Bullying of vascular surgery trainees.

OBJECTIVE: Bullying is defined as the perception of negative actions in which the target has difficulty in defending themself. Bullying can include verbal, physical, and psychological force used to influence the target's behavior. We sought to understand the factors associated with bullying identified in vascular surgery trainees and the barriers to reporting. METHODS: An anonymous electronic survey consisting of demographic information and validated scales for bullying (negative acts questionnaire - revised [NAQ-R]), social support, and grit was sent to vascular surgery trainees in the United States. The respondents who had reported experiencing bullying were compared with those who had not been bullied. RESULTS: Of the 516 trainees invited, 132 (26%) completed the survey. Of these 132 trainees, 63 (48%) reported having been bullied or witnessing a fellow trainee being bullied in the previous 6 months, with 42 (32%) reporting having been bullied. Gender, marital status, paradigm of vascular training, grit level, and social support did not predict for the receipt of bullying, although those in the highest quartile of grit showed a trend toward lower NAQ-R scores (P = .06). As expected, the trainees that reported having experienced bullying had had higher NAQ-R scores (P < .0001). No trainee reported daily bullying; however, 52% reported bullying "now and then" or several times a week. The most common perpetrator was their direct superior surgeon, although 12 (29%) had reported bullying from co-residents and 6 (14%) had reported bullying from patients. Of the 42 trainees who had reported experiencing bullying, 15 (36%) did not address the bullying behavior. The most common barriers to reporting bullying identified were fear of loss of support from their supervisor (48%), loss of reputation (45%), and effect on career choices (43%). Of those who reported addressing the behavior, 56% reported that the behavior had continued. Of the 132 respondents, 70 (53%) reported no knowledge of institution-specific policies to address bullying in their program. The most common reasons identified for why bullying might occur in vascular training programs were "high stress environments" and "learned behavior" from others. CONCLUSIONS: Our results indicate that bullying occurs for a significant number of vascular trainees. However, we did not find any clearly identified factors predictive of who will experience bullying. Trainees with higher grit might experience less bullying or be more likely to have a lower perception of bullying behavior. Further research is needed to determine the effects of bullying on vascular trainees.

Outcomes after endovascular reintervention for aortic interventions.

OBJECTIVE: Endovascular reinterventions are often performed after previous open or endovascular aortic procedures. We used the GREAT (Global Registry for Endovascular Aortic Treatment) database to compare the outcomes between these groups. We also compared reintervention of any type with a group of patients who had undergone primary endovascular abdominal aortic aneurysm repair (EVAR). METHODS: All patients enrolled in GREAT were grouped according to a previous EVAR or open abdominal aortic procedure (OAP). Univariate analysis was performed using the χ2, Wilcoxon rank sum, and Fisher exact tests. Cox proportional analysis was used to test the predictors for all-cause and aorta-related mortality. RESULTS: A total of 3974 subjects who had undergone EVAR with follow-up data available were included in the GREAT. Of the 3974 procedures, 196 (4.9%) were reinterventions (49 after OAP and 147 after previous EVAR). Reintervention after previous EVAR showed a trend toward a greater endoleak rate through 2 years (13.6% vs 4.1%; P = .07), although no difference was found in the occurrence of the intervention (12.2% vs 17.7%; P = .37). Reintervention after OAP resulted in higher all-cause mortality through 2 years of follow-up (32.7% vs 17.7%; P = .0.03). The predictors of mortality included prior OAP, renal insufficiency, and the use of cutdown for access. Compared with the patients who had undergone primary endovascular repair, patients in the reintervention cohort were older (75.3 years vs 73.3 years; P = .0005), had had only femoral artery access used (95.8% vs 90.3%; P < .0001), and were more likely to have undergone aortic branch vessel procedures (32.3% vs 13.3%; P < .0001). Both all-cause and aorta-related mortality through 2 years was higher in the reintervention group than in the primary EVAR group (21.4% vs 12.5% [P = .0003; and 4.6% vs 1% [P < .0001], respectively). On multivariate analysis, the predictors of aortic-related mortality included reintervention, renal insufficiency, chronic obstructive pulmonary disease, underweight body mass index, increasing aortic diameter, and the use of brachial artery or other arterial access sites. CONCLUSIONS: Endovascular reintervention for aortic pathology was associated with higher mortality than was primary EVAR. Reinterventions after prior OAPs were associated with higher mortality than were prior EVARs.

Operative management of an incidental portal vein aneurysm in the setting of an incarcerated congenital diaphragmatic hernia.

Portal vein aneurysms are rare pathologic entities. A 3.7-cm portal vein aneurysm was incidentally discovered in an 80-year-old male patient on imaging for acute abdominal pain secondary to an incarcerated diaphragmatic hernia. The aneurysm was resected, and primary repair of the portal vein was performed during a second-look operation after repair of the incarcerated hernia. Operative intervention was chosen for this patient because of the aneurysm's size and the additional indication for abdominal exploration.