OBJECTIVE:The Society for Vascular Surgery (SVS) partnered with Phairify, Inc., an organization with experience in physician compensation data compilation for several other medical specialties, to survey its membership and assess factors influencing vascular surgeon compensation. METHODS:The SVS Compensation Study Task Force developed a vascular surgery-specific survey between January 2023 and May 2023, including experience level, academic rank, bonuses, incentives, gender, race, ethnicity, geography, on-call pay, and other factors influencing overall reimbursement. After a soft launch on May 1, 2023, with an initial phase of SVS leadership engagement in completion, the survey was formally introduced to the SVS membership on June 14, 2023. Data were collected from May 1, 2023, to December 21, 2023. The survey was intended to focus on total compensation as well as its components. Mean compensation was analyzed based on respondent demographic characteristics. RESULTS:Of the 3200 active vascular surgery members of the SVS who were invited to participate in the survey, 708 (22%) completed the survey. The respondents were predominantly men (80%, 564) and White (57%, 403) with relatively equal distribution across regions of the United States. Forty-one percent (292) of vascular surgeons had an academic affiliation. Most respondents (85% [n = 605]) work more than 50 hours per week with 13% (92) reporting working more than 80 hours. The vast majority (93% [660/708]) of vascular surgeons took first call for vascular issues at their institutions, of which 64% (422/660) were on call on average one in four weekday nights and weekends. Most respondents (80% [545/682]) were not paid for a primary call separate from their salary. Although there was no difference between White and non-White respondents, the median total compensation for women was less than for men ($475,500 vs $576,000, respectively; P < .001). Male gender, years in practice, and being in a practice not owned or run by an academic institution were associated with higher compensation based on multivariate linear regression with ranked transfer of data to normalize values. There was no association between compensation and reported number of hours worked per week. CONCLUSIONS:This study highlights vascular surgery specialty-specific compensation models in a variety of practice settings and career levels with greater detail beyond those seen in traditional models. These data can be a useful tool for vascular surgeons when assessing compensation plans from potential employers and may help to achieve greater pay equity and workforce diversity.

BACKGROUND The purpose of this document is to outline the rationale and methodology used by the Society for Vascular Surgery (SVS) to develop appropriate use criteria (AUC) priorities and the methods of AUC development. Vascular surgery as a specialty has been transformed over recent decades with the development of minimally invasive techniques and advanced imaging, along with advances in medical management and periprocedural care. These rapid changes have improved the care of our patients, but have also placed unique strains on decision-making around procedural selection and appropriate care before and after an intervention. The cost of health care has increased substantially along with these rapid advances, and reimbursement to physicians and potentially unnecessary or low value care are frequent targets of scrutiny regarding health care expenditure. Clinical practice guidelines (CPGs) include evidence based recommendations that are systematically developed by experts for specific disease processes and interventions. Guidelines advise the everyday care of patients with vascular disease, and AUC complement guidelines, and provide additional guidance to clinicians. Like CPGs, AUC are also based on the scientific literature and physicians' clinical practice experience and judgment. They are not intended to be prescriptive or replace individual patient-centered clinical decision making, nor can they replace clinician judgment or patient preference in shared decision-making. It is imperative that AUC are developed by experts who represent diverse perspectives.

