Has endovascular surgery reduced the number of open vascular operations performed by an established surgical practice?

Abstract

Objective: Driven by new technology and the trend toward minimally invasive techniques, vascular surgeons have eagerly begun performing catheter-based arterial interventional procedures, a subspecialty termed endovascular surgery. How incorporation of endovascular surgery by vascular surgeons has influenced the number of standard open peripheral vascular operations is unknown. The purpose of this observational study was to examine the effect of endovascular surgery performed by the vascular surgeons of an established vascular surgery service on the volume of open peripheral vascular operations performed. Methods: With our prospective vascular registry, we compared the number of index vascular procedures from 1996 to 1998 (immediately before the start of an endovascular program) with the numbers from 1999 to 2000 (immediately after the start of an endovascular program). Differences in proportions (endovascular versus open/standard) between the two time periods were compared with the x2 test for homogeneity. Results: From 1996 to 1998, 122 procedures were referred to radiology for arterial intervention versus none from 1999 to 2000, reflecting the initiation of the endovascular program. During the entire study period, annual volume (endovascular + open/standard) of vascular procedures, excluding the procedures referred to radiology, increased by 70% (1996, n = 402; to 2000, n = 685). Although open procedures from 1996 to 1999 increased 49% (n = 356 to n = 531), the number decreased by 5% from 1999 to 2000 (n = 531 to n = 507). In contrast, the endovascular volume from 1996 to 2000 increased 324% (n = 42 to n = 178). A statistically significant reduction was seen over time in the proportion of open/standard cases to endovascular cases in comparison of 1996 to 1998 with 1999 to 2000 for total cases (n = 1539, 88% open; versus n = 1341, 77% open) and for all index procedures (aortoiliac, 70% versus 55%; abdominal aortic aneurysm, 100% versus 63%; brachiocephalic, 73% versus 47%; renal, 60% versus 24%) except carotid procedures (100% versus 99%) and femoral-popliteal/tibial procedures (87% versus 87%). Conclusion: The integration of endovascular procedures by vascular surgeons of an established vascular practice significantly reduced the proportion of all open vascular procedures except for carotid and femoral-popliteal/tibial intervention. These data may have important implications for the future training of general and vascular surgeons.