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Soenens G, Gorden L, Doyen B, Wheatcroft M, de Mestral C, Palter V, Van Herzeele I. Development and Testing of Step, Error, and Event Frameworks to Evaluate Technical Performance in Peripheral Endovascular Interventions. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00252-1. [PMID: 38492630 DOI: 10.1016/j.ejvs.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/22/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Tools for endovascular performance assessment are necessary in competency based education. This study aimed to develop and test a detailed analysis tool to assess steps, errors, and events in peripheral endovascular interventions (PVI). METHODS A modified Delphi consensus was used to identify steps, errors, and events in iliac-femoral-popliteal endovascular interventions. International experts in vascular surgery, interventional radiology, cardiology, and angiology were identified, based on their scientific track record. In an initial open ended survey round, experts volunteered a comprehensive list of steps, errors, and events. The items were then rated on a five point Likert scale until consensus was reached with a pre-defined threshold (Cronbach's alpha > 0.7) and > 70% expert agreement. An experienced endovascular surgeon applied the finalised frameworks on 10 previously videorecorded elective PVI cases. RESULTS The expert consensus panel was formed by 28 of 98 invited proceduralists, consisting of three angiologists, seven interventional radiologists, five cardiologists, and 13 vascular surgeons, with 29% from North America and 71% from Europe. The Delphi process was completed after three rounds (Cronbach's alpha; αsteps = 0.79; αerrors = 0.90; αevents = 0.90), with 15, 26, and 18 items included in the final step (73 - 100% agreement), error (73 - 100% agreement), and event (73 - 100% agreement) frameworks, respectively. The median rating time per case was 4.3 hours (interquartile range [IQR] 3.2, 5 hours). A median of 55 steps (IQR 40, 67), 27 errors (IQR 21, 49), and two events (IQR 1, 6) were identified per case. CONCLUSION An evaluation tool for the procedural steps, errors, and events in iliac-femoral-popliteal endovascular procedures was developed through a modified Delphi consensus and applied to recorded intra-operative data to identify hazardous steps, common errors, and events. Procedural mastery may be promoted by using the frameworks to provide endovascular proceduralists with detailed technical performance feedback.
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Affiliation(s)
- Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. https://www.twitter.com/GillesSoenens
| | - Lauren Gorden
- Division of Vascular Surgery, University of Toronto, Canada; International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada; Biomedical Engineering (BME), University of Toronto, Canada
| | - Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Mark Wheatcroft
- Division of Vascular Surgery, University of Toronto, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, University of Toronto, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Vanessa Palter
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM, Mendes LA, Arrighi JA, Breinholt JP, Day J, Dec GW, Denktas AE, Drajpuch D, Faza N, Francis SA, Hahn RT, Housholder-Hughes SD, Khan SS, Kondapaneni MD, Lee KS, Lin CH, Hussain Mahar J, McConnaughey S, Niazi K, Pearson DD, Punnoose LR, Reejhsinghani RS, Ryan T, Silvestry FE, Solomon MA, Spicer RL, Weissman G, Werns SW. 2023 ACC/AHA/SCAI advanced training statement on interventional cardiology (coronary, peripheral vascular, and structural heart interventions): A report of the ACC Competency Management Committee. J Thorac Cardiovasc Surg 2023; 166:e73-e123. [PMID: 37269254 DOI: 10.1016/j.jtcvs.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. JACC Cardiovasc Interv 2023; 16:1239-1291. [PMID: 37115166 DOI: 10.1016/j.jcin.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. J Am Coll Cardiol 2023; 81:1386-1438. [PMID: 36801119 DOI: 10.1016/j.jacc.2022.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Huie LC, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. Circ Cardiovasc Interv 2023; 16:e000088. [PMID: 36795800 DOI: 10.1161/hcv.0000000000000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Hawkins BM, Li J, Wilkins LR, Carman TL, Reed AB, Armstrong DG, Goodney P, White CJ, Fischman A, Schermerhorn ML, Feldman DN, Parikh SA, Shishehbor MH. SCAI/ACR/APMA/SCVS/SIR/SVM/SVS/VESS Position Statement on Competencies for Endovascular Specialists Providing CLTI Care. Vasc Med 2022; 27:405-414. [PMID: 35466841 PMCID: PMC9344564 DOI: 10.1177/1358863x221095278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Beau M. Hawkins
