
19.8
Overall intervention rate, %
39.5
17
25
52
68
48
28
25
29
43
68
57
38
Methods: A single-center retrospective cohort study was performed assessing outcomes of single-stage BT fistulas created by a single surgeon between January 1, 1999, and December 31, 2016. Demographic data, preoperative and postoperative vein and fistula flow velocity and volume metrics, and maturation rates and complications were recorded. Data were analyzed using descriptive statistics. Results: There were 247 patients who received BT fistulas, including 112 in patients aged $65. Overall successful maturation rate 68%. Older patients (>65 years) were more likely to have diabetes and coronary artery disease than younger patients; they were less likely to have had prior hemodialysis or to have had a previous AVF or AVG. Younger patients had higher average body mass index. There were no statistically significant differences between patient outcomes, including comorbidities, reoperation, and complication rates. Basilic vein diameter per preoperative mapping studies was comparable across groups (3.8 mm). Patient groups had similar arterial flow rates at the first postoperative assessment (230 vs 239 cm/s); younger patients tended to have higher outflow velocities (609 vs 521 cm/s). Mean volume flow across all patients was 1699 mL/min. Only one patient had a volume flow below the dialysis threshold of 600 mL/ min. Younger patients were more likely to require superficialization of their AVF due to difficult with access (13.7% vs 5%). Elderly patients were more likely to have a new AVF or AVG placed as their primary intervention. Data are presented in Tables I and II. Conclusions: This series demonstrates a maturation rate superior to much of what is reported in the medical literature for single- or doublestage BT. Single-stage BT yielded excellent flow volume rates across patient groups. These results suggest that a single-stage BT approach can have a high success rate and may therefore help patients avoid the complication risks of a two-step procedure or nonautologous hemodialysis access types.
the pace, including coil embolization slows in cold water. After all aneurysms were connected, the coil embolization procedure was practiced Results: These models are worthwhile in surgical education, for practicing, making implantable devices, invented biomaterials, planning before procedure, and as guidance during the procedure. These helped to check the feasibility of new equipment before using on patients. Conclusions: These models could assist the surgeons and trainees to exercise the techniques repeatedly in a harmless setting before using on patients. Thus 3D models will be competent to reproduce the exact true human anatomy in future with the use of more materials in the 3D printing era.
Fig. A, The complete three-dimensional (3D) model with all of the aneurysms.
Author Disclosures: M. Hoyler: Nothing to disclose; K. Konkar: Nothing to disclose; N. Morrissey: Nothing to disclose; M. Rao: Nothing to disclose.
IP163. Coil Embolization in 3D Models Muhammad Nadeem,1 Sonya Noor2. 1State University of New York, Buffalo, NY; 2Buffalo Endovascular and Vascular Surgical Associates, Buffalo, NY Objectives: The aim of this experimental study was to build all seven aneurysms in a three-dimensional (3D) model of blood vessels in humans and perform coil embolization with a catheter in all seven aneurysms. Thus, we elaborated the use of coil embolization in a 3D model to simulate seven peripheral aneurysms. Methods: In this pilot study, each aneurysm was the anatomically exact copy of a particular patient and was derived by computed tomography scan data after patients provided informed consent. These models were made of TangoPlus FLX930 (rubber-like translucent) materials having same diameter and thickness as related patients had. These were curved and swirled as same as those of the original patients. The outer layer was thicker than the original vessel for maintaining physical strength but varied. After the models were created, they were interconnected as in the human body by using tubes made of same materials. We used warm water with an added lubricant which simulated blood. The models were connected to a water pump to circulate water as blood circulates in the body. The ends of connecting tubes were dipped in a lubricated warm water tank. During the procedure, we replaced water with warm water frequently to simulate body temperature, because
Fig. B, Computed tomography angiogram shows the guidewire in a 3D model. Author Disclosures: M. Nadeem: Nothing to disclose; S. Noor: Nothing to disclose.
IP165. Faculty Gender Differences in Vascular Surgery Departments Ashley Slaughter, Michael F. Amendola. Virginia Commonwealth University Health System, Richmond, Va Objectives: Surgery, in particular vascular surgery, is becoming the career choice for female undergraduate medical students and general surgery residents. Current data from The American Board of Surgery indicates a total of 370 (9.8%) boarded vascular surgery diplomats are female. Additionally, in the last 3 years >20% of the yearly board applicants have been female. Despite this trend, we hypothesize there are gender differences in vascular faculty that are based at either integrated vascular surgery residencies or vascular surgery fellowships. We further hypothesize there will be gender differences among vascular surgery (VS-PD) and general surgery program directors (GS-PD).
