What is the best training for vascular access surgery?

Area of Science:

• Vascular Surgery
• Surgical Education
• Dialysis Access

Background:

• Concerns exist regarding the adequacy of training in vascular access creation and maintenance.
• The impact of junior surgeon training on arteriovenous (AV) fistula outcomes requires investigation.

Purpose of the Study:

• To survey expert opinions on current access training deficiencies.
• To evaluate the outcomes of AV fistulas created by trainees versus consultants.

Main Methods:

• A closed questionnaire survey was administered to vascular surgery "experts".
• A literature search identified studies comparing consultant and trainee AV fistula creation.
• A meta-analysis was performed on the pooled data from identified studies.

Main Results:

• The majority of experts identified significant deficits in access creation and maintenance training, especially in preoperative planning.
• Meta-analysis of four studies found no statistically significant difference in 1-year patency rates for AV fistulas created by consultants versus trainees.
• Trainee-performed access surgery did not lead to suboptimal outcomes.

Conclusions:

• There is a perceived major deficit in vascular access training, with preoperative planning being a key area.
• Trainee surgeons can achieve comparable outcomes to consultants in AV fistula creation for simpler cases.
• Access surgery is crucial for vascular surgery training and should be integrated into core curricula.