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VS02. Laparoscopic Division of the Median Arcuate Ligament
JOURNAL OF VASCULAR SURGERY Volume 63, Number 6S
Abstracts 53S
Author Disclosures: D. Assael: Nothing to disclose; P. L. Faries: Nothing to disclose; M. Kang: Nothing to disclose; S. Kim: Medtronic (Covidien) and Vascular Insight : consulting fees (eg, advisory boards); M. L. Marin: W. L. Gore: consulting fees (eg, advisory boards); C. M. Png: Nothing to disclose; R. O. Tadros: Vascular Insights: consulting fees (eg, advisory boards); M. Tardiff: Nothing to disclose.
trainee technical and procedural errors were noted to occur for each simulated procedure. The performance results identified a range of technical skills among the trainees. Faculty assessment was inconsistent with reporting errors or omissions occurring in 18%. Endovascular simulator malfunction occurred in just 4% of procedures. No malfunctions occurred in the open vascular simulators. Conclusions: These preliminary results indicate that it is feasible to perform objective assessment of senior vascular trainees by board-certified vascular surgery faculty using multiple objective assessment metrics. Simulation models overall exhibited good durability and consistency, and therefore appear to be useful in the assessment of advanced vascular surgical skills. Data from this initial feasibility study can be used to determine reproducible objective assessment metrics. These metrics, once validated, can than serve as a foundation for a technical competence examination in vascular surgery.
SS10.
Author Disclosures: O. Brown: Nothing to disclose; M. A. Mattos: Nothing to disclose.
showed significant improvements in understanding patient care, communication with surgeons, and overall patient well-being (P < .05). Conclusions: The implementation of a vascular comanagement service resulted in significantly improved IHM rates despite increased CMI. Though increased LOS was observed, this finding is a reflection of increased CMI. In addition to improved IHM, pain, AHRQ safety measures, and nursing perceptions all improved.
Advanced Vascular Surgery Surgical Skills and Simulated Assessment Program for Senior Vascular Surgery Trainees Mark A. Mattos, MD1, O.W. Brown, MD2. 1Michigan Vascular Center, Flint, Mich; 2William Beaumont Hospital, Bingham Farms, Mich Objectives: Cognitive competence in vascular surgery is determined by oral and written examinations administered by the Vascular Surgery Board. Technical competence of vascular surgery trainees is determined solely by subjective assessment from faculty members of the trainee’s institution. This program represents the first attempt to objectively evaluate the advanced vascular surgical skills of senior vascular trainees using high-fidelity simulation models by an independent faculty proctor. Methods: Nineteen senior vascular trainees were evaluated over a 3-day period. Twenty-five board-certified vascular surgeons served as assessment proctors. Assessment stations included thoracic and abdominal aortic aneurysm endograft repair, open abdominal aortic aneurysm repair, carotid endarterectomy, femoral-popliteal bypass, arteriovenous fistula creation, mismatched end-to-side anastomosis at depth, carotid, renal, iliac, and superficial femoral artery angioplasty and stenting, and use of a percutaneous closure device. Trainees were given 1 hour to complete each station. Technical performances were evaluated by a single faculty member using global rating scales, critical task and time assessment metrics, and a global rating summary. Competency was defined as achieving >80% global rating scale score, 100% achievement of all critical task metrics, or attainment of a level 4 (proficient) or level 5 (advanced) global rating summary score. Immediate feedback was provided after each performance. Six simulation stations were videotaped for future assessment metrics validation. Results: A total of 202 skill and simulation assessments were performed. Vascular trainees were graded as being proficient for 83% (global rating scale), 75% (global rating summary), and 49% (critical task metrics) of all surgical skills and simulated performances. Similar patterns of
VS02. Laparoscopic Division of the Median Arcuate Ligament Jacquelenn Stuhldreher, MD1, Stephen Kavic, MD1, Michael P. Lilly, MD1, Mariano Arosemena, MD2. 1 University of Maryland Medical Center, Baltimore, Md; 2 University of Maryland Medical Center, Philadelphia, Pa Background: This video presents an interesting case of median arcuate ligament syndrome, with preoperative CT and mesenteric duplex imaging. An intraoperative video demonstrates laparoscopic division of the median arcuate ligament, with neurolysis of the celiac plexus. Author Disclosures: S. Kavic: Nothing to disclose; J. Stuhldreher: Nothing to disclose. S3: Plenary Session 3 SS12. Stent Occlusion Following Iliocaval StentingdCharacteristics and Outcomes Arjun Jayaraj, MBBS1, William Crim, MS, BS2, Erin Murphy, MD2, Seshadri Raju, MD, FACS2. 1RANE Center for Venous and Lymphatic Disease, Flowood, Miss; 2RANE Center for Venous and Lymphatic Disease, Jackson, Miss Objectives: With increasing utilization of iliocaval stenting, complications of such stenting have come to the fore. Stent occlusion is one such outcome that has not been studied in detail. Characteristics of stent occlusion in addition to outcomes after intervention are presented. Methods: A retrospective review of 3000 initial iliocaval stents placed over an 18-year period from 1997 to 2015 was performed. A total of 104 stent occlusions were identified, amounting to a 3.5% stent occlusion rate after placement. Characteristics including onset poststent placement, technique used for recanalization (thrombolysis (pharmacomechanical and/or catheter directed) with or
Abstracts 53S
Author Disclosures: D. Assael: Nothing to disclose; P. L. Faries: Nothing to disclose; M. Kang: Nothing to disclose; S. Kim: Medtronic (Covidien) and Vascular Insight : consulting fees (eg, advisory boards); M. L. Marin: W. L. Gore: consulting fees (eg, advisory boards); C. M. Png: Nothing to disclose; R. O. Tadros: Vascular Insights: consulting fees (eg, advisory boards); M. Tardiff: Nothing to disclose.