Recent publications regarding outpatient sites of service for peripheral vascular interventions (PVIs) have highlighted the need for broader awareness of the economic realities of these sites of service. We congratulate Dr Sober et al1Sorber R. Dun C. Kawaji Q. Abularrage C.J. Black J.H. Makary M.A. et al.Early peripheral vascular interventions for claudication are associated with higher rates of late interventions and progression to chronic limb threatening ischemia.J Vasc Surg. 2023; 77: 836-847.e3Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar on their paper published in this issue regarding the potential implications of early intervention on patients with newly diagnosed intermittent claudication (IC). It was very rewarding to see that nearly 97% of the cases evaluated met the approved societal standards for the management of IC. Of the approximately 3% that underwent PVI earlier than current recommendations, a significant portion of those also underwent late PVI with inferior outcomes to those not receiving early PVI. For this study, the authors have presented an analysis of Medicare claims data for the years 2015 through 2017 with a median follow-up of 4.4 years. A total of 187,442 patients were newly diagnosed with claudication. These patients were separated into two groups by time from diagnosis to intervention for claudication. The authors focused on the group of patients who had a first peripheral vascular intervention (PVI) within 6 months of the diagnosis of IC. The physicians performing these early PVI were subdivided into a high use group (those physicians performing procedures at a rate greater than 2 standard deviations from the entire group) and those who are standard users. The authors speculate that the high use cohort may have been motivated by economic factors in the choice of early intervention but note that they cannot confirm this based on the claims data. The authors postulate that office-based lab (OBL) or ambulatory surgical center (ASC) reimbursement may present a compelling reason to recommend early intervention. They designate these venues (OBL and ASC) as high reimbursement settings. The authors do disclose and recognize the limitations of the Centers for Medicare and Medicaid Services (CMS) database evaluation. This includes the inability for the CMS claims data to quantify the degree of IC symptoms, the lack of objective testing data available, the lack of laterality documented, and the possibility that the early PVI interventions were due to significantly worse symptoms or an early failure of medical therapy. In addition, those with early PVI had a significantly higher smoking and hypertension prevalence – both suggesting the potential for a more significant disease process, leading to more severe symptoms failing medical management and thus earlier PVI. The analysis addresses the very important topic of intermittent claudication and the impact of early peripheral vascular intervention and their conclusions would indicate that that additional randomized control trials are needed with outcomes data and some element of severity evaluation. But, as has been demonstrated in previous publications, we feel compelled to address the characterization of OBLs as “high reimbursement settings”. This terminology appears repeatedly in presentations and publications and it is apparent that a true understanding of the finances of the OBL site of service is needed. It is imperative that the narrative of “high reimbursement settings” be debunked and it is evident that some education is needed to provide the appropriate framework for understanding the OBL as a site of service. Defining this site of service as a “high reimbursement setting” suggests that there is a financial windfall for providing any peripheral vascular intervention in an OBL. This is incorrect and fails to recognize the provision of needed outpatient sites of service for our communities and patients. To clarify the role of the OBL as a site of service, it is important to understand how OBLs are established, how they operate, and how they are reimbursed compared to the hospital outpatient setting. The development of a site capable of providing high-quality, expert vascular intervention requires significant investment. Consider the costs to rent or buy space sufficient for development of a center. This initial capital investment will have the added risk of a multiyear guarantee of payments from the provider – a personal guarantee that will remain whether the site is successful or not. Additional capital investment, again with financial risk and personal guarantees, is needed for the imaging systems, ultrasound equipment, computers, vital monitors, crash cart with equipment, and the list goes on. Consider if you had to purchase all of equipment that you see in the Cath lab in the hospital and you will soon recognize the costs necessary to establish this site of service. On top of this, and included in the reduced Medicare fee for the procedure, are the costs associated with staffing the OBL. A manager, nursing personnel, medical assistants, front desk personnel, radiology technicians, etc. These costs have become significantly higher in the past few years, with hiring and maintaining staff more difficult with the current shortages experienced by all sites of service, including hospital settings. We all need to understand that the payment to the facility covers all of these components as well as the costs associated with the intervention itself. Sterile packs, sheaths, preps, medication, wires, angioplasty balloons, stents, atherectomy devices, insufflators, contrast, heparin, emergent rescue medications, antibiotics – all the supplies needed to perform a highly advanced endovascular procedure just as it is provided in the hospital setting. As is quite evident, the cost to provide this highly efficient, patient-focused, and expert vascular care is significant and has been impacted by supply shortages, inflation, and increased overhead. Should the case be quite complex, the supplies used often lead to a loss compared to the reimbursement received. It is in this reality that the labelling of OBLs as “high reimbursement settings” is not accurate. The fact is, the reimbursement for any office-based procedure performed in the OBL site is 20% to 40% less than the exact same procedure in the hospital outpatient setting. Yet, patient and physician satisfaction, efficiency, and overall value of such an OBL procedure is significantly higher than in the hospital setting. Yes, the same procedure provided in the OBL costs Medicare significantly less than in the outpatient hospital setting. The risks of all the expenses required to provide such procedures falls upon the OBL and its owners. CMS provided for payments for PVI in the OBL in 2008, recognizing that these procedures could be performed in this outpatient site of service with safety, efficacy, and at a substantial savings to the system. They recognized a streamline efficiency of the office setting over the hospital setting. Implications that procedures are being performed in OBLs due to a significant financial windfall does not recognize the costs and risks associated with establishing and operating an OBL. The significant shift of vascular care to outpatient procedures is not going to abate. The ability for the OBL to provide improved access, patient satisfaction, and significant cost reductions to CMS and payors should be highlighted and supported. Without doubt, there will be outliers and those that provide interventions outside of the norm, but, as this article reports, nearly 97% of cases were performed within approved practice guidelines. As we embrace the continued evolution of our vascular specialty, we need to recognize the inevitable shift that is occurring. The majority of all vascular procedures will be outpatient procedures. Many of the current hospital systems are not efficient, are not patient friendly, have poor patient satisfaction, and are terribly inefficient for the busy vascular specialist to provide necessary patient care. Any opportunity to elevate the standard of care for our patients, to promote safe, effective, and value-based care to our communities, needs to be embraced and strengthened. The OBL provides a site of service that can provide efficient, expert, and indicated vascular care that is patient focused. It provides improved patient satisfaction, provider satisfaction, more time to provide essential services to the community, and significant cost savings to the patients, Medicare, and all payors. An analysis of the cost benefits, improved patient centered access, and the undeniable need for outpatient vascular services that can be, and are currently provided, in the OBL is much overdue.

