Peripheral Vascular Intervention Training—Gaps and Solutions (2024)

Central Illustration

Keywords: education, endovascular interventions, peripheral, think tank, training

Introduction

Each year at the Society for Cardiovascular Angiography & Interventions (SCAI) Annual Scientific Sessions meeting, collaborative think tanks involving interventional cardiologists, administrative partners, and members of industry are convened for each SCAI clinical practice area to discuss topics of interest to the group. This document presents the proceedings of the SCAI 2023 Peripheral Think Tank session, which focused on training in vascular interventions. The goals for this discussion were to identify current gaps and needs in vascular intervention education and training and delineate potential solutions that could lead to a positive impact on patient care.

Current landscape of peripheral vascular interventions

Peripheral vascular interventions (PVI) are performed by many vascular specialists including vascular surgeons, interventional cardiologists, and interventional radiologists. Interventional cardiologists who perform PVI usually acquire this skill set via 1 of 3 pathways1 (Central Illustration):

• 1.

  Formal, dedicated 1-year PVI fellowship training.

• 2.

  Integrated PVI training during the interventional cardiology fellowship training year(s).

• 3.

  On the job, informal, post-fellowship PVI training.

The disparate training pathways taken by interventional cardiologists result in heterogenous mastery of PVI core competencies. The SCAI 2023 Peripheral Think Tank session addressed several challenges in achieving PVI competencies:

Problem #1: What core skill sets are needed by interventional cardiologists to appropriately care for “peripheral vascular disease” patients?

Core PVI skill sets require a proper understanding of vascular pathophysiology and vascular imaging. A common misconception is that “peripheral vascular disease” refers solely to peripheral arterial disease or that cardiologists only treat coronary atherosclerotic disease. While “PVD” means different things to different people, it is important to clarify that vascular medicine and endovascular intervention encompasses: (1) different vascular beds including arterial and venous; (2) different anatomic regions ranging from the cervico-cerebral circulation through the peripheral arterial circulation of the lower extremities and everywhere in between; (3) different etiologies including obstructive (atherosclerosis, inflammation or compression syndrome) versus aneurysmal disease; (4) different pathophysiologic mechanisms and consequently (5) different management strategies.1^,2 Therefore, interventional cardiologists performing PVI must be prepared to achieve competency in vascular imaging and the management of both atherosclerotic and nonatherosclerotic arterial disease as well as venous disease.

Problem #2: How should we provide peripheral vascular intervention education to interventional cardiology trainees?

Due to an aging population and the increasing incidence of atherosclerotic risk factors, it is anticipated that the prevalence of PVD will continue to increase,3 leading to a greater need for PVD care and interventional cardiologists with PVI skills. Given the variability of vascular medicine and PVI expertise available at different institutions, training programs and cardiovascular societies may need to adopt a pragmatic approach to PVI postgraduate medical education and focus on core competencies required for practitioners. Not all PVI trainees will require or be exposed to the full breadth of PVI training during a combined 1-year interventional cardiology/vascular interventions fellowship or even in a dedicated advanced fellowship year of PVI training. Core competencies are well-delineated in the recent Advanced Training Statement for Interventional Cardiology1 and may serve as a preliminary roadmap for such specialized training. Evolving technology trends and the emergence of new technologies such as renal denervation, will necessitate that practicing endovascular interventionalists may require (re)training on new devices and techniques which may not have been available during the individual’s postgraduate medical education.

Problem #3: How should we provide peripheral vascular intervention education to practicing interventional cardiologists?

Given the duration of internal medicine residency through interventional cardiology fellowship training, not all interventional cardiology trainees can dedicate an additional year for PVI training. Some practicing coronary and structural interventional cardiologists may find that PVI skills are a needed skill set at their institution. It is therefore important that PVI learning opportunities are available for practicing interventional cardiologists interested in acquiring these skills.

Problem #4: Should SCAI address the barriers faced by practicing interventional cardiologists who are interested in peripheral vascular interventions?

Institutional barriers exist that hinder hospital credentialing by interventional cardiologists who acquire PVI skills outside of formal fellowship training. SCAI can address these barriers on multiple levels. Table1 highlights potential solutions by SCAI to address these barriers.

Future directions

Several questions were beyond the scope of the SCAI 2023 Peripheral Think Tank session. Future questions to address include: (1) whether there is a need to expand the interventional cardiology fellowship training to 2 years; (2) how to develop emerging/future leaders in this subspecialty; (3) how to work with industry to promote simulation training for endovascular interventions.

Conclusion

The SCAI 2023 Peripheral Think Tank meeting highlighted the importance of appropriate positioning of vascular medicine and endovascular intervention within interventional cardiology, the need for a multifaceted approach to PVI training, and the partnership role that industry can play with cardiovascular societies in supplementing basic PVI skills.

Peer review statement

References