Liapis C D, Avgerinos E D, Sillesen H, Beneddetti-Valentini F, Cairols M, Van Bockel J H, Bergqvist D, Greenhalgh R
Department of Vascular Surgery, School of Medicine, University of Athens, Chaidari, Athens, Greece.
Eur J Vasc Endovasc Surg. 2009 Jan;37(1):109-15. doi: 10.1016/j.ejvs.2008.09.015. Epub 2008 Nov 5.
To evaluate the influence of the status of vascular surgery (VS) training paradigms on the actual practice of endovascular therapy among the European countries.
An email-based survey concerning vascular surgery training models and endovascular practices of different clinical specialties was distributed to a VS educator within 14 European countries. European Vascular and Endovascular Monitor (EVEM) data also were processed to correlate endovascular practice with training models.
Fourteen questionnaires were gathered. Vascular training in Europe appears in 3 models: 1. Mono-specialty (independence): 7 countries, 2. Subspecialty: 5 countries, 3. An existing specialty within general surgery: 2 countries. Independent compared to non-independent certification shortens overall training length (5.9 vs 7.9 years, p=0.006), while increasing overall training devoted specifically to VS (3.9 vs 2.7 years, p=0.008). Among countries with independent certification an average of 76% of aortic and 50% of peripheral endovascular procedures are performed by vascular surgeons, while the corresponding values, for countries with a non-independent certification, are 69% and 36% respectively. Countries with independent vascular certification, despite their lower average endovascular index (procedures per 100,000 population), reported a higher growth rate of aortic endovascular procedures (VS independent 132% vs VS non-independent 87%), within a four-year period (2003-2007). Peripheral endovascular procedures, though, have similar growth rates in both country groups (VS independent 62% vs VS non-independent 60%).
In European countries with VS as an independent specialty, vascular surgeons have a shorter total training period but spend more time in VS training, although they may not undertake a greater proportion of the endovascular procedures their countries appear to have adopted endovascular technologies more rapidly compared to the ones with non-independent VS curricula. Whether such differences influence patient outcomes requires investigation in future studies.
评估血管外科（VS）培训模式的现状对欧洲各国血管内治疗实际应用的影响。
向14个欧洲国家的一名VS教育工作者发送了一份基于电子邮件的关于血管外科培训模式和不同临床专业血管内治疗实践的调查问卷。还对欧洲血管和血管内监测（EVEM）数据进行了处理，以关联血管内治疗实践与培训模式。
共收集到14份问卷。欧洲的血管培训呈现出3种模式：1. 单一专科（独立）：7个国家；2. 亚专科：5个国家；3. 普通外科中的一个现有专科：2个国家。与非独立认证相比，独立认证缩短了总体培训时长（5.9年对7.9年，p = 0.006），同时增加了专门用于VS的总体培训时间（3.9年对2.7年，p = 0.008）。在具有独立认证的国家中，血管外科医生平均进行76%的主动脉和50%的外周血管内手术，而对于具有非独立认证的国家，相应的值分别为69%和36%。具有独立血管认证的国家，尽管其平均血管内指数（每10万人口的手术量）较低，但在四年期间（2003 - 2007年），其主动脉血管内手术的增长率较高（VS独立132%对VS非独立87%）。然而，两个国家组的外周血管内手术增长率相似（VS独立62%对VS非独立60%）。
在将VS作为独立专科的欧洲国家，血管外科医生的总培训期较短，但在VS培训上花费的时间更多，尽管他们可能没有承担本国血管内手术的更大比例，但与具有非独立VS课程的国家相比，他们似乎更快地采用了血管内技术。这种差异是否会影响患者预后需要在未来的研究中进行调查。