- University of Oklahoma Health Sciences
Center, Oklahoma City, Oklahoma
| | - Jun Li
- University Hospitals Harrington Heart
& Vascular Institute, Cleveland, Ohio
| | - Luke R. Wilkins
- University of Virginia Health System,
Charlottesville, Virginia
| | - Teresa L. Carman
- University Hospitals Harrington Heart
& Vascular Institute, Cleveland, Ohio
| | - Amy B. Reed
- University of Minnesota, Minneapolis,
Minnesota
| | | | | | | | - Aaron Fischman
- Icahn School of Medicine at Mount
Sinai, New York, New York
| | | | | | - Sahil A. Parikh
- NewYork-Presbyterian/Columbia
University Irving Medical Center, New York, New York
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Hawkins BM, Li J, Wilkins LR, Carman TL, Reed AB, Armstrong DG, Goodney P, White CJ, Fischman A, Schermerhorn ML, Feldman DN, Parikh SA, Shishehbor MH. SCAI/ACR/APMA/SCVS/SIR/SVM/SVS/VESS position statement on competencies for endovascular specialists providing CLTI care. J Vasc Surg 2022; 76:25-34. [PMID: 35483980 DOI: 10.1016/j.jvs.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Beau M Hawkins
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Jun Li
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Luke R Wilkins
- University of Virginia Health System, Charlottesville, Virginia
| | - Teresa L Carman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Amy B Reed
- University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Aaron Fischman
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Dmitriy N Feldman
- NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Sahil A Parikh
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Mehdi H Shishehbor
- University Hospitals Harrington Heart & Vascular Institute, Cleveland, Ohio
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Gordon L, Soenens G, Doyen B, Sunavsky J, Wheatcroft M, de Mestral C, Palter V, Grantcharov T, Van Herzeele I. Step, Error, and Event Frameworks in Endovascular Aortic Repair. J Endovasc Ther 2022; 29:937-947. [PMID: 35012393 DOI: 10.1177/15266028211068768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Competency-based surgical education requires detailed and actionable feedback to ensure adequate and efficient skill development. Comprehensive operative capture systems such as the Operating Room Black Box (ORBB; Surgical Safety Technologies, Inc), which continuously records and synchronizes multiple sources of intraoperative data, have recently been integrated into hybrid rooms to provide targeted feedback to endovascular teams. The objective of this study is to develop step, error, and event frameworks to evaluate technical performance in elective endovascular aortic repair (EVAR) comprehensively captured by the ORBB (Surgical Safety Technologies, Inc; Toronto, Canada). METHODS This study is based upon a modified Delphi consensus process to create evaluation frameworks for steps, errors, and events in EVAR. International experts from Vascular Surgery and Interventional Radiology were identified, based on their records of publications and invited presentations, or serving on relevant journal editorial boards. In an initial open-ended survey round, experts were asked to volunteer a comprehensive list of steps, errors, and events for a standard EVAR of an infrarenal aorto-iliac aneurysm (AAA). In subsequent survey rounds, the identified items were presented to the expert panel to rate on a 5-point Likert scale. Delphi survey rounds were repeated until the process reached consensus with a predefined agreement threshold (Cronbach α>0.7). The final frameworks were constructed with items achieving an agreement (responses of 4 or 5) from greater than 70% of experts. RESULTS Of 98 invited proceduralists, 38 formed the expert consensus panel (39%), consisting of 29 vascular surgeons and 9 interventional radiologists, with 34% from North America and 66% from Europe. Consensus criteria were met following the third round of the Delphi consensus process (Cronbach α=0.82-0.93). There were 15, 32, and 25 items in the error, step, and event frameworks, respectively (within-item agreement=74%-100%). CONCLUSION A detailed evaluation tool for the procedural steps, errors, and events in infrarenal EVAR was developed. This tool will be validated on recorded procedures in future work: It may focus skill development on common errors and hazardous steps. This tool might be used to provide high-quality feedback on technical performance of trainees and experienced surgeons alike, thus promoting surgical mastery.
