Training and Credentialing in Endovascular Surgery

Abstract

The explosive interest in minimally invasive endoluminal repair of occlusive lesions and aortic aneurysms and the extension of this technology to the repair of traumatic lesions, arteriovenous malformations, and fistulas is having a major impact on the direction of training in vascular surgery. Although the durability and long-term success of endoluminal procedures are only beginning to be known (especially in comparison to conventional, open vascular surgical procedures), it is likely that vascular repairs performed transluminally will comprise a significant portion of vascular surgical practice in the future. A large body of preliminary work suggests that this approach offers a potentially better method to treat a significant proportion of vascular surgical cases because of reduced morbidity and mortality and enthusiastic patient acceptance.¹ It has been estimated that within the next decade one-third to one-half of vascular prosthetic reconstructions currently carried out by open surgical approaches could be replaced by endovascular prostheses inserted percutaneously or by open means from a remote access site.¹ The inference is clear: If these devices prove successful over time, a significant amount of conventional vascular surgery will become obsolete.