Sept
Issue
18 79
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Recruitment for vascular disease management struggles to keep up with expected demands on the workforce
Alison Halliday:
Profile
Shortages in the US vascular surgery workforce was the focus of this year’s Stanley Crawford Critical Issues Forum at the Society for Vascular Surgery’s (SVS) Vascular Annual Meeting (VAM; 20–23 June, Boston, USA). The session highlights a problem faced by governments and healthcare providers across the world, as specialists struggle to keep up with increasing older demographics and a globally escalating vascular disease burden.
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Post-atherectomy IVUS better than angiography for dissection detection
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he annual Critical Issues Forum, as explained by SVS president Michel Makaroun, focuses each year on a “very important topic facing our specialty and practice”. Opening the session, Makaroun said “most of you are well aware that we have a national surgeon shortage”, and it is true that the challenge facing vascular surgery in the USA is one that has been discussed frequently in recent years. A report on behalf of the SVS and published in the Journal of Vascular Surgery in 1996 identified future workforce issues in the field, and proposed ways to mitigate this problem. Makaroun acknowledged that although “it is not a new problem, unfortunately, it seems all we have been doing about it so far is applying band-aids—and the problem keeps on getting worse.” Similar warnings have been raised in other countries, as a 2014 survey of the UK vascular surgeon workforce carried out by the Vascular Society of Great Britain and Ireland reported: “As we anticipate the changing demographics and treatable disease patterns over the next 40 years, we consider it inevitable that our specialty will be in short supply at a time when demand for our services is growing rapidly”. Sophie Renton, consultant vascular surgeon at the London North West Healthcare NHS Trust and member of the vascular Specialty Training Committee in London, UK, tells Vascular News “It is anticipated that there will be a shortage of vascular surgeons in the UK. We recruit less than 30 vascular trainees every year, the number is
a little variable. We also recognise that up to 50% of our established consultants will retire in the next five years. At the same time, we recognise that the need for vascular surgeons will increase with the increasingly elderly population and the increase in diabetic foot disease.” A 2013 study published in Health Affairs by Timothy Dall and colleagues similarly posited the problem that “An ageing population and growing disease burden will require a large and specialised healthcare workforce by 2025”, and goes on to project that “the demand for adult primary care services will grow by approximately 14% between 2013 and 2025. Vascular surgery has the highest projected demand growth (31%), followed by cardiology (20%) and neurological surgery, radiology, and general surgery (each 18%).” Five years have passed since that paper, as Makaroun argued at SVS VAM: “The shortage is not really in the future. The shortage is really upon us, right now.”
The age of the vascular surgeon—and the patient
The ageing population, often mentioned in the context of the so-called “baby boomer generation”, is a problem faced across the Western world. The continuing swell in numbers of this demographic comes with clear implications for the vascular workforce, as Makaroun points out this is the Continued on page 6
A study published in the Journal of Invasive Cardiology has found that dissections post atherectomy are grossly under-appreciated on angiogram when compared to intravascular ultrasound (IVUS) and calls for a multicentre registry to correlate these findings with clinical outcomes.
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icolas Shammas (Midwest Cardiovascular Research Foundation, Davenport, USA) and colleagues explain that cine angiography has been widely utilised as the main tool to evaluate and treat the infrainguinal arteries. However, they write, “angiographic images are suboptimal in identifying the severity of calcium, presence of intraluminal thrombus, plaque morphology, true vessel diameter, and residual narrowing post intervention. Also, the number and severity of dissections including medial and adventitial injury have long been suspected to be under-estimated on angiography”. In various studies atherectomy has been reported to reduce angiographic dissections and therefore bailout stenting. The extent and nature of dissections following atherectomy, however, Shammas et al write, may have been under-appreciated on cine angiography. Atherectomy has not been shown to be superior to angioplasty in reducing target-lesion revascularisation (TLR) or restenosis, which may be partly explained by undetected deeper dissections on an angiogram. The authors therefore present data on the number and severity of dissections as seen on IVUS following atherectomy based on the iDissection classification and Continued on page 4