100S
Journal of Vascular Surgery
Abstracts
June Supplement 2017 Methods: The Accreditation Council for Graduate Medical Education (ACGME) database was queried for all vascular surgery residencies and fellowships registered as of July 1, 2016. The programs were broken into two groups: those with solely dedicated vascular surgery fellowships and those that with a vascular surgery integrated residency. A program that had both a fellowship and residency was listed in the residency group. Department Web sites were examined for the total, male and female faculty personnel listings. Additionally, sex of VS-PDs and GS-PDs was also collected. Results: A total of 112 programs were found, of which 61 were solely fellowships. A total of 133 female faculty (16.4%) were identified in all programs of the 813 total faculty examined. The two groups are compared in the Table. Women comprised 23.8% GS-PD positions in vascular surgery fellowships vs 21.6% in integrated vascular surgery residencies (P ¼ .83, Fisher exact test) Conclusions: Integrated vascular surgery residencies were more likely to have more total and female vascular surgery faculty. VS-PD listings were not significantly different between the two groups. Comparatively there were fewer female VS-PDs compared to GS-PDs. These data should be used to enlighten potential recruiting efforts made by vascular surgery departments to address the lack of female presence not only as vascular surgery faculty but as program directors. Table. Compared vascular fellowship programs and integrated vascular surgery residencies Variable Total faculty (6 SD)
Fellowships (n ¼ 63) 6.61 6 2.83
Residencies (n ¼ 51)
P value
8.04 6 3.09
publications. In the U.S., five programs (4.4%) had no publications, and 21 (18.4%) had no JVS publications. In Europe, 82 programs (30.0%) had no publications, while 180 (65.9%) had no JVS publications. As shown in the Table, abstracts were categorized by topic for comparison. Conclusions: In both Europe and the U.S., the top one-third produced more than two-thirds of the publications, with the disparity being even more pronounced in Europe, where the top one-third produced almost 90% of the total publications. Comparing the topics of the publications from Europe and the U.S., it was found that the U.S. program directors published a great deal more on endovascular lower extremity, open lower extremity, education, thoracic endovascular aortic repair, open carotid, and endovascular venous, while their European counterparts published more in the areas of vascular medicine, replies, and not vascularrelated topics.
Table. Comparison between Europe and United States (U.S.) based on the category of the abstracta Category
European (%)
U.S. (%)
Endo AAA
13.1
Open AAA
1.5
4.2
Endo LE
3.8
8.9
Open LE
1.5
4.2
Basic science
6.0
6.8
Education
1.5
3.3
30.9
16.4
.01a
Vascular medicine
16.6
Female faculty (%)
13.4
19.3
.03b
Endo UE
0.1
0.2
Female VS-PD (%)
7.9
11.7
.53b
Open UE
0.0
0.4
TEVAR
4.8
9.9
Endo carotid
6.7
4.4
Open carotid
0.1
3.0
Reply
3.5
0.7
SD, Standard deviation; VS-PD, vascular surgery program director. a Two-tail t-test. b Fisher exact test.
Author Disclosures: M. F. Amendola: Nothing to disclose; A. Slaughter: Nothing to disclose.
Endo venous
1.5
4.4
Open venous
0.3
0.8
Guideline
0.8
1.3
Not vascular
10.6
2.1
IP167.
Case report
11.2
8.3
Recent Trends in Publications of U.S. and European Directors for Vascular Surgery Training
AV access
1.8
3.0
Afsha Aurshina,1 Anil Hingorani,2 Enrico Ascher,3 Sheila Blumberg,4 Natalie Marks,5 Amrit Hingorani,2 Ahmad Alsheekh,2 Eleanor 2 Iadagarova3. 1Total Vascular Care, New Haven, Conn; Total Vascular Care, Brooklyn, NY; 3New York University Langone Med4 ical Center, New York, NY; New York University, Brooklyn, NY; 5 Lutheran Medical Center, Brooklyn, NY Objectives: We noted large differences between academic productivity of the training programs in the United States (U.S.) and Europe. In an effort to explore this variability, we reviewed the number of vascular publications listed in PubMed from 2010 to 2015 for U.S. and European program directors in vascular surgery. Methods: The list of program directors from the Association of Program directors in Vascular Surgery (APDVS) and the European Union of Medical Specialists (EUMS) were queried for the names of the directors of vascular surgical training programs at the end of 2015. PubMed listed 5474 citations published from 2010 to 2015; of these, 3561 were from Europe, while 1912 were from the U.S. The United Kingdom and German programs did not list their directors’ names in the EUMS Web site and were not included in this analysis. Results: The average number of citations in PubMed per program director was 2.36 per year. In Europe, each of the 273 program directors averaged 2.17 publications per year, while each of the 114 U.S. program directors averaged 2.80 publications per year (P ¼ .37). Journal of Vascular Surgery (JVS) publications contributed to 24.0% (12.7% in Europe and 45.0% in the U.S.). In the U.S., the top third institutions produced 69% of the publications and 77% of the JVS publications, while in Europe, the top third produced 87% of the publications and 98% of the JVS
AAA, Abdominal aortic aneurysm; AV, arteriovenous; Endo, endovascular LE, lower extremity; TEVAR, thoracic endovascular aortic repair; UE, upper extremity; U.S., United States. a Bold text indicates (P < .05).