trainee technical and procedural errors were noted to occur for each simulated procedure. The performance results identified a range of technical skills among the trainees. Faculty assessment was inconsistent with reporting errors or omissions occurring in 18%. Endovascular simulator malfunction occurred in just 4% of procedures. No malfunctions occurred in the open vascular simulators. Conclusions: These preliminary results indicate that it is feasible to perform objective assessment of senior vascular trainees by board-certified vascular surgery faculty using multiple objective assessment metrics. Simulation models overall exhibited good durability and consistency, and therefore appear to be useful in the assessment of advanced vascular surgical skills. Data from this initial feasibility study can be used to determine reproducible objective assessment metrics. These metrics, once validated, can than serve as a foundation for a technical competence examination in vascular surgery.
SS10.
Author Disclosures: O. Brown: Nothing to disclose; M. A. Mattos: Nothing to disclose.
showed significant improvements in understanding patient care, communication with surgeons, and overall patient well-being (P < .05). Conclusions: The implementation of a vascular comanagement service resulted in significantly improved IHM rates despite increased CMI. Though increased LOS was observed, this finding is a reflection of increased CMI. In addition to improved IHM, pain, AHRQ safety measures, and nursing perceptions all improved.
Advanced Vascular Surgery Surgical Skills and Simulated Assessment Program for Senior Vascular Surgery Trainees Mark A. Mattos, MD1, O.W. Brown, MD2. 1Michigan Vascular Center, Flint, Mich; 2William Beaumont Hospital, Bingham Farms, Mich Objectives: Cognitive competence in vascular surgery is determined by oral and written examinations administered by the Vascular Surgery Board. Technical competence of vascular surgery trainees is determined solely by subjective assessment from faculty members of the trainee’s institution. This program represents the first attempt to objectively evaluate the advanced vascular surgical skills of senior vascular trainees using high-fidelity simulation models by an independent faculty proctor. Methods: Nineteen senior vascular trainees were evaluated over a 3-day period. Twenty-five board-certified vascular surgeons served as assessment proctors. Assessment stations included thoracic and abdominal aortic aneurysm endograft repair, open abdominal aortic aneurysm repair, carotid endarterectomy, femoral-popliteal bypass, arteriovenous fistula creation, mismatched end-to-side anastomosis at depth, carotid, renal, iliac, and superficial femoral artery angioplasty and stenting, and use of a percutaneous closure device. Trainees were given 1 hour to complete each station. Technical performances were evaluated by a single faculty member using global rating scales, critical task and time assessment metrics, and a global rating summary. Competency was defined as achieving >80% global rating scale score, 100% achievement of all critical task metrics, or attainment of a level 4 (proficient) or level 5 (advanced) global rating summary score. Immediate feedback was provided after each performance. Six simulation stations were videotaped for future assessment metrics validation. Results: A total of 202 skill and simulation assessments were performed. Vascular trainees were graded as being proficient for 83% (global rating scale), 75% (global rating summary), and 49% (critical task metrics) of all surgical skills and simulated performances. Similar patterns of
VS02. Laparoscopic Division of the Median Arcuate Ligament Jacquelenn Stuhldreher, MD1, Stephen Kavic, MD1, Michael P. Lilly, MD1, Mariano Arosemena, MD2. 1 University of Maryland Medical Center, Baltimore, Md; 2 University of Maryland Medical Center, Philadelphia, Pa Background: This video presents an interesting case of median arcuate ligament syndrome, with preoperative CT and mesenteric duplex imaging. An intraoperative video demonstrates laparoscopic division of the median arcuate ligament, with neurolysis of the celiac plexus. Author Disclosures: S. Kavic: Nothing to disclose; J. Stuhldreher: Nothing to disclose. S3: Plenary Session 3 SS12. Stent Occlusion Following Iliocaval StentingdCharacteristics and Outcomes Arjun Jayaraj, MBBS1, William Crim, MS, BS2, Erin Murphy, MD2, Seshadri Raju, MD, FACS2. 1RANE Center for Venous and Lymphatic Disease, Flowood, Miss; 2RANE Center for Venous and Lymphatic Disease, Jackson, Miss Objectives: With increasing utilization of iliocaval stenting, complications of such stenting have come to the fore. Stent occlusion is one such outcome that has not been studied in detail. Characteristics of stent occlusion in addition to outcomes after intervention are presented. Methods: A retrospective review of 3000 initial iliocaval stents placed over an 18-year period from 1997 to 2015 was performed. A total of 104 stent occlusions were identified, amounting to a 3.5% stent occlusion rate after placement. Characteristics including onset poststent placement, technique used for recanalization (thrombolysis (pharmacomechanical and/or catheter directed) with or