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Affiliation(s)
- Lauren Gordon
- Division of Vascular Surgery, University of Toronto, Toronto, ON, Canada.,International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,BioMedical Engineering, University of Toronto, ON, Canada
| | - Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Juliana Sunavsky
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Mark Wheatcroft
- Division of Vascular Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Vanessa Palter
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Teodor Grantcharov
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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Kadian-Dodov D, Creager MA, Hamburg NM, Aronow H. SVM Communications: Interview with writing committee of Advanced Training Statement on vascular medicine and talking points from Paclitaxel Coalition. Vasc Med 2021; 26:232-234. [PMID: 33710941 DOI: 10.1177/1358863x21993906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniella Kadian-Dodov
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Mark A Creager
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Naomi M Hamburg
- The Whitaker Cardiovascular Institute, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Herbert Aronow
- Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI, USA Lifespan Cardiovascular Institute, Providence, RI, USA
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10
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Patel SV, Sonani R, Patel P, Patel M, Bhatt P, Badheka A. Effect of hospital volume on outcomes of percutaneous peripheral atherectomy - An observational analysis from National Inpatient Sample. Vascular 2018; 26:615-625. [PMID: 29973108 DOI: 10.1177/1708538118786596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the published literature has reported an inverse association between hospital volume and outcomes of coronary interventions, sparse data are available for percutaneous peripheral atherectomy (PPA). The aim of our study was to examine the effect of hospital volume on outcomes of PPA. METHODS Using the Nationwide Inpatient Sample (NIS) database of the year 2012, PPA with ICD-9 code of 17.56 was identified. The primary outcomes were mortality and amputation rates; secondary outcomes were peri-procedural complications, cost, and length of hospitalization and discharge disposition of the patient. Multivariate models were generated for predictors of the outcomes. RESULTS We identified a total of 21,015 patients with mean age of 69.53 years, with 56% males. Higher hospital volume centers were associated with a significantly lower mortality (OR 0.42, 95% CI 0.30-0.57, p < 0.0001), amputation rates (5.34% vs. 9.32%, p < 0.0001), combined endpoint of mortality and complications (OR 0.53, 95% CI 0.49-0.58, p < 0.0001), shorter length of hospital stay (LOS) (4.86 vs. 6.79 days, p < 0.0001) and lower hospitalization cost ($23,062 vs. $30,794, p < 0.0001). Subgroup analysis for acute and chronic limb ischemia showed similar results. CONCLUSION Hospital procedure volume is an independent predictor of mortality, amputation rates, complications, LOS, and costs in patients undergoing PPA with an inverse relationship.
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Affiliation(s)
- Samir V Patel
- 1 Sparks Regional Medical Center, University of Arkansas Medical Sciences west, Fort Smith, AR, USA
| | | | - Palak Patel
- 3 Massachusetts College of Pharmacy and Health Sciences, Manchester, NH, USA
| | | | - Parth Bhatt
- 5 Texas Tech Health Sciences Center, Amarillo, TX, USA
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Abstract
In the past decade, impressive strides have been made in the diagnosis and management of atherosclerotic, aneurysmal, and thromboembolic diseases, thanks in large part to the explosive growth in both vascular biology and clinical vascular medicine. We review what we consider to be the top 12 advances in this field: the discovery of nitric oxide, the metabolic syndrome, new thrombophilic disorders, therapeutic angiogenesis, endoluminal treatment of chronic venous disease, and a variety of drugs, including sildenafil, cilostazol, low-molecular-weight heparins, oral direct thrombin inhibitors, clopidogrel, statins, and angiotensin-converting enzyme inhibitors and angiotensin-receptor blocking agents.
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Affiliation(s)
- Allan W Reid
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
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12
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Abstract
Carotid artery revascularization using stent placement with embolic protection requires capable operators, well-prepared facilities, and appropriate patient selection. The recommendations in this document are intended to assist in the safe and appropriate dissemination of this new technique. Careful systematic evaluation of patient and procedure outcomes, locally and nationally, will ensure adherence to national benchmark standards and competency levels.
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Bates ER, Babb JD, Casey DE, Cates CU, Duckwiler GR, Feldman TE, Gray WA, Ouriel K, Peterson ED, Rosenfield K, Rundback JH, Safian RD, Sloan MA, White CJ. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting. Vasc Med 2016; 12:35-83. [PMID: 17451093 DOI: 10.1177/1358863x06076103] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Panaich SS, Patel N, Agnihotri K, Arora S, Savani C, Sonani R, Patel NJ, Patel SV, Solanki S, Schreiber T, Grines C, Badheka AO. Volume-outcome relationship for peripheral endovascular interventions: a review of existing literature. Expert Rev Pharmacoecon Outcomes Res 2016; 16:103-9. [PMID: 26732517 DOI: 10.1586/14737167.2016.1138859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The incidence and prevalence of peripheral vascular disease has been increasing. When coexistent with coronary artery disease (CAD), it has shown to predict higher mortality along with poorer quality-of-life consequently leading to a marked increase in healthcare costs. Broadly, there has been an increase in utilization of endovascular techniques in the management of peripheral vascular diseases. An inverse relation between volume and outcomes has been noted in these procedures. Additionally, improved resource utilization has also been noted with higher hospital and operator volumes. This has led to proposals to regionalize these procedures to high volume hospitals. There have also been calls to introduce the idea of having a set threshold of procedures for providers. This review presents an overview of published literature on the volume-outcome relationship affecting the outcomes of peripheral endovascular procedures.