Background: With the evolution in vascular surgery toward increased endovascular therapy and decreased open surgical training, comfort with open procedures by current trainees is declining. A proposed method to improve this discomfort is simulator training. We hypothesized that open, cadaver, and endovascular surgery simulation would be associated with increased self-perceived comfort in performing corresponding procedures. Methods: Integrated (0 + 5) vascular surgery residents and recent graduates in the United States were asked to complete a survey quantifying comfort via a Likert scale with procedures and experience with simulation training. Simulation groups were then matched using coarsened exact matching. Ordinal logistic regression assessed the association between simulation experience and comfort in performing procedures. Results: Surveys were completed by 68 trainees and 20 attending surgeons in their first 5 years of practice. On unmatched analyses, there were no significant differences in comfort in performing any open or endovascular aorto-mesenteric or peripheral vascular procedures between respondents who reported experience with open or endovascular simulation, respectively. However, respondents who reported cadaver simulation experience (58%, 51/88) had a significantly higher reported comfort score performing open juxtarenal aortic repair (2.4 vs. 1.7), superior mesenteric artery thrombectomy or bypass (2.5 vs. 1.9), inferior vena cava or iliac vein repair (2.2 vs. 1.7), axillary-femoral artery bypass (3.4 vs. 2.5), femoral-popliteal artery bypass (3.7 vs. 2.8), and inframalleolar artery bypass (2.8 vs. 2.1; all P < 0.05). After matching on training level, number of abdominal cases completed, and number of open vascular cases completed, ordinal logistic regression demonstrated that previous cadaver simulation was significantly associated with increased comfort in performing open aortic repairs, venous repair, visceral revascularization, and peripheral bypasses. Conclusions: In this nationally representative sample, cadaver, but not open or endovascular, simulation was associated with increased comfort in performing open vascular surgery. Providing cadaver simulation to trainees may help to improve comfort levels in performing open surgery. Integrated vascular surgery training programs should consider implementing these experiences into their curriculum.

Vascular surgeons of all backgrounds play an important role in providing high quality vascular surgical care in their communities. In America, with our diverse population and communities, patients presenting with vascular disease are very common and could pattern the community demographic. Often faced with the challenges of community hospital politics and demand, the vascular surgical workforce has continued to be active members in their communities, focusing on their strengths to lead vascular surgery healthcare in an environment of high patient demand. Having a varied vascular surgery workforce provides all patients afflicted by vascular disease a comfortable opportunity for compassionate and empathic vascular care. This is a significant strength of vascular care when diversity, equity, and inclusion are supported by the leadership.

