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Objective To describe the development and implementation of virtual vascular surgery rotations among 6 integrated vascular surgery programs. Design A collaborative teleconference retrospectively discussing 6 independently developed virtual vascular surgery rotations to make a framework for future use. Setting University of California Davis initiated a joint teleconference among the various integrated vascular surgery programs. Participants Vascular surgery faculty and residents from 6 programs participated in the teleconferences and drafting of a framework for building a virtual vascular surgery rotation. Results Four specific domains were identified in discussing the framework to build a virtual vascular surgery rotation: planning, development, curriculum, and feedback. Each domain has specific aspects in making a virtual rotation that has applicability to other surgical rotations that seek to do the same. Conclusion Virtual vascular surgery rotations are feasible and important; these electives can be established and implemented successfully with appropriate planning and consideration. This work hopes to help programs navigate this new space in education by making it more transparent and highlighting potential pitfalls.

Background: Prior studies report improved mortality rates for patients of female internists, few studies have evaluated the effect of surgeon gender on post-operative mortality. Methods: A retrospective analysis using the Agency for Health Care Administration Florida database from 2010-2015 examined patients undergoing one of 25 selected surgical procedures. Surgeon gender (self-reported), number of Medicare beneficiaries and years of experience were imported from CMS Physician Compare/Provider Utilization & Payment Data set using NPI. 25 procedures of varying complexity from all subspecialties were selected. For each procedure, inverse probability of treatment weighting (IPTW) was used to match cases performed by male vs female surgeons to achieve maximum balance between the groups. Results: There were 73,994 admissions for patients undergoing surgical procedures performed by 2,828 surgeons(361 females, 2467 males). Fewer patients who had emergent procedures performed by female surgeons died in the hospital(291/13957,2.08% vs 348/14017,2.48% p=0.026). Those who underwent the following procedures had significantly lower rates of in-hospital mortality if the surgeon was female: CABG(2/387,0.52% vs 8/387,2.07%), mastectomy(2/4797,0.04% vs 10/4797,0.21%), open cholecystectomy(7/955,0.73% vs 17/955, 1.78%) all p≤0.05. Conclusion: Patients who underwent CABG, mastectomy and open cholecystectomy had lower rates of in-hospital mortality if the surgeon was female while male surgeons did not have a significant mortality advantage for any procedure. Further studies examining national data may provide additional insight regarding the effect of surgeon gender on patient outcomes.

Objective: We present a case of recurrent bilateral lower extremity venous stasis ulcers in association with a superficial venous aneurysm at the right saphenofemoral junction that was misdiagnosed on preoperative duplex scanning. Methods: A 53-year-old female presented to our clinic with 6-year history of bilateral lower extremity venous stasis ulcers. Her past medical history was significant for refractory venous stasis ulcers of the bilateral lower extremities present for 6 years and morbid obesity. Results: Preoperative venous duplex demonstrated severe venous insufficiency of the superficial and deep systems, but a venous aneurysm was not appreciated. During the high ligation of the right saphenofemoral junction, a 3 × 4 × 5 cm aneurysm was encountered. Repair consisted of aneurysm resection, high ligation of the greater saphenous vein, dissociation of the great saphenous and anterior saphenous veins, and stab phlebectomy of large varicose veins of the thigh and lower leg. The patient recovered uneventfully and experienced complete healing of the venous stasis ulcer in several weeks. Conclusion: Superficial venous aneurysms of the lower extremity are rare and can be often missed on preoperative duplex ultrasound imaging. Large diameter measurements of the proximal greater saphenous vein and obesity increase the risk of misdiagnosing venous aneurysms with duplex imaging; therefore, clinical suspicion must remain high. These aneurysms can be associated with significant symptoms for which repair is indicated.