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Affiliation(s)
| | - Nilay Patel
- b Internal Medicine Department , Saint Peter's University Hospital , New Brunswick , NJ , USA
| | - Kanishk Agnihotri
- b Internal Medicine Department , Saint Peter's University Hospital , New Brunswick , NJ , USA
| | - Shilpkumar Arora
- c Internal Medicine Department , Mount Sinai St. Luke's Roosevelt Hospital , New York , NY , USA
| | - Chirag Savani
- d Epidemiology Department , New York Medical College , Valhalla , NY , USA
| | - Raj Sonani
- e Public Health Department , Emory University School of Medicine , Atlanta , GA , USA
| | - Nileshkumar J Patel
- f Cardiology Department , University of Miami Miller school of Medicine , Miami , FL , USA
| | - Samir V Patel
- g Internal Medicine Department , Western Reserve Health System , Youngstown , OH , USA
| | - Shantanu Solanki
- h Internal Medicine Department , Westchester Medical center at New York Medical College , Valhalla , NY , USA
| | | | - Cindy Grines
- i Cardiology Department , Detroit Medical Centre , Detroit , MI , USA
| | - Apurva O Badheka
- j Cardiology Department , The Everett Clinic , Everett , WA , USA
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Aronow HD, Collins TJ, Gray WA, Jaff MR, Kluck BW, Patel RAG, Rosenfield KA, Safian RD, Sobieszczyk PS, Wayangankar SA, White CJ. SCAI/SVM expert consensus statement on Carotid Stenting: Training and credentialing for Carotid Stenting. Catheter Cardiovasc Interv 2015; 87:188-99. [DOI: 10.1002/ccd.26304] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/09/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Herbert D. Aronow
- Cardiovascular Institute of RI; Alpert Medical School of Brown University; Providence Rhode Island
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Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, Reekers J, Norgren L. An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries: A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II): The TASC Steering Comittee(.). Ann Vasc Dis 2015; 8:343-57. [PMID: 26730266 DOI: 10.3400/avd.tasc.15-01000] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) guidelines were last updated in 2007 (TASC II) and represented the collaboration of international vascular specialties involved in the management of patients with peripheral arterial disease (PAD). Since the publication of TASC II, there have been innovations in endovascular revascularization strategies for patients with PAD. The intent of this publication is to provide a complete anatomic lower limb TASC lesion classification, including the infrapopliteal segment, and an updated literature review of new endovascular techniques and practice patterns employed by vascular specialists today.
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Affiliation(s)
| | - Christopher J White
- The Ochsner Clinical School-University of Queensland, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - William R Hiatt
- Division of Cardiology, University of Colorado School of Medicine, and CPC Clinical Research, Aurora, CO, USA
| | - Gerry R Fowkes
- Centre for Population Health Sciences, The University of Edinburgh, UK
| | | | | | - Jim Reekers
- Academic Medical Center, University Hospital, Amsterdam, The Netherlands
| | - Lars Norgren
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Arora S, Panaich SS, Patel N, Patel N, Lahewala S, Solanki S, Patel P, Patel A, Manvar S, Savani C, Tripathi B, Thakkar B, Jhamnani S, Singh V, Patel S, Patel J, Bhimani R, Mohamad T, Remetz MS, Curtis JP, Attaran RR, Grines C, Mena CI, Cleman M, Forrest J, Badheka AO. Impact of Hospital Volume on Outcomes of Lower Extremity Endovascular Interventions (Insights from the Nationwide Inpatient Sample [2006 to 2011]). Am J Cardiol 2015; 116:791-800. [PMID: 26100585 DOI: 10.1016/j.amjcard.2015.05.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 05/23/2015] [Accepted: 05/23/2015] [Indexed: 10/23/2022]
Abstract
Our primary objective was to study postprocedural outcomes and hospitalization costs after peripheral endovascular interventions and the multivariate predictors affecting the outcomes with emphasis on hospital volume. The study cohort was derived from Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (2006 to 2011). Peripheral endovascular interventions were identified using appropriate International Classification of Diseases, Ninth Revision diagnostic and procedural codes. Annual institutional volumes were calculated using unique identification numbers and then divided into quartiles. Two-level hierarchical multivariate mixed models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and postprocedural complications. Amputation rates and hospitalization costs were also assessed. Multivariate analysis (odds ratio, 95% confidence interval, p value) revealed age (1.46, 1.37 to 1.55, p <0.001), female gender (1.28, 1.12 to 1.46, p <0.001), baseline co-morbidity status as depicted by a greater Charlson co-morbidity index score (≥2: 4.32, 3.45 to 5.40, p <0.001), emergent or urgent admissions(2.48, 2.14 to 2.88, p <0.001), and weekend admissions (1.53, 1.26 to 1.86, p <0.001) to be significant predictors of primary outcome. An increasing hospital volume quartile was independently predictive of improved primary (0.65, 0.52 to 0.82, p <0.001 for the fourth quartile) and secondary (0.85, 0.73 to 0.97, 0.02 for the fourth quartile) outcomes and lower amputation rates (0.52, 0.45 to 0.61, p <0.001). A significant reduction hospitalization costs ($-3,889, -5,318 to -2,459, p <0.001) was also seen in high volume centers. In conclusion, a greater hospital procedural volume is associated with superior outcomes after peripheral endovascular interventions in terms of inhospital mortality, complications, and hospitalization costs.
