Trends in aortic aneurysm surgical training for general and vascular surgery residents in the era of endovascular abdominal aortic aneurysm repair

Hypothesis. The emergence of endovascular abdominal aortic aneurysm (AAA) repair may negatively impact the open AAA experience of general surgery residents. Methods. Prospectively collected data on general and vascular surgery resident training in AAA repair for a 5-year period (1997 to 2001) at a single institution were retrospectively reviewed. Five general surgery residents and one vascular resident completed training yearly. Institutional volume of open and endovascular repair of AAA was also assessed. Results. The cumulative mean general surgical resident experience with open AAA repair fell significantly over a 5-year period; 9.5 +/- 2.5 cases were performed per general surgical resident finishing in 1997, 7.5 +/- 0.3 cases in 1998, 4.6 +/- 0.4 cases in 1999, 4.0 +/- 1.3 cases in 2000, and 4.2 +/- 1.0 cases in 2001 (P = .03). The vascular resident experience with open AAA repair did not change significantly over the 5 -year period. However, the active development of an endovascular AAA program increased total AAA exposure of the vascular resident from 26 cases in 1997 to a mean of 70 cases in 2000 and 2001. The institution volume of open nonsuprarenal AAA repairs fell 38% during the 5-year period (P = .33) during a period when endovascular AAA repair increased from 9 (1996) to 55 (2000) cases (P <.001). The complexity of open AAA surgery also increased: 23.3% of open cases (7/30) in 2000 were juxta/pararenal versus 2.9% (1/35) in 1996 (P = .05). Conclusion: The introduction of endovascular AAA repair may have negatively impacted general surgical resident training in open AAA repair. The number of open AAA cases declined, and their complexity significantly increased. Many uncomplicated AAAs were managed with endovascular means. At programs with such a paradigm shift in AAA treatment, expectation that general surgery residents gain the proficiency necessary to safely perform AAA repair without additional training may be unrealistic.