Cardiovascular Surgery Board Certification and the Training of Vascular Surgery Specialists in Japan, Including Training in Endovascular Treatment: Experience at Jikei University

Abstract

Objectives: The case loads and varieties of vascular therapies in each vascular institution are very important factors in obtaining the Japanese Board of Cardiovascular Surgery Certification. At the Department of Vascular Surgery at our institution, we investigated the number of surgeons eligible to take this board examination, the number of surgeons who were able to perform endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) and the required number of proctors for EVAR and TEVAR as defined by the Japanese Committee for Stent-graft Management. We compared these figures before and after 2006, when Professor Takao Ohki came to our institution and launched a new vascular and endovascular program.
Methods: From July 2006 to December 2009, we performed a total of 2,465 vascular procedures, 95% of which were for arterial disease. We analyzed the case loads and distribution from 2007 to 2009.
Results: The annual case load was 658 in 2007, 834 in 2008 and 720 in 2009. In 2005, we performed 7 abdominal aortic aneurysm (AAA) and 11 peripheral arterial disease (PAD) procedures, whereas in 2009, we performed 236 AAA repair procedures (EVAR: 206, open surgery: 30), 79 thoracic aortic aneurysm (TAA) repair procedures, 24 thoracoabdominal aortic aneurysm (TAAA) repair procedures, 14 chronic aortic dissection repair procedures, 106 PAD procedures (endovascular treatment [EVT]: 35, bypass: 35, amputations, others: 36), 18 visceral artery aneurysm procedures, 23 renal artery stenosis repairs, 30 carotid artery stenosis (CEA: 19, EVT: 11) repairs, and 190 other procedures. A wide variety of vascular diseases was treated with either EVT or open surgery utilizing 3 operating rooms, including 2 hybrid vascular operating rooms equipped with a fixed fluoroscopy system. Of the 2,212 procedures performed between 2007 and 2009, 1,492 cases (67.5%) were eligible as cases for required experience to qualify to take the examination for the Certification of the Japanese Board of Cardiovascular Surgery.
Conclusions: The launch of an endovascular program increased our aortic case load by 50-fold. Although both renal and carotid interventions require advanced EVT skills, neither is eligible for qualification to take the cardiovascular board examination. Each vascular teaching institution needs to provide a sufficient case load and variety of procedures including both EVTs and open surgery.