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18
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Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, Reekers J, Norgren L. An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries: A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Vasc Med 2015; 20:465-78. [DOI: 10.1177/1358863x15597877] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) guidelines were last updated in 2007 (TASC II) and represented the collaboration of international vascular specialties involved in the management of patients with peripheral arterial disease (PAD). Since the publication of TASC II, there have been innovations in endovascular revascularization strategies for patients with PAD. The intent of this publication is to provide a complete anatomic lower limb TASC lesion classification, including the infrapopliteal segment, and an updated literature review of new endovascular techniques and practice patterns employed by vascular specialists today.
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Affiliation(s)
| | | | - Christopher J. White
- The Ochsner Clinical School–University of Queensland, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - William R. Hiatt
- Division of Cardiology, University of Colorado School of Medicine, and CPC Clinical Research, Aurora, CO, USA
| | - Gerry R. Fowkes
- Centre for Population Health Sciences, The University of Edinburgh, UK
| | | | | | - Jim Reekers
- Academic Medical Center, University Hospital, Amsterdam, The Netherlands
| | - Lars Norgren
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, Reekers J, Norgren L. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: A supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II): The TASC steering commi. Catheter Cardiovasc Interv 2015; 86:611-25. [DOI: 10.1002/ccd.26122] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Christopher J. White
- The Ochsner Clinical School-University of Queensland, Ochsner Clinic Foundation; New Orleans LA USA
| | - William R. Hiatt
- Division of Cardiology; University of Colorado School of Medicine, and CPC Clinical Research; Aurora CO USA
| | - Gerry R. Fowkes
- Centre for Population Health Sciences, The University of Edinburgh; UK
| | | | | | - Jim Reekers
- Academic Medical Center, University Hospital; Amsterdam The Netherlands
| | - Lars Norgren
- Department of Surgery; Faculty of Medicine and Health, Örebro University; Örebro Sweden
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20
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Creager MA, Gornik HL, Gray BH, Hamburg NM, Iobst WF, Mohler ER, White CJ. COCATS 4 Task Force 9: Training in Vascular Medicine. Vasc Med 2015; 20:384-94. [DOI: 10.1177/1358863x15590348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Bruce H Gray
- †American Board of Vascular Medicine Representative
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21
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Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, Reekers J, Norgren L. An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries. J Endovasc Ther 2015; 22:663-77. [DOI: 10.1177/1526602815592206] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) guidelines were last updated in 2007 (TASC II) and represented the collaboration of international vascular specialties involved in the management of patients with peripheral arterial disease (PAD). Since the publication of TASC II, there have been innovations in endovascular revascularization strategies for patients with PAD. The intent of this publication is to provide a complete anatomic lower limb TASC lesion classification, including the infrapopliteal segment, and an updated literature review of new endovascular techniques and practice patterns employed by vascular specialists today.
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Affiliation(s)
| | | | - Christopher J. White
- The Ochsner Clinical School–University of Queensland, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - William R. Hiatt
- Division of Cardiology, University of Colorado School of Medicine, and CPC Clinical Research, Aurora, CO, USA
| | - Gerry R. Fowkes
- Centre for Population Health Sciences, The University of Edinburgh, UK
| | | | | | - Jim Reekers
- Academic Medical Center, University Hospital, Amsterdam, The Netherlands
| | - Lars Norgren
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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22
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23
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Truesdell AG, Delgado GA, Blakeley SW, Bachinsky WB. Transradial peripheral vascular intervention: challenges and opportunities. Interv Cardiol 2015. [DOI: 10.2217/ica.14.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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24
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Lanza G, Setacci C, Cremonesi A, Ricci S, Inzitari D, de Donato G, Castelli P, Pratesi C, Peinetti F, Lanza J, Zaninelli A, Gensini GF. Carotid Artery Stenting: Second Consensus Document of the ICCS/ISO-SPREAD Joint Committee. Cerebrovasc Dis 2014; 38:77-93. [DOI: 10.1159/000365501] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/25/2014] [Indexed: 11/19/2022] Open
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25
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Kaufman JA. The 28th Annual Dr. Charles T. Dotter Lecture: IR 360-the external and internal forces that shape our specialty. J Vasc Interv Radiol 2012; 23:1117-24. [PMID: 22920975 DOI: 10.1016/j.jvir.2012.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 06/10/2012] [Accepted: 06/11/2012] [Indexed: 11/30/2022] Open