Author Disclosures: A. Alsheekh: Nothing to disclose; E. Ascher: Nothing to disclose; A. Aurshina: Nothing to disclose; S. Blumberg: Nothing to disclose; A. Hingorani: Nothing to disclose; A. Hingorani: Nothing to disclose; E. Iadagarova: Nothing to disclose; N. Marks: Nothing to disclose.
IP169. One-Year Experience of a Regional Service Model of Teleconsultation for Planning and Treatment of Complex Thoracoabdominal Aortic Aneurysm Emiliano Chisci,1 Gianmarco de Donato,2 Leonardo Ercolini,1 Giuseppe Galzerano,2 Mario Cecchi,3 Stefania Saccardi,4 Stefano Michelagnoli,1 Carlo Setacci5. 1San Giovanni di Dio Hospital - USL CENTRO, florence, Italy; 2University Hospital of Siena, Tuscany, Italy; 3 Health Technology Assessment, Regione Toscana, Tuscany, Italy; 4 5 Health National System, Tuscany, Italy; University of Siena, Tuscany, Italy Objectives: This study reports the methodology and 1-year results of a regional service model of teleconsultation for planning and treatment of complex thoracoabdominal aortic aneurysm (TAAA).
Abstracts
99S
Volume 65, Number 6S Table II. Intervention and outcomes by age decile Variable Patients, No.
20-29 30-39 40-49 50-59 60-69 70-79 80-89 9
Rate of intervention, % 37.5 Overall maturation rate, %
68
Overall stenosis rate, %
19.8
Overall intervention rate, %
39.5
17
25
52
68
48
28
25
29
43
68
57
38
Methods: A single-center retrospective cohort study was performed assessing outcomes of single-stage BT fistulas created by a single surgeon between January 1, 1999, and December 31, 2016. Demographic data, preoperative and postoperative vein and fistula flow velocity and volume metrics, and maturation rates and complications were recorded. Data were analyzed using descriptive statistics. Results: There were 247 patients who received BT fistulas, including 112 in patients aged $65. Overall successful maturation rate 68%. Older patients (>65 years) were more likely to have diabetes and coronary artery disease than younger patients; they were less likely to have had prior hemodialysis or to have had a previous AVF or AVG. Younger patients had higher average body mass index. There were no statistically significant differences between patient outcomes, including comorbidities, reoperation, and complication rates. Basilic vein diameter per preoperative mapping studies was comparable across groups (3.8 mm). Patient groups had similar arterial flow rates at the first postoperative assessment (230 vs 239 cm/s); younger patients tended to have higher outflow velocities (609 vs 521 cm/s). Mean volume flow across all patients was 1699 mL/min. Only one patient had a volume flow below the dialysis threshold of 600 mL/ min. Younger patients were more likely to require superficialization of their AVF due to difficult with access (13.7% vs 5%). Elderly patients were more likely to have a new AVF or AVG placed as their primary intervention. Data are presented in Tables I and II. Conclusions: This series demonstrates a maturation rate superior to much of what is reported in the medical literature for single- or doublestage BT. Single-stage BT yielded excellent flow volume rates across patient groups. These results suggest that a single-stage BT approach can have a high success rate and may therefore help patients avoid the complication risks of a two-step procedure or nonautologous hemodialysis access types.
the pace, including coil embolization slows in cold water. After all aneurysms were connected, the coil embolization procedure was practiced Results: These models are worthwhile in surgical education, for practicing, making implantable devices, invented biomaterials, planning before procedure, and as guidance during the procedure. These helped to check the feasibility of new equipment before using on patients. Conclusions: These models could assist the surgeons and trainees to exercise the techniques repeatedly in a harmless setting before using on patients. Thus 3D models will be competent to reproduce the exact true human anatomy in future with the use of more materials in the 3D printing era.
