Infrapopliteal bypass surgery in the endovascular era

Area of Science:

• Vascular Surgery
• Surgical Training
• Peripheral Arterial Disease Management

Background:

• Endovascular-first strategies are increasingly adopted for peripheral arterial disease (PAD).
• This shift raises concerns about surgical training quality, especially for tibial and pedal bypasses.
• Assessing current surgical and endovascular experience in German vascular surgery programs is needed.

Purpose of the Study:

• To evaluate the surgical and endovascular experience of German vascular surgery program directors.
• To assess clinical experience, bypass surgery techniques, and revascularization decision-making.
• To determine the perceived adequacy of vascular surgery training.

Main Methods:

• A questionnaire-based survey was distributed to German vascular surgeons qualified for further training in 2024.
• The survey collected data on clinical experience, technical approaches, decision algorithms, and training adequacy.
• Response rate was 77.7% (272 out of 350 invited surgeons).

Main Results:

• Respondents reported a median of 524 below-the-knee bypasses and 57 pedal bypasses performed.
• Academic teaching hospitals performed more bypasses, while non-teaching hospitals performed more endovascular procedures.
• Significant heterogeneity in technical aspects (anticoagulation, clamping, quality control) was observed, unrelated to institution type.

Conclusions:

• High variability exists in surgical experience, techniques, and training exposure within German vascular surgery programs.
• An aging surgeon workforce and advancing endovascular techniques necessitate action.
• Structured mentorship and standardized curricula are essential to ensure proficiency in tibial and pedal bypass surgery.