MESH Headings
- Competitive Behavior
- Diffusion of Innovation
- Economic Competition
- Endovascular Procedures/economics
- Endovascular Procedures/history
- Endovascular Procedures/trends
- Health Care Costs
- Health Services Needs and Demand/organization & administration
- History, 20th Century
- History, 21st Century
- Humans
- Models, Organizational
- Radiography, Interventional/economics
- Radiography, Interventional/history
- Radiography, Interventional/trends
- Radiology, Interventional/economics
- Radiology, Interventional/history
- Radiology, Interventional/organization & administration
- Radiology, Interventional/trends
- Specialization/economics
- Specialization/history
- Specialization/trends
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26
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Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, Hermiller JB, Kinlay S, Landzberg JS, Laskey WK, McKay CR, Miller JM, Moliterno DJ, Moore JWM, Oliver-McNeil SM, Popma JJ, Tommaso CL. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol 2012; 59:2221-305. [PMID: 22575325 DOI: 10.1016/j.jacc.2012.02.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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27
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Lanzer P, Prechelt L. Expanding the base for teaching of percutaneous coronary interventions: The explicit approach. Catheter Cardiovasc Interv 2010; 77:372-80. [DOI: 10.1002/ccd.22790] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 08/24/2010] [Indexed: 11/05/2022]
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Matsumura JS, Gray W, Chaturvedi S, Gao X, Cheng J, Verta P. CAPTURE 2 risk-adjusted stroke outcome benchmarks for carotid artery stenting with distal embolic protection. J Vasc Surg 2010; 52:576-83, 583.e1-583.e2. [DOI: 10.1016/j.jvs.2010.03.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 03/19/2010] [Accepted: 03/25/2010] [Indexed: 11/15/2022]
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29
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Capturing the Essence of Developing Endovascular Expertise for the Construction of a Global Assessment Instrument. Eur J Vasc Endovasc Surg 2010; 40:292-302. [DOI: 10.1016/j.ejvs.2010.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 04/29/2010] [Indexed: 01/18/2023]
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30
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Starr J. Required skills and interdisciplinary teams in starting a TEVAR practice. J Vasc Surg 2010; 52:45S-9S. [PMID: 20800421 DOI: 10.1016/j.jvs.2010.06.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 06/16/2010] [Accepted: 06/17/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Jean Starr
- The Ohio State University, 456 W 10th Ave, Cramblett Hall 3018, Columbus, Ohio 43210, USA.
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31
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Mudra H. Carotid artery stenting: what do recent trials and registries tell us? Future Cardiol 2009; 4:449-53. [PMID: 19804338 DOI: 10.2217/14796678.4.5.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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32
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Sacks D, Connors JJ. Carotid stenting, stroke prevention, and training. J Vasc Interv Radiol 2009; 20:S302-5. [PMID: 19560014 DOI: 10.1016/j.jvir.2009.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- David Sacks
- Department of Radiology, Reading Hospital and Medical Center, Sixth and Spruce Streets, West Reading, PA 19603, USA.
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33
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Karmy-Jones R, Kouchoukos NT. Endovascular credentialing and assembling the endovascular team. J Card Surg 2009; 24:334-42. [PMID: 19438793 DOI: 10.1111/j.1540-8191.2009.00839.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Riyad Karmy-Jones
- Department of Thoracic and Vascular Surgery, Southwest Washington Medical Center, Vancouver, Washington, USA
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34
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Goldstein LB. New data about stenting versus endarterectomy for symptomatic carotid artery stenosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2009; 11:232-40. [DOI: 10.1007/s11936-009-0024-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Meyers PM, Schumacher HC, Higashida RT, Barnwell SL, Creager MA, Gupta R, McDougall CG, Pandey DK, Sacks D, Wechsler LR. Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures. Circulation 2009; 2:177-88. [PMID: 19349327 DOI: 10.1161/circulationaha.109.192217] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Although carotid angioplasty and stenting have been performed for more than 20 years, the regulations surrounding its performance have remained a controversial issue. Intervention in the cerebral vascular bed is the only area in which regulations have limited the applicability of interventional techniques to vascular disease. Whether or not this is the correct approach remains to be seen, but knowledge of the regulations and requirements surrounding the performance of carotid stenting are of paramount importance for those performing these procedures. A review of the regulations affecting everything from the institutions to the physicians performing these procedures, as outlined in this article, will be helpful in clarifying for physicians and institutions what is mandated before performing carotid intervention.
