Solomon Houman, Chao Alexander B, Weaver Fred A, Katz Steven G
Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California University Hospital, Los Angeles, CA, USA.
Arch Surg. 2007 Aug;142(8):733-6; discussion 736-7. doi: 10.1001/archsurg.142.8.733.
Technological advances have required that faculty of academic divisions of vascular surgery acquire new technical skills and significantly alter their past clinical practice patterns.
Retrospective medical record review.
An academic tertiary referral center and a community teaching hospital.
All patients undergoing 10 specific vascular procedures during a 5-year period.
We analyzed volumes for 10 specific open and endovascular index procedures performed by 5 vascular surgeons during a 60-month period. Procedures reviewed included open abdominal aortic aneurysm repair, endovascular abdominal aortic aneurysm repair, carotid endarterectomy, carotid artery stent, suprainguinal arterial reconstruction, suprainguinal percutaneous transluminal angioplasty/stent (PTA/S), infrainguinal arterial reconstruction, infrainguinal PTA/S, renal and visceral arterial reconstruction, and renal and visceral PTA/S. In-hospital length of stay was compared between open procedures and their endovascular counterparts.
In 2000, 453 open and 44 endovascular index procedures were performed. In contrast, by 2005, open index cases had decreased by 47.0% (239) and endovascular index cases had increased by 679.5% (299). Open abdominal aortic aneurysm repairs had decreased by 54.5% (68 vs 31), carotid endarterectomies by 28.8% (139 vs 99), suprainguinal arterial reconstructions by 47.5% (40 vs 21), infrainguinal arterial reconstructions by 56.5% (186 vs 81), and renal/visceral arterial reconstructions by 65.0% (20 vs 7). In 2005, 62 endovascular abdominal aortic aneurysm repairs and 45 carotid stents were performed, whereas none were performed in 2000. In addition, infrainguinal PTA/S had increased by 675.0% (12 vs 81) and suprainguinal PTA/S by 20.0% (20 vs 24).
Although the total number of procedures performed has remained relatively constant, there has been a dramatic increase in the number of endovascular procedures as well as an associated decline in the number of open procedures. This change in practice pattern has allowed the members of our division to maintain a significant role in the care of patients undergoing vascular surgery, as evidenced by stable overall procedural volume. This will provide a platform for future outcome-related analyses of open vs endovascular procedures performed within a single specialty group.
技术进步要求血管外科各学术部门的教员掌握新的技术技能，并显著改变他们过去的临床实践模式。
回顾性病历审查。
一所学术性三级转诊中心和一家社区教学医院。
在5年期间接受10种特定血管手术的所有患者。
我们分析了5名血管外科医生在60个月期间进行的10种特定开放性和血管腔内索引手术的例数。审查的手术包括开放性腹主动脉瘤修复术、血管腔内腹主动脉瘤修复术、颈动脉内膜切除术、颈动脉支架置入术、腹股沟上动脉重建术、腹股沟上经皮腔内血管成形术/支架置入术（PTA/S）、腹股沟下动脉重建术、腹股沟下PTA/S、肾和内脏动脉重建术以及肾和内脏PTA/S。比较开放性手术与其血管腔内对应手术的住院时间。
2000年，进行了453例开放性索引手术和44例血管腔内索引手术。相比之下，到2005年时，开放性索引病例减少了47.0%（239例），而血管腔内索引病例增加了679.5%（299例）。开放性腹主动脉瘤修复术减少了54.5%（68例对31例），颈动脉内膜切除术减少了28.8%（139例对99例），腹股沟上动脉重建术减少了47.5%（40例对21例），腹股沟下动脉重建术减少了56.5%（186例对81例），肾/内脏动脉重建术减少了65.0%（20例对7例）。2005年，进行了62例血管腔内腹主动脉瘤修复术和45例颈动脉支架置入术，而2000年未进行此类手术。此外，腹股沟下PTA/S增加了675.0%（12例对81例），腹股沟上PTA/S增加了20.0%（20例对24例）。
虽然手术总例数保持相对稳定，但血管腔内手术例数显著增加，同时开放性手术例数相应减少。这种实践模式的改变使我们科室的成员在血管外科手术患者的护理中继续发挥重要作用，总体手术例数稳定即证明了这一点。这将为未来对单一专业组内开放性手术与血管腔内手术的相关结果分析提供一个平台。
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