Facilitators and Barriers to Implementation of Simulation Based Education in Vascular Surgery in Europe.

Objective: This study explored the status and availability of simulation based education (SBE) for learning vascular surgical procedures identified in the 2019 General Needs Assessment in vascular surgery in Europe (GNA-2019) and identified facilitators and barriers to SBE implementation in vascular surgery.

Methods: A three round iterative survey was distributed via the European Society for Vascular Surgery and the Union Européenne des Médecins Spécialistes. Members from leading committees and organisations within the European vascular surgical community were invited to participate as key opinion leaders (KOLs).

Evaluating the feasibility and acceptability of an exercise and behaviour change intervention in socioeconomically deprived patients with peripheral arterial disease: The textpad study protocol.

This pilot randomised controlled trial aims to assess the feasibility and acceptability of a 12-week home-based telehealth exercise and behavioural intervention delivered in socioeconomically deprived patients with peripheral artery disease (PAD). The study will also determine the preliminary effectiveness of the intervention for improving clinical and health outcomes. Sixty patients with PAD who meet the inclusion criteria will be recruited from outpatient clinic at the Freeman Hospital, United Kingdom.

The adverse impact of pre-operative anaemia on survival following major lower limb amputation.

Introduction: Approximately 5000 major lower-limb amputations (MLLA) for PAD occur per-annum in the UK with clinical outcomes being poor for this high-risk cohort of patients. Existing evidence suggests that anaemic surgical patients have an increased 30-day mortality, but this has not been explored in the context of MLLA. Recent prioritization processes suggested that MLLAs are a target area for research into outcome improvement.

Interventions for great saphenous vein incompetence.

Background: Great saphenous vein (GSV) incompetence, causing varicose veins and venous insufficiency, makes up the majority of lower-limb superficial venous diseases. Treatment options for GSV incompetence include surgery (also known as high ligation and stripping), laser and radiofrequency ablation, and ultrasound-guided foam sclerotherapy. Newer treatments include cyanoacrylate glue, mechanochemical ablation, and endovenous steam ablation.

Anaemia: A risk factor for death and adverse outcomes following surgery for acute lower limb ischaemia.

Introduction: Acute limb ischaemia (ALI) forms a significant part of the vascular surgery workload and carries with it high rates of morbidity and mortality. Anaemia is also common amongst vascular surgical patients and has been linked with poor outcomes in some subgroups. We aimed to assess the frequency of anaemia in patients with ALI and its impact on survival and complications following revascularisation to help direct future efforts to optimise outcomes in this patient group.

Reliability of the Edinburgh Claudication Questionnaire for Identifying Symptomatic PAD in General Practice.

The Edinburgh Claudication Questionnaire (ECQ) was developed to help identify peripheral arterial disease (PAD) in the general population but has not been validated against diagnostic arterial imaging methods such as Duplex Vascular Ultrasound Scanning (DUS). In the present study, we assessed the accuracy of the ECQ for diagnosis using DUS. As part of a National Institute of Health Research funded project looking at novel diagnostic methods, 250 patients were studied from 15 general practices across North East England from May 2015 and November 2016.

Transvenous endovascular repair of symptomatic type II endoleak following endovascular repair of a ruptured common iliac aneurysm with arteriovenous fistula.

Arteriovenous fistula (AVF) is an uncommon presentation of ruptured aortoiliac aneurysm (rAIA). Symptomatic persistence of an AVF fed by a type II endoleak after endovascular aneurysm repair (EVAR) for rAIA is rare, with little in the literature to guide practice. We present a novel transvenous approach to treatment of symptomatic type II endoleak after EVAR for rAIA with AVF.

Reducing the risk of venous thromboembolism following superficial endovenous treatment: A UK and Republic of Ireland consensus study.

Objectives: Venous thromboembolism is a potentially fatal complication of superficial endovenous treatment. Proper risk assessment and thromboprophylaxis could mitigate this hazard; however, there are currently no evidence-based or consensus guidelines. This study surveyed UK and Republic of Ireland vascular consultants to determine areas of consensus.

The Interplay between Preoperative Anemia and Postoperative Blood Transfusion on Survival following Fenestrated Aortic Aneurysm Repair.

Background: Anemia is associated with a higher mortality following standard endovascular aortic repair (EVAR). This study evaluates the impact of anemia on fenestrated endovascular aneurysm repair (FEVAR) for complex aneurysm (AAA) repair.

Methods: All elective FEVARs performed between 2010 and 2018 at a tertiary vascular center were analyzed.

Perceived Anxiety is Negligible in Medical Students Receiving Video Feedback During Simulated Core Practical Skills Teaching: A Randomised Trial Comparing Two Feedback Modalities.

Introduction The ability to undertake simple practical procedures is essential for graduating medical students and is typically assessed using simulated models. Feedback is a key component of the learning process in developing proficiency in these key skills. Video feedback (VF) has previously shown promise, however, negative effects of VF-related anxiety on performance have been previously reported.

The Influence of Preoperative Anemia on Clinical Outcomes After Infrainguinal Bypass Surgery.

Background: Anemia is associated with greater mortality and complications in cardiovascular surgery. Within chronic limb-threatening ischemia, the effect of anemia is becoming apparent. This study aimed to further understand the influence of anemia in patients undergoing surgical revascularization for lower limb ischemia.

Educational Impact of a Pulsatile Human Cadaver Circulation Model for Endovascular Training.

Objectives: The face and construct validity of a novel pulsatile human cadaver model (PHCM) was recently demonstrated for endovascular training. This study aimed to assess the model's educational impact.

Methods: Twenty-four endovascular novices were recruited and split into two equal training groups: PHCM and virtual reality simulator (VRS).

