Five-year follow-up of an endovascular program initiated by vascular surgeons

Strategies developed by vascular surgeons to establish an endovascular program and the 5-year results of the program are reported. In 1994, the operating room was chosen as the site for the endovascular suite. With this strategy, vascular surgeons would be able to 1) govern appropriate indications for intervention, 2) perform procedures independently and direct the course of the intervention, 3) treat unexpected findings during traditional surgical repair with endovascular techniques, and 4) teach these techniques to vascular surgery fellows. Initial procedures were performed under the supervision of radiologists or other vascular surgeons experienced with these techniques. Endovascular catheters were obtained with operating room capital. During a 5-year period (1/1/94-12/31/98), 224 balloon angioplasties (including placement of 65 stents) were performed for stenoses in 84 failing lower extremity arterial bypasses; 58 iliac, 35 femoral, 19 popliteal, 10 tibial, 7 aortic, and 7 subclavian arteries; and 3 subclavian veins and 1 superior vena cava. Ninety-eight procedures were performed concomitantly with an open surgical procedure and 102 interventions were performed as the sole intervention. There were ten (4%) technically unsatisfactory results treated with immediate surgery and two (0.8%) hematomas that required surgery. One-month primary patency was 94%. Endovascular skills gained with this experience has enabled the performance of endovascular aortic aneurysm repair independently. Developing an endovascular suite using the above model is a safe and effective approach. The operating room may be the most practical location to establish an endovascular suite for many vascular surgeons.