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Affiliation(s)
- Daniel G Clair
- Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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38
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Qureshi AI, Abou-Chebl A, Jovin TG. Qualification Requirements for Performing Neurointerventional Procedures: A Report of the Practice Guidelines Committee of the American Society of Neuroimaging and the Society of Vascular and Interventional Neurology. J Neuroimaging 2008; 18:433-47. [DOI: 10.1111/j.1552-6569.2007.00210.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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39
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Tsang J, Naughton P, Leong S, Hill A, Kelly C, Leahy A. Virtual reality simulation in endovascular surgical training. Surgeon 2008; 6:214-20. [DOI: 10.1016/s1479-666x(08)80031-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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40
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Berns JS, O'Neill WC. Performance of procedures by nephrologists and nephrology fellows at U.S. nephrology training programs. Clin J Am Soc Nephrol 2008; 3:941-7. [PMID: 18417748 DOI: 10.2215/cjn.00490108] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Some procedures (e.g., placement of temporary hemodialysis catheters and kidney biopsies) are required in nephrology fellowship training. Others (e.g., placement of tunneled hemodialysis catheters, ultrasonography, and hemodialysis access interventions) are not required but are performed at some centers. To assess the procedures performed by nephrologists and nephrology fellows at U.S. adult nephrology training programs and the number of procedures required for fellow competency, a survey was conducted of all such training programs. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS An on-line survey was e-mailed to the directors of all U.S. adult nephrology fellowship programs in October to November 2007. RESULTS Responses were received from 93 of 136 programs. Nephrologists and nephrology trainees perform native and transplant kidney biopsies in 98% to 99% of programs and, in about half of programs, also perform the ultrasound guidance. Diagnostic ultrasounds are performed at fewer programs. Temporary dialysis catheters are inserted at nearly all programs. Tunneled hemodialysis catheters and peritoneal dialysis catheters are placed at < or =20% of programs. Interventional procedures on hemodialysis access are performed at 13% to 21% of programs. Continuous renal replacement therapy is performed at 99% of programs, plasmapheresis at 40%. Many programs either do not specify a minimum number of supervised procedures that need to be performed to demonstrate competence or require a very limited number. CONCLUSIONS Core procedures are performed at almost all programs. Experience and training in other procedures are variable. Many programs have limited requirements for the number of procedures trainees need to perform to demonstrate competence.
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Affiliation(s)
- Jeffrey S Berns
- University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Founders Pavilion, Philadelphia, PA 19104, USA.
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41
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Creager MA, Cooke JP, Olin JW, White CJ. Task force 11: Training in vascular medicine and peripheral vascular catheter-based interventions: Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society for Vascular Medicine. Catheter Cardiovasc Interv 2008. [DOI: 10.1002/ccd.21515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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42
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Guidelines for hospital privileges in vascular and endovascular surgery: Recommendations of the Society for Vascular Surgery. J Vasc Surg 2008; 47:1-5. [DOI: 10.1016/j.jvs.2007.10.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 09/28/2007] [Accepted: 10/03/2007] [Indexed: 11/22/2022]
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43
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Creager MA, Cooke JP, Olin JW, White CJ. Task Force 11: Training in Vascular Medicine and Peripheral Vascular Catheter-Based Interventions. J Am Coll Cardiol 2008; 51:398-404. [DOI: 10.1016/j.jacc.2007.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Peripheral arterial disease is one manifestation of systemic atherosclerosis. The prevalence of peripheral arterial disease increases with the age of the population. It is important to remember the significant association of coincident coronary artery disease, which is the major cause of mortality in these patients. Remarkable technological advances in the past decade, along with patient preference, have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments. The availability of stents, more than any other advance, has fueled the growth of catheter-based procedures by improving the safety, durability, and predictability of percutaneous revascularization.
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Affiliation(s)
- Christopher J White
- Department of Cardiology, Ochsner Clinic Foundation, 1514 Jefferson Hwy, New Orleans, LA 70121-2483, USA.
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45
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Levin DC, Rao VM, Bonn J. Turf wars in radiology: the battle for peripheral vascular interventions. J Am Coll Radiol 2007; 2:68-71. [PMID: 17411763 DOI: 10.1016/j.jacr.2004.07.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Indexed: 11/19/2022]
Abstract
Interventional radiologists in many hospitals are involved in confrontations with cardiologists and vascular surgeons over who should be allowed to perform percutaneous noncardiac peripheral vascular interventions. There are valid reasons why radiologists should be the ones doing these procedures: first, because in any given hospital, radiologists are generally the physicians with the best training and most experience, and second, because they are generally not in a position to self-refer and will therefore be able to help keep utilization under control. If cardiologists or vascular surgeons request vascular interventional privileges at your hospital, there are steps you can take to see if they are properly qualified. If they are granted privileges, there are other steps you can take to ensure that high standards of patient care are maintained. The authors also present some discussion of how interventional radiologists can position themselves to either compete with or collaborate with the other clinical services. Throughout any confrontations that might occur, radiologists should stress that patients undergoing these procedures deserve the best possible care, which means that they should be performed by those physicians on the hospital staff who are the most knowledgeable and the least likely to commit medical errors.