OBJECTIVE:In the last two decades, vascular surgery training evolved from exclusively learning open skills to learning endovascular skills in addition to a functional reduction in training duration with 0+5 residency programs. The implications for this on trainee evolution to independence are unknown. We aimed to assess self-perceived comfort performing open and endovascular procedures and to identify predictors of high comfort among senior vascular surgery trainees and recent graduates. METHODS:Junior and senior 0+5 vascular surgery residents, traditional fellows, and attendings in their first 4 years of practice were asked to complete a survey assessing the number of vascular procedures performed to date, comfort performing these procedures on a Likert scale, and validated scales of self-efficacy and grit. Groups were then matched by training level and age. Logistic regression identified independent predictors of the top quartile of self-perceived comfort performing procedures. RESULTS:Surveys were completed by 92 trainees and 71 attending surgeons in their first 4 years of practice. After matching, completing ≥7 open juxtarenal aortic repairs (OR = 4.73, 95% CI = 1.59-14.07) and a higher self-efficacy score (OR = 3.24, 95% CI = 1.20-8.76), were independent predictors of top quartile comfort performing open vascular procedures. 0+5 residency training inversely correlated with top quartile comfort performing open vascular operations (OR = 0.12, 95% CI = 0.03-0.47). Completing ≥7 complex EVARs (OR = 3.94, 95% CI = 1.61-9.59) and a higher self-efficacy personality score (OR = 2.76, 95% CI = 1.09-7.02) were predictors of top quartile comfort performing endovascular procedures. CONCLUSION:In this nationally representative survey, both trainees and junior attendings completed a paucity of complex open vascular cases, which corresponded to reduced comfort performing these procedures. Furthermore, 0+5 residency training was associated with lower self-perceived comfort performing open vascular surgery, a trend that persisted through the first years of practice. Endovascular comfort did not show a similar correlation.

The Society for Vascular Surgery Alternative Payment Model (APM) Taskforce document explores the drivers and implications for developing objective value-based reimbursement plans for the care of patients with peripheral arterial disease (PAD). The APM is a payment approach that highlights high-quality and cost-efficient care and is a financially incentivized pathway for participation in the Quality Payment Program, which aims to replace the traditional fee-for-service payment method. At present, the participation of vascular specialists in APMs is hampered owing to the absence of dedicated models. The increasing prevalence of PAD diagnosis, technological advances in therapeutic devices, and the increasing cost of care of the affected patients have financial consequences on care delivery models and population health. The document summarizes the existing measurement methods of cost, care processes, and outcomes using payor data, patient-reported outcomes, and registry participation. The document also evaluates the existing challenges in the evaluation of PAD care, including intervention overuse, treatment disparities, varied clinical presentations, and the effects of multiple comorbid conditions on the cost potentially attributable to the vascular interventionalist. Medicare reimbursement data analysis also confirmed the prolonged need for additional healthcare services after vascular interventions. The Society for Vascular Surgery proposes that a PAD APM should provide patients with comprehensive care using a longitudinal approach with integration of multiple key medical and surgical services. It should maintain appropriate access to diagnostic and therapeutic advancements and eliminate unnecessary interventions. It should also decrease the variability in care but must also consider the varying complexity of the presenting PAD conditions. Enhanced quality of care and physician innovation should be rewarded. In addition, provisions should be present within an APM for high-risk patients who carry the risk of exclusion from care because of the naturally associated high costs. Although the document demonstrates clear opportunities for quality improvement and cost savings in PAD care, continued PAD APM development requires the assessment of more granular data for accurate risk adjustment, in addition to largescale testing before public release. Collaboration between payors and physician specialty societies remains key.

