Evolution of vascular fellowship training in the new era of endovascular techniques

Purpose: The endovascular technique has revolutionized the treatment of inf rarenal abdominal aortic aneurysm (AAA). At our institution, we examined th e impact of an endovascular program on the traditional operative training o f the vascular fellows in the treatment of infrarenal AAA. Methods: We examined the records of our vascular fellows' experience from J uly 1995 to May 2000. We introduced the endovascular treatment for infraren al AAA in 1995. Results: The fellows have performed increasing numbers of endovascular case s each year, with a predicted number of 124 cases for 1999-2000. However, d espite an increase in the overall volume of patients with infrarenal AAA (1 02 cases in 1998-1999 and a predicted 160 cases in 1999-2000), the trainees will experience a reduction in the number of open AAAs from 61 cases in 19 98-1999 to a predicted 36 cases in 1999-2000. However, the volume of open s uprarenal AAA has also increased from eight cases in 1998 to 1999 to a pred icted 24 cases in 1999-2000. With no significant change in the open aortoil iac occlusive cases from previous years, the current fellows will graduate with a similar volume of open aortic procedures as their predecessors. Conclusion: With the recent advances in endovascular technology, our tradit ional operative approach to the treatment of AAA disease may be lacking in the training of future vascular surgeons. At our institution, although fewe r open infrarenal AAA cases were performed, the trainees have maintained th e open aortic experience by performing an increased volume of suprarenal AA As. We have to critically reevaluate and redefine what constitutes adequate vascular fellow experience in the surgical treatment of abdominal aortic a neurysms.