Perspectives on Surgical Leadership: A Panel Discussion at the Society for Clinical Vascular Surgery.

Leadership is a skill that all surgeons are confronted with in some capacity. Surprisingly in the US most training programs do not offer a structured program in leadership and there certainly are no metrics used to assess leadership competency. As a response to this, at The Society for Clinical Vascular Surgery (SCVS) a panel of leaders in vascular surgery both national and international, along with leadership experts discussed some of the salient issues in this space.

Experimental multiparametric magnetic resonance imaging characterization of iliocaval venous thrombosis pathological changes.

Objective: Iliocaval thrombotic obstruction is a challenging condition, especially because thrombus age and corresponding pathological remodeling at presentation are unknown, which directly impacts management. Our aim was to assess the ability of magnetic resonance imaging (MRI) in determining age thresholds of experimentally created inferior vena cava (IVC) thrombosis in pigs.

Methods: We used a previously described swine model of IVC thrombosis.

Convolutional Neural Networks to Study Contrast-Enhanced Magnetic Resonance Imaging-Based Skeletal Calf Muscle Perfusion in Peripheral Artery Disease.

Peripheral artery disease (PAD) is associated with impaired blood flow in the lower extremities and histopathologic changes of the skeletal calf muscles, resulting in abnormal microvascular perfusion. We studied the use of convolution neural networks (CNNs) to differentiate patients with PAD from matched controls using perfusion pattern features from contrast-enhanced magnetic resonance imaging (CE-MRI) of the skeletal calf muscles. We acquired CE-MRI based skeletal calf muscle perfusion in 56 patients (36 patients with PAD and 20 matched controls).

Editor's Choice - Development and Testing of Step, Error, and Event Frameworks to Evaluate Technical Performance in Peripheral Endovascular Interventions.

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.

Configuration affects parallel stent grafting results.

Objective: A number of adjunctive "off-the-shelf" procedures have been described to treat complex aortic diseases. Our goal was to evaluate parallel stent graft configurations and to determine an optimal formula for these procedures.

Methods: This is a retrospective review of all patients at a single medical center treated with parallel stent grafts from January 2010 to September 2015.

Intraoperative Gutter Leaks That Merit Our Attention.

Introduction: The natural history and potential morbidity of gutter endoleaks are unclear. We present our experience with intraoperative gutter endoleaks and strategies to determine which of these require intervention.

Methods: This is a retrospective review of all patients treated with parallel stent grafts from January 2010 to September 2015.

Positive Impact of an Aortic Center Designation.

Background: In January 2015, we created a multidisciplinary Aortic Center with the collaboration of Vascular Surgery, Cardiac Surgery, Interventional Radiology, Anesthesia and Hospital Administration. We report the initial success of creating a Comprehensive Aortic Center.

Methods: All aortic procedures performed from January 1, 2015 until December 31, 2016 were entered into a prospectively collected database and compared with available data for 2014.

Open abdominal surgical training differences experienced by integrated vascular and general surgery residents.

Background: As the integrated vascular residency program reaches almost a decade of maturity, a common area of concern among trainees is the adequacy of open abdominal surgical training. It is our belief that although their overall exposure to open abdominal procedures has decreased, integrated vascular residents have an adequate and focused exposure to open aortic surgery during training.

Methods: National operative case log data supplied by the Accreditation Council for Graduate Medical Education were compiled for both graduating integrated vascular surgery residents (IVSRs) and graduating categorical general surgery residents (GSRs) for the years 2012 to 2014.

Comparison of the integrated vascular surgery resident operative experience and the traditional vascular surgery fellowship.

Objective: After almost 10 years since its approval, residents in integrated vascular surgery training programs now outnumber traditional vascular fellows. We examined the Accreditation Council for Graduate Medical Education (ACGME) case log data to assess whether there is a difference in operative experience between the graduating integrated residents and vascular fellows.

Methods: We analyzed the total clinical experience of vascular surgery trainees during the academic years between 2012 and 2014 for the 30 graduated integrated vascular surgery residents (VSRs) and the 243 graduated vascular surgery fellows (VSFs).

An approach to EVAR simulation using patient specific modeling.

Background: The Simbionix Angiomentor Procedure Rehearsal Studio (PRS) offers accurate virtual anatomy for measurement, stent graft selection, and deployment of endovascular aneurysm repair (EVAR) devices.

Methods: Selected Gore Excluder EVAR cases from our EVAR database were reviewed and DICOM data loaded into the Simbionix Angiomentor simulator using PRS software. Using centerline measurements created on PRS, neck diameter (D1), length from lowest renal artery to each iliac bifurcation (Ll and Lr), and common iliac artery diameter (Dl and Dr) were recorded.