Vascular surgery in Pakistan: critical issues

PAFMJ, 2021

Objective: To determine the challenges being faced by vascular surgeons in acceptability of their specialty by the medical community of Pakistan. Study Design: Qualitative case study. Place and Duration of Study: Various training institutes & teaching hospitals all over the Pakistan, from Sep 2019 to Feb 2020. Methodology: Semi structured interview format comprising of a series of open ended and broad questions to get maximum relevant information, were sent to 13 surgeons (vascular and part time vascular surgeons) practicing vascular surgery at least for the last five years in various training institutes and teaching hospitals of Pakistan. Interviews were audio recorded on telephone and in persons. The data was transcribed, cleansing was done, and analyzed through inductive and thematic content analysis. Results: Handful of qualified vascular surgeons, inadequate vascular training program, part time vascular surgery and unawareness/misconceptions/myths about vascular diseases, were ...

The vascular surgeon is trained in the management of diseases affecting all parts of the vascular system except that of the heart and brain whereas cardiothoracic surgeons manage surgical diseases of the heart and its vessels. Although vascular surgery was previously a field within general surgery, it is now considered a specialty on its own right in many countries such as the UK and the United States. Other countries such as Iraq have a mixed practice in which the cardiac or thoracic surgeon performs vascular surgery. Programs of training in vascular surgery are slightly different depending on the region of the world one is in. In the United States, a 5-year general surgery residency is followed by 2 years training in vascular surgery. In Iraq, the time table allocated for the general surgical trainee in vascular surgery is unfortunately short (1-3 months). This period is hardly enough for the candidate to grasp the decision-making and technical skills of vascular surgery. We believe that general surgeons need to have adequate training and expertise in vascular surgery particularly in areas and situations lacking this facility to deal with the life- and/or limb-threatening emergencies. This review article aims to orient the general surgical trainee about the scope of vascular surgery and enable them to correctly diagnose and treat common vascular emergencies such as extremity and abdominal vascular injuries (AVI).

Asian Journal of Surgery, 2014

To evaluate the quantity and quality of published vascular surgery research articles from the Gulf Cooperation Council (GCC) countries so as to identify areas for improvement. Design: Descriptive study. Materials: Published MEDLINE articles on vascular surgery from the GCC countries (1960e2010). Methods: Critical analysis of the articles. Results: A total of 146 articles were studied, majority of which were case series/case reports (55.5%); 33% of the articles were prospective. The first author was from a university in 67.1% of the articles. Only one randomized controlled trial was found. The median (range) impact factor of the journals was 1.16 (0.16e12.64). Kuwait had the highest number of publications/country, standardized/100,000 inhabitants. There were 11 experimental studies, which were all from Kuwait. More statistically significant, experimental vascular surgery papers were published prior to 1993 (11/30 compared with 0/111 afterward, p < 0.0001; Fisher exact test). The GCC countries had the lowest vascular surgery research output compared with Turkey, Hong Kong, Singapore, and Japan when standardized by the population. The h index of the GCC countries' vascular research publications was the lowest (19) compared with the other four countries (29e97). Furthermore, the average citation of the GCC countries (5.81) was similar to Turkey (5.66), but less than Hong Kong (17.38), Singapore (12.79), and Japan (11.75). Conclusion: The quality and quantity of vascular surgery research in the GCC countries should be improved to answer important local questions related to vascular diseases. This needs better strategic planning and more collaboration between various institutions.

