Society for Vascular Surgery

Objective: To compare outcomes of endovascular versus open infrainguinal bypass in patients with claudication. Summary of Background Data: PAD research has focused largely on CLTI, yet 20% of patients present with claudication and may not improve with medical therapy alone. Durability of endovascular intervention remains uncertain. Methods: Patients undergoing bypass for femoropopliteal disease were propensity matched to endovascular procedures using demographics, cardiovascular comorbidities, and center volume quartiles. Primary outcomes (CLTI, MALE) were ascertained via VISION-Medicare linkage. Secondary outcomes included reintervention and mortality. Kaplan-Meier and Cox models quantified associations between intervention and outcome. Sensitivity analysis used inverse probability weighting and Fine-Gray models. Results: Seven hundred twenty open bypass procedures were matched to 3259 endovascular procedures (median follow-up 2.8 y, IQR 1.6–4.4). Median age was 72 versus 70 years (open vs. endovascular, P <0.001); most patients were non-Hispanic White (91.1% vs. 85.6%, P <0.001) and male (74.4% vs. 61.3%, P <0.001). MALE rates were higher with endovascular intervention at 1 year (33.4% vs. 37.3%, P =0.015), but not at 3 (49.5% vs. 49.1%, P =0.172), or 5 years (57.0% vs. 59.1%, P =0.149). CLTI progression, reintervention rates, and mortality were similar at 5 years. Endovascular intervention was not associated with MALE (HR 1.13, 95% CI: 0.97–1.32), CLTI progression (HR 0.90, 95% CI: 0.72–1.13), reintervention (HR 1.13, 95% CI: 0.97–1.32), or mortality (HR 0.86, 95% CI: 0.66–1.12). Conclusion: Open bypass and endovascular intervention demonstrated similar long-term MALE and progression to CLTI through 5 years, suggesting endovascular intervention may offer comparable outcomes in appropriately selected patients with claudication.

Background: Office-based laboratories (OBLs) have expanded rapidly since the introduction of Centers for Medicare & Medicaid Services (CMS) reimbursement for outpatient vascular interventions in 2008, driven by advances in endovascular technology and cost effectiveness. Alongside ambulatory surgery centers (ASCs), OBLs enable minimally invasive vascular procedures to be performed safely outside hospital settings with same-day discharge. Over the past decade, peripheral vascular interventions (PVIs) have increasingly shifted to outpatient environments, with OBLs demonstrating the most rapid growth. Despite this transition, national trends and geographic variation in OBL growth remain incompletely characterized. This study examined the longitudinal growth and geographic distribution of vascular OBLs in the United States from 2010 to 2023. Methods: We analyzed all outpatient lower extremity PVIs performed from 2010 to 2023 using 100% fee-for-service Medicare claims data. Endovascular PVIs were identified by procedural codes and categorized by treatment modality and arterial segment. Facilities were classified as hospitals, ASCs, or OBLs. OBLs were further categorized as private, hospital affiliated, or multispecialty based on CMS records and practice websites and designated as vascular if a vascular surgeon was listed. State-level OBL densities were normalized to the population aged ≥65 years using 2021 US Census data and visualized geographically using state-level heat maps. Results: Between 2010 and 2023, the number of hospitals performing PVIs decreased by 52.9%, and the number of ASCs increased by 53.3%. OBLs increased from 1209 in 2010 to 1409 in 2015, followed by a plateau, resulting in a net increase of 12.9% by 2023. Over time, the number of annual OBL openings decreased, and year-to-year facility persistence improved from 59.3% to 81.8%. In 2021, OBL density varied noticeably by state, with the highest concentrations in Texas, Arizona, and Florida, and substantially lower densities in much of the Midwest and New England. Private vascular OBLs predominated in low-regulation states, and hospital-affiliated OBLs were uncommon and geographically limited. Conclusions: The shift of PVIs to OBLs reflects a broader movement toward outpatient, minimally invasive care that enhances physician autonomy. However, OBL growth has been uneven and increasingly constrained by rising operating costs and declining inflation-adjusted CMS reimbursements. Geographic variation in OBL prevalence suggests that state policy environments play a critical role, with higher densities observed in less restrictive states. Long-term sustainability of office-based vascular care will likely require reimbursement policies that account for inflation and regulatory frameworks that support physician-led outpatient practice.

