Practice Patterns and Barriers to Vascular Genetic Testing among Vascular Surgeons

Introduction Engaging patients living with or at risk for aortic dissection via the Aortic Dissection Collaborative, physician education in vascular genetics was identified as a research priority. We surveyed vascular surgeons to characterize practice patterns, motivations, and barriers regarding aortopathy genetic testing. Methods An anonymous 27-question survey was distributed on social media platforms between November and December 2022. Domains included: demographics, vascular genetic education, testing attitudes and utilization, and experience in treating patients with genetic vascular aortopathies. The analysis included summary statistics and unpaired t-test to compare responses by interest in incorporating testing and practice type. Results 171 vascular surgeons from 15 countries responded to the survey (23% trainees). Over half received vascular genetics education during training (59%) and most (86%) were interested in incorporating genetic testing into their practice. Academic surgeons were more likely to have cared for a patient with a known genetic aortopathy over the past year as compared to surgeons in hospital-based and private practices (83% vs 56% vs 27%; p<0.01), to have ever made a referral to a medical geneticist (78% vs 51% vs 9%; p<0.01) and have access to genetic counselors or geneticists (66% vs 46% vs 0%; p<0.01). Barriers to genetic testing were rated as more significant by surgeons in non-academic practices, with top barriers being insurance coverage of testing, cost of genetic testing, and access to genetic counselors. Evidence-based professional society guidelines were the strongest rated motivating factor for testing incorporation among respondents. Conclusion Vascular surgeon attitudes are not major barriers to incorporating genetic testing for patients with aortopathies, however practical challenges regarding genetic testing and counseling are barriers to implementation especially for vascular surgeons in non-academic practices. Future efforts should focus on evidence-based society guidelines, continuing medical education to increase adoption, and facilitating access to genetic counseling.