The Executive Board (EB) of the Society for Vascular Surgery (SVS) is pleased to receive and respond to the Report of the Diversity, Equity and Inclusion (DEI) Taskforce (TF). In September 2019, the TF members were charged with envisioning a more diverse and inclusive SVS and vascular surgery workforce. The timeline of their response, stretching back over the past year, encompasses perhaps the most controversial and socially contentious period of the past generation. The issues identified by the TF, significant and compelling as they are, also demand our attention at this moment in time. In summary, in accepting the TF Report, your EB commits to the changes necessary to implement its more than 40 recommendations, objectives, and requested actions. Many can be readily achieved in the near term; others require strategic alignment and resource allocation, and a few await the more comprehensive culture change that only sustained effort will achieve. The report articulates well the “why” of this effort: the health, vitality and future relevance of the SVS and the specialty itself depend on our ability to understand what needs to be done. The recommendations themselves define the “what”—our opportunity to respond. This document introduces the “how”—our action plan to implement change. This plan acknowledges the central goal or outcome of each respective recommendation, identifies the SVS committee or council best positioned to respond, and the likely timeline to completion. This framework summarizes, at a glance, the who, what and when of our response (Table).TableDiversity, Equity and Inclusion Taskforce Report recommendationsRecommendationDomainAssigned toTimelineaNear term: 0-6 months; midterm: 6-12 months; long term: ≥12 months.Commission the DEI Committee as an element of the EB governance structureGovernance, Policy and ProcessEB; Appointments CommitteeNear termCreate a Diversity Position StatementGovernance, Policy and ProcessEB; DEI CommitteeNear termRevise our Mission and Core Values Statements and update respective BylawsGovernance, Policy and ProcessEBMid termAppoint DEI Committee liaisons to Councils and Committees implementing DEI initiativesGovernance, Policy and ProcessAppointments CommitteeNear termDevelop/curate DEI educational resources, including implicit bias training for leadershipGovernance, Policy and ProcessDEI CommitteeLong termAlign the annual appointments process with the DEI prioritiesGovernance, Policy and ProcessAppointments CommitteeMid termLaunch the member censusMeasurement and ResearchEBNear termProduce an annual DEI Report that tracks progress across multiple domainsMeasurement and ResearchDEI CommitteeLong termEstablish and underwrite a new Health Disparities Research awardMeasurement and ResearchPopulation Health TF; Research Council; SVS FoundationLong termDevelop and implement a multi-year action plan to augment the URiM and LGBTQ+ workforce in vascular surgeryRepresentation and EngagementCOVERS CoalitionLong termIdentify and recruit women, URiM and LGBTQ+ vascular surgeons to membership in the SVSRepresentation and EngagementMembership CommitteeLong termSubstantially evolve the SVS appointments process to leverage the growing diversity of the organizationRepresentation and EngagementAppointments CommitteeMid termEmphasize diversity awareness in SVS Nominations Committee deliberationsRepresentation and EngagementExecutive Committee; DEI CommitteeMid termIncrease opportunities for women, URiM, and LGBTQ+ members to participate in and lead SVS-sponsored activitiesRepresentation and EngagementAppointments CommitteeLong termIncorporate DEI principles into eligibility requirements for scholarships and awardsRepresentation and EngagementResearch Council and other Committees overseeing awards and scholarshipsNear termExpand SVS leadership training and grant opportunities for women, URiM and LGBTQ+ membersProgramsLeadership Development CommitteeLong termDevelop programs to help members navigate hospital disciplinary proceedings, privileging hurdles, Ongoing and Focused Professional Practice Evaluations and similar practice impedimentsProgramsDEI CommitteeLong termEnhance DEI programming in all SVS educational offerings including the Vascular Annual MeetingProgramsEducation CouncilLong termAssure diverse representation in SVS-sponsored programs and events, including moderators, panelists, and invited presentersProgramsEducation CouncilMid termDevelop specific programming for women, URiM, and LGBTQ+ trainees and medical studentsProgramsResident and Student Outreach Committee; Young Surgeons Committee; COVERS CoalitionLong termIntentional consideration of women, URiM and LGBTQ+ members for leadership opportunities at every levelProgramsAppointments Committee; Councils and Committees developing ProgramsLong termOperationalize the new Communications Committee and charge it with highlighting our support for DEIPublications and CommunicationsAppointments Committee; Communications CommitteeNear termImplement and extend the 14 point diversification plan announced by JVS LeadershipPublications and CommunicationsEB; JVS LeadershipNear termEnsure that all voices are represented in our ongoing Town Halls, Meet the Leadership, and Ask the Experts sessionsPublications and CommunicationsCommunications CommitteeLong termCommission an updated Journal of Vascular Surgery DEI SupplementPublications and CommunicationsExecutive Committee; DEI CommitteeNear termEvolve mentorship programs to champion DEI principles and prioritiesRecruitment and OutreachResident and Student Outreach Committee; Young Surgeons Committee; COVERS CoalitionLong termEmpower COVERS