Fig. A, The complete three-dimensional (3D) model with all of the aneurysms.
Author Disclosures: M. Hoyler: Nothing to disclose; K. Konkar: Nothing to disclose; N. Morrissey: Nothing to disclose; M. Rao: Nothing to disclose.
IP163. Coil Embolization in 3D Models Muhammad Nadeem,1 Sonya Noor2. 1State University of New York, Buffalo, NY; 2Buffalo Endovascular and Vascular Surgical Associates, Buffalo, NY Objectives: The aim of this experimental study was to build all seven aneurysms in a three-dimensional (3D) model of blood vessels in humans and perform coil embolization with a catheter in all seven aneurysms. Thus, we elaborated the use of coil embolization in a 3D model to simulate seven peripheral aneurysms. Methods: In this pilot study, each aneurysm was the anatomically exact copy of a particular patient and was derived by computed tomography scan data after patients provided informed consent. These models were made of TangoPlus FLX930 (rubber-like translucent) materials having same diameter and thickness as related patients had. These were curved and swirled as same as those of the original patients. The outer layer was thicker than the original vessel for maintaining physical strength but varied. After the models were created, they were interconnected as in the human body by using tubes made of same materials. We used warm water with an added lubricant which simulated blood. The models were connected to a water pump to circulate water as blood circulates in the body. The ends of connecting tubes were dipped in a lubricated warm water tank. During the procedure, we replaced water with warm water frequently to simulate body temperature, because
Fig. B, Computed tomography angiogram shows the guidewire in a 3D model. Author Disclosures: M. Nadeem: Nothing to disclose; S. Noor: Nothing to disclose.
IP165. Faculty Gender Differences in Vascular Surgery Departments Ashley Slaughter, Michael F. Amendola. Virginia Commonwealth University Health System, Richmond, Va Objectives: Surgery, in particular vascular surgery, is becoming the career choice for female undergraduate medical students and general surgery residents. Current data from The American Board of Surgery indicates a total of 370 (9.8%) boarded vascular surgery diplomats are female. Additionally, in the last 3 years >20% of the yearly board applicants have been female. Despite this trend, we hypothesize there are gender differences in vascular faculty that are based at either integrated vascular surgery residencies or vascular surgery fellowships. We further hypothesize there will be gender differences among vascular surgery (VS-PD) and general surgery program directors (GS-PD).
100S
Journal of Vascular Surgery
Abstracts
June Supplement 2017 Methods: The Accreditation Council for Graduate Medical Education (ACGME) database was queried for all vascular surgery residencies and fellowships registered as of July 1, 2016. The programs were broken into two groups: those with solely dedicated vascular surgery fellowships and those that with a vascular surgery integrated residency. A program that had both a fellowship and residency was listed in the residency group. Department Web sites were examined for the total, male and female faculty personnel listings. Additionally, sex of VS-PDs and GS-PDs was also collected. Results: A total of 112 programs were found, of which 61 were solely fellowships. A total of 133 female faculty (16.4%) were identified in all programs of the 813 total faculty examined. The two groups are compared in the Table. Women comprised 23.8% GS-PD positions in vascular surgery fellowships vs 21.6% in integrated vascular surgery residencies (P ¼ .83, Fisher exact test) Conclusions: Integrated vascular surgery residencies were more likely to have more total and female vascular surgery faculty. VS-PD listings were not significantly different between the two groups. Comparatively there were fewer female VS-PDs compared to GS-PDs. These data should be used to enlighten potential recruiting efforts made by vascular surgery departments to address the lack of female presence not only as vascular surgery faculty but as program directors. Table. Compared vascular fellowship programs and integrated vascular surgery residencies Variable Total faculty (6 SD)
Fellowships (n ¼ 63) 6.61 6 2.83
Residencies (n ¼ 51)
P value
8.04 6 3.09
publications. In the U.S., five programs (4.4%) had no publications, and 21 (18.4%) had no JVS publications. In Europe, 82 programs (30.0%) had no publications, while 180 (65.9%) had no JVS publications. As shown in the Table, abstracts were categorized by topic for comparison. Conclusions: In both Europe and the U.S., the top one-third produced more than two-thirds of the publications, with the disparity being even more pronounced in Europe, where the top one-third produced almost 90% of the total publications. Comparing the topics of the publications from Europe and the U.S., it was found that the U.S. program directors published a great deal more on endovascular lower extremity, open lower extremity, education, thoracic endovascular aortic repair, open carotid, and endovascular venous, while their European counterparts published more in the areas of vascular medicine, replies, and not vascularrelated topics.
