Where You Train Matters: Academic Vascular Surgery Training Programs Drive Adherence to Svs Guidelines

Document Type

Conference Proceeding

Publication Date

4-1-2026

Publication Title

J Vasc Surg

Keywords

accreditation, ankle brachial index, best practice, claudication, comorbidity, complication, conference abstract, evidence based practice, female, heart infarction, human, major clinical study, male, medical education, multicenter study, peripheral arterial disease, practice guideline, probability, propensity score, smoking cessation, surgery, surgical infection, surgical training, training, treatment outcome, vascular surgery, vascularization

Abstract

Objectives: The Society for Vascular Surgery (SVS) has established evidence-based best practice recommendations for infrainguinal bypass (IIB) aimed at improving procedural quality and patient outcomes. However, the influence of academic training environments on adherence to these guidelines remains understudied. This study evaluates the impact of academic training programs on adherence to SVS best practices in IIB procedures. Methods: Patients undergoing elective IIB for peripheral artery disease between January 2016 and December 2024 were identified in a prospective, statewide, multicenter registry encompassing 37 medical centers. Centers were classified according to the presence of an Accreditation Council for Graduate Medical Education (ACGME)-accredited vascular surgery training program (VSTP), defined as either an integrated residency (0+5) or traditional fellowship (5+2). Propensity score matching and inverse probability of treatment weighting were utilized to adjust for baseline patient differences. Results: Among 37 medical centers performing IIB, 24% (9/37) had an ACGME-accredited VSTP and treated 38% (n = 1804) of the 4816 patients undergoing elective IIB. After propensity score matching, all patient demographics and comorbidities were balanced between the two groups. Centers with VSTP were less likely to perform bypass for claudication (53% vs 72%; P < .001) and more likely to perform distal bypasses (32% vs 19%; P < .001) compared to non-VSTP centers. Medical centers with VSTP demonstrated significantly greater adherence to SVS best practices, including preoperative ankle-brachial index testing (79% vs 63%; P < .001), preoperative vein mapping (70% vs 49%; P < .001), autologous vein utilization (64% vs 44%; P < .001), intraoperative completion imaging (72% vs 64%; P < .001), and statin and antiplatelet therapy at discharge (87% vs 84%; P = .008) (Fig). In contrast, smoking cessation counseling was more frequent at non-VSTP centers (48% vs 38%; P < .001). VSTP centers had higher rates of surgical site infection (9% vs 7%; P = .009) and myocardial infarction (2% vs 1%; P = .010). Thirty-day (93% vs 87%; P < .001) and 1-year (86% vs 84%; P = .380) patency rates were also higher at VSTP centers, whereas 1-year bypass revision was more frequent at VSTP centers (12% vs 9%; P = .001). Conclusions: Academic centers with accredited VSTP demonstrate higher adherence to SVS best practices in elective IIB procedures, highlighting the role of training environments in promoting guideline-based care. Targeted quality initiatives are needed to help extend these benefits across nonacademic practice settings. [Formula presented]

Volume

84

Issue

1

First Page

e163

Last Page

e164

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