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Affiliation(s)
- David C Levin
- Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
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46
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Forbes TL, Chu MWA, Lawlor DK, DeRose G, Harris KA. Learning curve analysis of thoracic endovascular aortic repair in relation to credentialing guidelines. J Vasc Surg 2007; 46:218-22. [PMID: 17600665 DOI: 10.1016/j.jvs.2007.03.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 03/23/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Recently, practice guideline documents have recommended the completion of different levels of interventional experience and 5 or 10 thoracic endovascular aortic cases prior to surgeon credentialing. This study's purpose was to determine whether these requirements are valid by reviewing three surgeons' learning curves with thoracic aortic endovascular repairs. METHODS Between 1998 and 2006, 67 patients underwent emergent or elective endovascular repair of thoracic aortic pathologies by one of three vascular surgeons with extensive experience with catheter manipulation and abdominal aortic endografts. Following standard retrospective review, each surgeon's learning curve was analyzed using the cumulative sum failure method with a target success rate of 95% derived from the literature. The main outcome variable was primary technical success. RESULTS These 67 patients presented with several pathologies including elective (n = 31) and ruptured (n = 11) thoracic aortic aneurysms, acute dissections or aortic ulcers (n = 10), and acute blunt thoracic aortic trauma (n = 15). The mean age was 65 (range: 20 to 90) and the early (30 day) mortality rate was 19.4% in urgent cases (n = 36) and 0% in elective cases (n = 31). Paraplegia occurred in two patients (3%). Primary technical success was achieved in 62 cases (92.5%) and did not differ between surgeons (92.6%, 91.3%, 94.1%, respectively; P = .9). Each surgeon's cases were plotted sequentially and the resulting learning curves were similar. Although acceptable outcomes were obtained throughout the study period, improved results, compared with the target success rate, were not achieved until each surgeon treated 5 to 10 patients. CONCLUSION This study supports the case volume requirements of the Society for Vascular Surgery credentialing guidelines, which also requires extensive catheter and guidewire experience. With this background in catheter manipulation and endovascular abdominal aortic repair, surgeons can achieve optimal outcomes with thoracic aortic lesions following 5 to 10 cases.
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Affiliation(s)
- Thomas L Forbes
- Division of Vascular Surgery, London Health Sciences Centre and the University of Western Ontario, London, Ontario, Canada.
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King SB, Aversano T, Ballard WL, Beekman RH, Cowley MJ, Ellis SG, Faxon DP, Hannan EL, Hirshfeld JW, Jacobs AK, Kellett MA, Kimmel SE, Landzberg JS, McKeever LS, Moscucci M, Pomerantz RM, Smith KM, Vetrovec GW, Creager MA, Hirshfeld JW, Holmes DR, Newby LK, Weitz HH, Merli G, Piña I, Rodgers GP, Tracy CM. ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures. J Am Coll Cardiol 2007; 50:82-108. [PMID: 17601554 DOI: 10.1016/j.jacc.2007.05.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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48
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King SB, Aversano T, Ballard WL, Beekman RH, Cowley MJ, Ellis SG, Faxon DP, Hannan EL, Hirshfeld JW, Jacobs AK, Kellett MA, Kimmel SE, Landzberg JS, McKeever LS, Moscucci M, Pomerantz RM, Smith KM, Vetrovec GW. ACCF/AHA/SCAI 2007 update of the clinical competence statement on cardiac interventional procedures a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians task Force on Clinical Competence and Training (writing committee to update the 1998 clinical competence statement on recommendations for the assessment and maintenance of proficiency in coronary interventional procedures). Catheter Cardiovasc Interv 2007. [DOI: 10.1002/ccd.21313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Black SA, Pandey VA, Wolfe JHN. Training for Carotid Intervention: Preparing the Next Generation. Eur J Vasc Endovasc Surg 2007; 33:518-24. [PMID: 17296317 DOI: 10.1016/j.ejvs.2006.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 12/18/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Carotid interventions are performed to reduce the cumulative risk of stroke. The success of the procedure is dependent upon maintaining low operative risk. This article reviews the current state of training for both carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS). METHODS Medline searches were performed to identify articles with the combination of the following key words: carotid, endarterectomy, stent, training, assessment and simulation. Manual searches of the reference lists and related papers was conducted. RESULTS Training and assessment for CEA and CAS follows the traditional apprenticeship model. There is no formal training protocol or objective means of assessment for either carotid endarterectomy or stenting. Models and simulators to allow for training and assessment away from the operative theatre have been developed, and exist for both CEA and CAS. CONCLUSION The technology exists to allow for both training and assessment of competency to take place in a controlled and objective environment for both CEA and CAS. The use of simulation needs to be robustly evaluated and assessed to both complement and augment existing training programs to ensure that the highest standards of care are maintained for treatment of carotid territory disease. Objective competency based training and assessment is no longer unattainable. Simulators augment this process and without them operative exposure is sporadic and crisis management infrequent.
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Affiliation(s)
- S A Black
- St Mary's Hospital Regional Vascular Unit, Praed Street, London W2 1NY, UK
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50
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