Table. Comparison between Europe and United States (U.S.) based on the category of the abstracta Category
European (%)
U.S. (%)
Endo AAA
13.1
Open AAA
1.5
4.2
Endo LE
3.8
8.9
Open LE
1.5
4.2
Basic science
6.0
6.8
Education
1.5
3.3
30.9
16.4
.01a
Vascular medicine
16.6
Female faculty (%)
13.4
19.3
.03b
Endo UE
0.1
0.2
Female VS-PD (%)
7.9
11.7
.53b
Open UE
0.0
0.4
TEVAR
4.8
9.9
Endo carotid
6.7
4.4
Open carotid
0.1
3.0
Reply
3.5
0.7
SD, Standard deviation; VS-PD, vascular surgery program director. a Two-tail t-test. b Fisher exact test.
Author Disclosures: M. F. Amendola: Nothing to disclose; A. Slaughter: Nothing to disclose.
Endo venous
1.5
4.4
Open venous
0.3
0.8
Guideline
0.8
1.3
Not vascular
10.6
2.1
IP167.
Case report
11.2
8.3
Recent Trends in Publications of U.S. and European Directors for Vascular Surgery Training
AV access
1.8
3.0
Afsha Aurshina,1 Anil Hingorani,2 Enrico Ascher,3 Sheila Blumberg,4 Natalie Marks,5 Amrit Hingorani,2 Ahmad Alsheekh,2 Eleanor 2 Iadagarova3. 1Total Vascular Care, New Haven, Conn; Total Vascular Care, Brooklyn, NY; 3New York University Langone Med4 ical Center, New York, NY; New York University, Brooklyn, NY; 5 Lutheran Medical Center, Brooklyn, NY Objectives: We noted large differences between academic productivity of the training programs in the United States (U.S.) and Europe. In an effort to explore this variability, we reviewed the number of vascular publications listed in PubMed from 2010 to 2015 for U.S. and European program directors in vascular surgery. Methods: The list of program directors from the Association of Program directors in Vascular Surgery (APDVS) and the European Union of Medical Specialists (EUMS) were queried for the names of the directors of vascular surgical training programs at the end of 2015. PubMed listed 5474 citations published from 2010 to 2015; of these, 3561 were from Europe, while 1912 were from the U.S. The United Kingdom and German programs did not list their directors’ names in the EUMS Web site and were not included in this analysis. Results: The average number of citations in PubMed per program director was 2.36 per year. In Europe, each of the 273 program directors averaged 2.17 publications per year, while each of the 114 U.S. program directors averaged 2.80 publications per year (P ¼ .37). Journal of Vascular Surgery (JVS) publications contributed to 24.0% (12.7% in Europe and 45.0% in the U.S.). In the U.S., the top third institutions produced 69% of the publications and 77% of the JVS publications, while in Europe, the top third produced 87% of the publications and 98% of the JVS
AAA, Abdominal aortic aneurysm; AV, arteriovenous; Endo, endovascular LE, lower extremity; TEVAR, thoracic endovascular aortic repair; UE, upper extremity; U.S., United States. a Bold text indicates (P < .05).
Author Disclosures: A. Alsheekh: Nothing to disclose; E. Ascher: Nothing to disclose; A. Aurshina: Nothing to disclose; S. Blumberg: Nothing to disclose; A. Hingorani: Nothing to disclose; A. Hingorani: Nothing to disclose; E. Iadagarova: Nothing to disclose; N. Marks: Nothing to disclose.
IP169. One-Year Experience of a Regional Service Model of Teleconsultation for Planning and Treatment of Complex Thoracoabdominal Aortic Aneurysm Emiliano Chisci,1 Gianmarco de Donato,2 Leonardo Ercolini,1 Giuseppe Galzerano,2 Mario Cecchi,3 Stefania Saccardi,4 Stefano Michelagnoli,1 Carlo Setacci5. 1San Giovanni di Dio Hospital - USL CENTRO, florence, Italy; 2University Hospital of Siena, Tuscany, Italy; 3 Health Technology Assessment, Regione Toscana, Tuscany, Italy; 4 5 Health National System, Tuscany, Italy; University of Siena, Tuscany, Italy Objectives: This study reports the methodology and 1-year results of a regional service model of teleconsultation for planning and treatment of complex thoracoabdominal aortic aneurysm (TAAA).