to recruit a fully representative workforce in vascular surgeryRecruitment and OutreachCOVERS CoalitionLong termCOVERS, Coalition for Optimization of Vascular Surgeon Trainees and Students; DEI, Diversity, Equity and Inclusion; EB, Executive Board; JVS, Journal of Vascular Surgery; LGBTQ+, lesbian, gay, bisexual, transgender and queer; SVS, Society for Vascular Surgery; TF, taskforce; URiM, underrepresented in medicine.a Near term: 0-6 months; midterm: 6-12 months; long term: ≥12 months. Open table in a new tab COVERS, Coalition for Optimization of Vascular Surgeon Trainees and Students; DEI, Diversity, Equity and Inclusion; EB, Executive Board; JVS, Journal of Vascular Surgery; LGBTQ+, lesbian, gay, bisexual, transgender and queer; SVS, Society for Vascular Surgery; TF, taskforce; URiM, underrepresented in medicine. To facilitate strategic alignment, the recommendations are further sorted into Implementation Domains based on core purposes. The domains seek to stimulate change in the following key strategic areas (Fig):➢Governance, policy, and process➢Measurement and research➢Representation and engagement➢Programs➢Publications and communications➢Recruitment and outreach An oft-stated strategic planning axiom holds that, “Culture eats strategy for lunch.” Sustainable, meaningful change depends on cultural alignment. Although the “culture” of a medical specialty or professional organization is ultimately derived from its membership, it is strongly influenced by the credibility and consistency of leadership. Many TF recommendations address the fundamental building blocks of culture change: governance, policy, and process evolution. These are the responsibility of the Executive and Strategic Board of Directors, with guidance from their governance-related committees including Appointments, DEI, and Communications—the latter two newly created to catalyze change, the former in the process of significant evolution for the same purpose. Bringing the SVS charter documents (eg, constitutions and bylaws) as well as key board policies and positions into alignment with DEI principles will be our initial and primary focus, with processes subsequently aligned to these new standards. Key recommendations in this domain include the following.•Commission the DEI Committee as an element of the EB governance structure. This committee will serve as a resource and guide to the EB and Strategic Board of Directors, as well as councils, committees, sections, and TFs with governance interests. Further, the DEI Committee will take primary responsibility for achieving many of the objectives outlined in the DEI TF Report;•Create a Diversity Position Statement, including elements addressing:○Commitment to a diverse workforce;○Prohibition of bias related to race, ethnicity, gender, religion, or sexual identity;○Resources needed to eradicate discrimination, bias, and harassment; and○Equitable participation and leadership opportunities for all members.•Revise our Mission and Core Values Statements and update respective bylaws;•Appoint DEI Committee liaisons to councils and committees implementing these initiatives;•Develop/curate DEI educational resources, including implicit bias training for leadership; and•Align the annual appointments process with DEI priorities. You cannot change what you cannot measure, and the TF report repeatedly cites the lack of comprehensive membership demographics as a significant impediment to change. The SVS can safely acquire and archive the demographic and practice variables we need to measure, but we need members to provide the necessary information. This year's inaugural member census, with input from the Clinical Practice and Research Councils, as well as the Membership Committee, EB, and multiple staff departments, will anchor robust longitudinal trend analyses necessary to populate dashboards and measure progress. We need every member's help in completing this census. In addition to the member census, several other DEI research projects are envisioned for the DEI Committee, Research Council, and SVS Foundation Board, including those related to the vascular workforce as well as the communities we serve. Key recommendations in this domain include the following.•Launch the member census;•Produce an annual DEI Report that tracks progress across multiple domains;•Establish and underwrite a new Health Disparities Research award; and•Incorporate DEI principles into eligibility requirements for research awards. A common theme expressed throughout the DEI TF Report is the need to acknowledge and embrace the growing diversity of the SVS membership to achieve equity for women, underrepresented in medicine (URiM), and lesbian, gay, bisexual, transgender and queer (LGBTQ+) vascular surgeons. As has been so commonly stated recently, “you cannot be what you cannot see.” Proportional participation and opportunities for advancement are essential, if not existential, imperatives for organizational effectiveness and member engagement. The SVS Appointments, Nominations, and DEI Committees, as well as the EB itself, will be seeking guidance from membership on how to achieve the desired balance of background and ability to serve and lead effectively. Key recommendations in this domain include the following.