Evaluating the Construct Validity of a Pulsatile Fresh Frozen Human Cadaver Circulation Model for Endovascular Training.

Background: We recently described a pulsatile fresh frozen human cadaver model (PHCM) for training endovascular practitioners. This present study aims to assess the construct validity of PHCM; its ability to differentiate between participants of varying expertise.

Methods: Twenty-three participants with varying endovascular experience (12 novice, 4 intermediate, and 7 expert) were recruited.

Asynchronous Unsupervised Video-Enhanced Feedback As Effective As Direct Expert Feedback in the Long-Term Retention of Practical Clinical Skills: Randomised Trial Comparing 2 Feedback Methods in a Cohort of Novice Medical Students.

Objectives: To determine the degree of practical clinical skills' retention over a 7-week period after receiving either video-enhanced direct expert feedback (DEF) or asynchronous unsupervised video-enhanced feedback (UVF).

Design: A prospective single-blinded randomized trial was conducted over a 7-week period with novice medical students. Following a generic introduction, PowerPoint presentation and live demonstration of intravenous cannulation was given by an expert, and candidates performed the same task in isolation while being recorded and were randomized to receive either DEF or UVF.

A Pulsatile Fresh Frozen Human Cadaver Circulation Model for Endovascular Training: A Trial of Face Validity.

Background: The authors have published their design of a pulsatile fresh frozen human cadaver circulation model (PHCM) for endovascular training the face validity of the PHCM for training endovascular practitioners was subsequently assessed.

Methods: Twelve endovascular clinicians performed the same 2 procedures (catheterization of the left renal artery and left subclavian artery) on PHCM and Simbionix angiomentor virtual reality simulator (SVR). They were randomized to begin on either the PHCM or SVR.

Design of a Pulsatile Fresh Frozen Human Cadaver Circulation Model for Endovascular Training.

Background: The objective of this project was to create a model capable of training endovascular skills using a freshly frozen human cadaver (HC). We present the results of our experience creating a cadaveric model for endovascular skills training. We undertook a unique cadaver laboratory-based research project.

Maintenance of Hemodialysis Vascular Access and Prevention of Access Dysfunction: A Review.

Background: Current Renal Association guidelines recommend the creation of an arteriovenous fistula as the first choice for hemodialysis access, with artificial grafts kept in reserve. However, maintaining working access comes with significant difficulties, as well as an estimated annual cost to the National Health Service of greater than £84 million. Multiple methods of improving the successful creation of hemodialysis access, improving access maintenance and preventing access dysfunction therefore exist.

Three-dimensional (3D) printed endovascular simulation models: a feasibility study.

Background: Three-dimensional (3D) printing is a manufacturing process in which an object is created by specialist printers designed to print in additive layers to create a 3D object. Whilst there are initial promising medical applications of 3D printing, a lack of evidence to support its use remains a barrier for larger scale adoption into clinical practice. Endovascular virtual reality (VR) simulation plays an important role in the safe training of future endovascular practitioners, but existing VR models have disadvantages including cost and accessibility which could be addressed with 3D printing.

Individualised Expert Feedback is Not Essential for Improving Basic Clinical Skills Performance in Novice Learners: A Randomized Trial.

Objective: To determine whether unsupervised video feedback (UVF) is as effective as direct expert feedback (DEF) in improving clinical skills performance for medical students learning basic surgical skills-intravenous cannulation, catheterization, and suturing.

Background: Feedback is a vital component of the learning process, yet great variation persists in its quality, quantity, and methods of delivery. The use of video technology to assist in the provision of feedback has been adopted increasingly.

The role of simulation in the development of endovascular surgical skills.

Endovascular trainees in the National Health Service still largely rely on the apprentice-apprenticeship model from the late 19th century. As the scope for endovascular therapy increases, due to the rapid innovation, evolution and refinement of technology, so too do patients' therapeutic options. This climate has also opened the door for more novel training adjuncts, to address the gaps that exist in our current endovascular training curriculum.

Student Views on the Use of 2 Styles of Video-Enhanced Feedback Compared to Standard Lecture Feedback During Clinical Skills Training.

Background: Feedback plays an important role in the learning process. However, often this may be delivered in an unstructured fashion that can detract from its potential benefit. Further, students may have different preferences in how feedback should be delivered, which may be influenced by which method they feel will lead to the most effective learning.

Randomized trial to assess the effect of supervised and unsupervised video feedback on teaching practical skills.

Background: Feedback is a vital component of the learning process; however, great variation exists in the quality, quantity, and method of delivery. Video feedback is not commonly used in the teaching of surgical skills. The aim of this trial was to evaluate the benefit of 2 types of video feedback-individualized video feedback (IVF), with the student reviewing their performance with an expert tutor, and unsupervised video-enhanced feedback (UVF), where the student reviews their own performance together with an expert teaching video-to determine if these improve performance when compared with a standard lecture feedback.

Developing cross-specialty endovascular simulation training.

Background: Simulation is increasingly recognised as a valuable tool in training tomorrow's doctors. This technology has the potential to improve patient safety and address some of the challenges posed by recent changes in doctors' training, yet the uptake has been slow in the majority of institutions. In our own centre, we noted existing equipment was used infrequently.

Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices.

Background: Minimally invasive techniques to treat great saphenous varicose veins include ultrasound-guided foam sclerotherapy (UGFS), radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). Compared with flush saphenofemoral ligation with stripping, also referred to as open surgery or high ligation and stripping (HL/S), proposed benefits include fewer complications, quicker return to work, improved quality of life (QoL) scores, reduced need for general anaesthesia and equivalent recurrence rates. This is an update of a review first published in 2011.