Educational challenges in vascular surgery: an Australasian response.

In Australia and New Zealand, training requirements in vascular surgery have substantially changed since 2002. Training in general surgery is no longer required. Trainees in vascular surgery need to be competent in open vascular surgery and in performing and interpreting vascular ultrasound imaging. They must also master a full range of endovascular procedures, including cannulation of arteries, and angioplasty and stenting procedures, and endoluminal repair of aneurysms with stent grafting. Applicants complete a rigorous selection process and are ranked nationally. Training is started in postgraduate year 3 or at any time beyond that. The 5-year program is the competency-based surgical education training (SET) program. The trainees sit an examination at the end of the SET 1 and also an exit examination in SET 5. Before the final examination, the trainees must have performed 400 major cases as primary operators and 150 peripheral percutaneous interventions. In addition they must satisfy the requirements of the on-line in-service examinations and show adequate ultrasound case volumes and completion of research projects.

Australian Vascular Quality of Life Index (AUSVIQUOL): a pilot study of a disease-specific quality of life measure.

BACKGROUND: To develop and test a quality of life (QOL) index specific for patients with vascular disease and appropriate for patients with abdominal aortic aneurysm (AAA) in the clinical setting. METHODS: The questions and domains of the Australian Vascular Quality of Life Index (AUSVIQUOL) were determined by examination of a prospective database for frequency of symptoms and an in-depth interview of a sample population. The validity of the AUSVIQUOL was tested by comparing it with the Medical Outcomes Short Form Health Survey (SF-36) in a study involving 60 patients who underwent endovascular AAA repair and 48 open AAA repair. A subpopulation of 22 patients representative of the two groups was then reassessed using the SF-36 and the AUSVIQUOL, to compare the reliability of the two indices. RESULTS: Similar domains of the SF-36 and the AUSVIQUOL measured common QOL elements. The correlation between the two indices was moderate; the AUSVIQUOL measured additional disease-specific QOL factors. The AUSVIQUOL showed better reliability than the SF-36 in all domains and statistically better in the physical function domain (P < 0.05). CONCLUSION: The AUSVIQUOL is an appropriate tool for the QOL assessment of patients with AAA in the clinical setting.

Endovascular abdominal aortic aneurysm repair: a 7 year experience at the Launceston General Hospital.

BACKGROUND: To review our 7 year experience of endovascular abdominal aortic aneurysm repair (EVR) and to compare this to open repair (OR) during the same time period. METHODS: One hundred and one EVR and 65 OR patients were studied. Parameters analysed included patient and procedure details, intensive care unit (ICU) and hospital admission time, and morbidity and mortality with particular emphasis on procedure-related problems. RESULTS: Endovascular grafts were deployed with successful abdominal aortic aneurysm (AAA) exclusion in 100 patients. Primary technical success was achieved in 84%, clinical success in 86% and secondary success in 90% of cases. Complications occurred in 63% and 88% of EVR and OR patients, respectively. Early device-related complications occurred in 40 EVR patients (40%); 24 (60%) were corrected immediately by further stenting. Late device-related complications occurred in 15 EVR patients (15%); four (27%) required additional stenting. Most of the complications in the OR group were systemic (89%) resulting in longer ICU and hospital stays (median 48 vs 17 h and 13 vs 4 days for OR and EVR, respectively). Death within 30 days of the procedure occurred in three EVR patients. There was no perioperative mortality in the OR group. CONCLUSION: Endovascular AAA repair can be undertaken successfully in a district general hospital. The majority of local and device-related complications can be corrected immediately, while those persisting beyond the initial procedure usually resolve spontaneously. EVR offers a minimally invasive approach to a problem that in the past has involved major surgery.