具有血管外科培训计划的中心更有可能利用静脉映射和自身静脉进行下内绕道
Hassan Chamseddine1, Mouhammad Halabi1, Loay Kabbani1
1Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI.
Journal of vascular surgery
|June 5, 2025
概括
血管外科培训课程与手术前静脉映射 (PVM) 和自身静脉 (AV) 导管用于下内绕道 (IIB) 的使用增加有关. 加强对指南的遵守对于改善外周动脉疾病 (PAD) 护理至关重要.
科学领域:
- 血管外科 血管外科
- 医学教育 医学教育
- 医疗保健服务研究 医疗服务研究
背景情况:
- 血管外科协会建议在手术前进行静脉映射 (PVM) 和自身静脉 (AV) 导管用于下内绕道 (IIB).
- 在对外周动脉疾病 (PAD) 进行下 inguinal 绕道 (IIB) 程序时,这些推实践的利用有所不同.
- 血管外科 (VS) 培训计划对采用PVM和AV导管的影响尚未得到充分证实.
研究的目的:
- 评估在医疗中心存在 VS 培训计划与 IIB 中使用 PVM 和 AV 导管之间的关联.
- 确定VS培训计划是否会影响遵守PAD管理的血管外科协会指南.
主要方法:
- 一个全州的,多中心的观察登记,从2016年到2022年,对外周动脉疾病 (PAD) 进行可选的下指甲绕道 (IIB) 程序.
- 患者的分类是基于他们的治疗中心是否有研究生医学教育认证委员会认证的VS培训计划.
- 用贝叶斯混合效应物流回归来分析VS培训计划与PVM/AV利用之间的关联.
主要成果:
- 具有VS培训计划的中心更有可能进行PVM (57.7%vs39.0%) 和使用AV导管 (60.0%vs45.3%) 进行IIB.
- 在有VS培训计划的中心的患者不太可能接受IIB进行关,并且更有可能进行手术前的脚-手臂指数测试.
- 多变量分析显示,VS培训计划与PVM利用率的两倍以上和AV导管使用率的近两倍相关.
结论:
- 对IIB的PVM和AV导管的整体利用率低于50%,表明需要改善外周动脉疾病 (PAD) 护理.
- 拥有VS培训计划的医疗中心在IIB中对PVM和AV导管使用的血管外科协会指南的遵守率更高.
- 未来的质量改进举措应集中在所有血管外科实践环境中加强对PAD指南的遵守.
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