•Develop and implement a multiyear action plan to augment the URiM and LGBTQ+ workforce in vascular surgery;•Identify and recruit women, URiM, and LGBTQ+ vascular surgeons to membership in the SVS;•Substantially evolve the SVS appointments process to leverage our growing diversity;•Emphasize diversity awareness in SVS Nominations Committee deliberations;•Increase opportunities for women, URiM, and LGBTQ+ members to participate in and lead SVS-sponsored activities; and•Incorporate DEI principles into eligibility requirements for scholarships and awards. SVS programs are the vehicle through which member ideas and visions become reality. Ideally, these programs develop into valuable contributions to vascular health. We commit to embedding DEI principles throughout the programmatic activities of the SVS. Whether in clinical education, wellness, leadership development, advocacy, quality, practice management, or branding, all programs will reflect this commitment, and every committee, council, and TF will be asked to review their program portfolio accordingly. Key recommendations in this domain include the following:•Expand SVS leadership training and grant opportunities for women, URiM, and LGBTQ+ members;•Develop programs to help members navigate hospital disciplinary proceedings, privileging hurdles, Ongoing and Focused Professional Practice Evaluations and similar practice impediments;•Enhance DEI programming in all SVS educational offerings, including the Vascular Annual Meeting;•Ensure diverse representation in SVS-sponsored programs and events, including moderators, panelists, and invited presenters;•Develop specific programming for women, URiM, and LGBTQ+ trainees and medical students; and•Intentionally consider women, URiM, and LGBTQ+ members for leadership opportunities at every level. The SVS portfolio of communication portals, through which we share our work and achievements with the world, “tells our story.” Everything we publish and communicate, whether through our journals, magazines, newsletters, e-mail blasts, video, social media, or podcasts, is being evaluated not only for its content, but also for the sensitivity of its context. We agree with the DEI TF assessment that cultural competency depends on a diversity of backgrounds, perspectives, and experiences in those responsible for editorial processes throughout the publishing enterprise. Key recommendations in this domain include the following.•Operationalize the new Communications Committee and charge it with highlighting our support for DEI;•Implement and extend the 14-point diversification plan recently announced by the JVS leadership;•Ensure that all voices are represented in our ongoing Town Halls, Meet the Leadership, and Ask the Experts sessions; and•Commission an updated Journal of Vascular Surgery DEI Supplement this academic year. The previous five domains are SVS-centric. They refer to initiatives and activities within the direct control of the SVS. The TF Report stresses the importance of extending DEI principles into the development of the future workforce in vascular surgery. These efforts require effective, coordinated actions across all vascular societies. The SVS Strategic Board, conceiving of such a coalition at its January 2020 retreat, organized the Coalition for Optimization of Vascular Surgeon Trainees and Students (COVERS), including the Association of Program Directors in Vascular Surgery, SVS, Society for Clinical Vascular Surgery, and Vascular & Endovascular Surgery Society to focus on medical student recruitment and trainee development. Key recommendations in this domain include the following:•Evolve mentorship programs to champion DEI principles and priorities; and•Empower COVERS to recruit a fully representative workforce in vascular surgery. Two universal constants in our world include the speed of light and the constant state of evolution and change. Whether as individuals or organizations, we either develop sufficient insight, foresight, and resilience to adapt to the changing environment around us, or we choose a path of diminishment and eventual extinction. Vascular surgery as a relatively young specialty, and the SVS as its champion, are both familiar with this dynamic. The SVS has evolved substantially to meet the challenges of today. The pace of change is quickening, however, and by its nature increasingly broad, diverse, and compelling. DEI have been on our collective radar for some time, but it took the leadership of Kim Hodgson, the 2019-2020 SVS President, to frame DEI as strategic opportunities for our society. Under his directive, your EB established the DEI TF to develop this action plan to guide our efforts going forward. As we approach the 75th anniversary of our founding in San Francisco in 1946, historical precedent is difficult to ignore. The surgeons who created the SVS had learned from experience, both in peacetime and in war, that more effective methods were needed for the management of vascular injuries and disease. Your current leadership recognizes now that more effective methods are needed to resolve structural and cultural barriers to career development and advancement for women, URiM, and LGBTQ+ SVS members, as well as improving access to, and outcomes from, vascular care for underprivileged and minority populations across our society. This is our moment to maximize opportunity for all, both within the SVS and the larger communities we serve, starting with the proposed bylaws provisions and extending throughout all facets of our organization. We appreciate the work and insight of the DEI TF in preparing these comprehensive recommendations. Their contribution will help to ensure at least 75 more years of effective member advocacy and exemplary public service from your SVS.

Stenting of the iliac veins has increased significantly over the last two decades. Wide-spread use of stents in both thrombotic and nonthrombotic conditions has led to careful consideration of the efficacy of this procedure and patient selection.