Objective Since 1962, vascular surgery training has traditionally been accomplished via fellowship. In the last two decades, however, integrated residency programs have provided an alternative pathway. This study aimed to investigate the demographics and consistency of leaders in vascular surgery training programs across the United States. Methods A cross-sectional study was performed to identify the chief vascular surgeons and program directors (PDs) of vascular surgery training programs (integrated residency and fellowship) across the United States in December 2025. Data was extracted primarily from programs’ official websites and social media platforms. Results A total of 136 programs were included in the final analysis (78 integrated and 119 fellowships). Most vascular surgery chiefs, integrated residency PDs, and fellowship PDs had undergone fellowship training (96.7%, 85.9%, and 96.6%, respectively). Female and minority races were underrepresented in the positions of chief, residency PD and fellowship PD (9.8%, 25.6%, and 22.9%, respectively, were female; and minorities represented 23%, 34.6%, and 28% respectively). Mean age was 55 years for the chiefs, 49 for residency PDs, and 51 for fellowship PDs, respectively. In 37 programs, the chief of the division held the position of PD (30.3%), while in 77% of the 61 programs that had both fellowship and residency programs, the same surgeon held the PD position. Conclusions The tendency for overlap between the roles of chief and PD is significant. Black, Asian and female sex were underrepresented in both these positions. Future studies will be able to demonstrate trends among these positions and identify opportunities to increase representation.

Background and Objective: Over the past decade substantial government and market-driven efforts focused on the use of real-world evidence (RWE) to improve healthcare decision-making. A successful strategy has been mounted by specialty societies and their registries that have created RWE through a model known as the Coordinated Registry Network (CRN), which has accelerated innovation, improved care quality, addressed the safety and efficacy of medical products, and supported medical research. This three-part manuscript works to understand how the CRNs have succeeded by applying organizational sociology and the theory of Systemic Coordinated Inter-Organizational Networks (SCIONs). Methods: We describe CRNs as organizations that evolved from the traditional registries of clinical specialty societies. We present the SCIONs theory, a network of organizations that deploy a coordination strategy based on trust and cooperation to solve complex problems. By applying sociological concepts, we identified key characteristics and functions that can inform the development of CRNs, providing practical guidance for their implementation. Results: Our analysis reveals that CRNs offer a unique mode of coordination that can address complex healthcare challenges, leveraging traditional market and government efforts. CRNs can support the vision of a learning health system and evidence-based medicine by harnessing the power of RWE, transforming, and improving healthcare delivery. Conclusion and Implications for Translation: CRNs have the potential to transform evidence generation in healthcare by curating and integrating multiple data sources that can address the data needs of multiple CRN partners. This American solution to the provision of evidence for supporting decision-making in healthcare builds on professional society relationships; the CRN model has demonstrated success in large national registries and warrants expansion to other specialty areas. By understanding the organizational sociology of CRNs, we can unlock their full potential to drive innovation, efficiency, and quality improvement in healthcare.

Background and Objective: Previous work in this series has introduced real-world evidence (RWE), coordinated registry networks (CRNs), and systemic, coordinated, inter-organizational networks (SCIONs) theory. The application of SCIONs theory to CRNs illuminates how their structure and function foster trust and cooperation in a network of organizations to successfully address complex problems in healthcare. This third part in the series asks questions about how SCIONs theory can benefit CRNs and how the experience of CRNs can further develop the SCIONs theory. Methods: This manuscript analyzes reciprocal relationships related to SCIONs theory and CRN practice, examining how each can be used to benefit the other. While SCIONs theory has not yet formally been used to direct the development of a CRN, future application is proposed. Conversely, we explored how the practical experiences of CRNs can inform and refine our understanding of SCIONs, including identifying areas for theoretical development and through an exploration of the current limitations of CRNs. Results: The SCIONs theory may usefully direct CRN development in key leadership areas, including increasing human capital, encouraging organizational adaptiveness, expanding institutional capacity, mobilizing political engagement, and generating cooperative behavior. CRNs, guided by SCIONs theory, can offer a pathway towards a more efficient, equitable, and learning-oriented healthcare system. A comprehensive approach proposed for CRNs may facilitate the expansion of the evaluation component in SCIONs theory. Conclusion and Implications for Translation: CRN program managers should prioritize strategic approaches that foster human capital, organizational adaptability, and institutional capacity. Government agencies may consider investments in CRN as a way to build RWE infrastructure that improves quality and efficiency of healthcare broadly. Public discourse may benefit from a clearer understanding of the role of cooperation in society to address issues that government and markets are not well suited to address. The literature on SCIONs can support the non-profit literature in the way the business literature supports the for-profit sector.