Asian Cardiovascular and Thoracic Annals, 2014

Background: The field of vascular surgery is evolving in sub-Saharan Africa but the practice is bedeviled by lack of expertise and infrastructure challenges. The consequences are a low volume of operations and a dearth of data. Available data are not representative of the wider picture, therefore, this study was undertaken to evaluate the practice of vascular surgery in a tertiary institution, in the light of the prevailing challenges. Methods: Data from all patients with vascular-related pathologies managed in our surgical outpatient clinic and accident and emergency wards were obtained from the clinic and in-patient records from January 2008 to December 2012. Age, sex, diagnosis, treatment, and complications were noted. There were 73 patients comprising 45 (61.6%) males and 28 (38.4%) females. The age range was 1-90 years (mean 43.5 years). Results: The pathologies managed included end-stage renal disease (n ¼ 36, 49.3%), nontraumatic and posttraumatic aneurysms (n ¼ 13, 17.8%), vascular trauma (n ¼ 12, 16.4%), peripheral vascular disease (n ¼ 5, 6.9%), congenital vascular malformations (n ¼ 4, 5.5%), and thrombotic diseases (n ¼ 3, 4.1%). Fifty-four (74.0%) surgeries were performed, with a complication rate of 5.5% and 2.7% mortality. Conclusions: The practice of vascular surgery in Zaria, Nigeria, is fraught with challenges. The gap created by the dearth of skilled vascular surgeons is filled by competent cardiothoracic surgeons. Infrastructure decay and lack of prostheses limit the number and variety of operable cases. These challenges result in preventable morbidity and mortality.

Sage Open Medicine, 2019

Objectives: High-quality research is fundamental to the advancement of surgical practice. Currently, there is no quantitative assessment of the research output of vascular surgeons in Australia and New Zealand. By conducting this bibliometric analysis, we aim to provide an objective representation of the trends in vascular surgery and guide future research. Methods: A list of all current vascular surgeons in Australia and New Zealand was compiled from the Royal Australasian College of Surgeons 'Find a Surgeon' website tool and correlated with the Australia and New Zealand Society for Vascular Surgery database. A Scopus search of each surgeon's author profile over the last 20 years was conducted. Results: In total, 2120 articles were published by 208 Australasian vascular surgeons between 1998 and July 2018, with an overall increase in publications over time. Audits or case series were the most published type of study and only 8% of the publications were of high-level evidence. The most popular topics were thoracoabdominal aortic pathologies (24%), followed by peripheral arterial disease (15%). Chronological analysis illustrates an increasing volume of peripheral arterial disease research over time and there is a clear trend towards more endovascular and hybrid surgery publications. The top 10 (5%) highest publishing authors by h-index account for 41% of all publications and 49% of all citations and are also responsible for producing significantly more high-level evidence research. Conclusion: Australasian vascular surgeons have made a significant contribution to medical research. However, the majority of these articles are of low-level evidence. In this time, there has been an increasing number of publications on endovascular and hybrid surgery in keeping with the trend in clinical practice. These areas, as well as research regarding peripheral arterial disease, show potential for high-evidence research in the future.

Journal of Islamabad Medical & Dental College

Background: Peripheral vascular trauma is fairly common and its repercussions lead to need for urgent management and multidisciplinary approach. We hereby evaluate the presentation, management and outcomes of peripheral vascular injuries presenting in a tertiary care hospital in Islamabad, Pakistan. Material and Methods: This was a prospective clinical study conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS) Hospital, Islamabad Pakistan from January 2016 to June 2018. A total of 60 patients with vascular extremity trauma were included in the study. Initial assessment and resuscitation were done and patients with vascular injury were directly shifted to operating room for primary vascular repair (if defect size &lt; 2 cm) or vein graft (great saphenous). Fractures and nerve injuries were also treated. Fasciotomies were performed where indicated. Post-operative monitoring of limb was done for palpable pulses, temperature and color changes. Co...

Journal of Vascular Surgery, 2008

The increasing cases of road traffic accidents and firearm injuries have increased the incidence of vascular injuries. There is huge burden of vascular surgical diseases and general surgeons are helping vascular surgeons to reduce surgical workload. Objective: To determine the various factors leading to poor outcome of vascular repairs done by general surgeons Study Design: Retrospective study Setting: Methodology: All patients of all age groups who required emergency vascular surgery, diagnosed by consultant surgeon at surgical emergency were included. Operations were performed after pre-anesthetic evaluation by consultant general surgeons. Variables including injury type, vessel injuries, injury severity score (ISS), surgical repair done, hospital stay, complications and mortality, were recorded from old data. Various complications after the surgery were compared with the type of repair done, age group and time till presentation after injury. The p-value <0.05 was considered significant. Limb amputation or mortality was taken as poor outcome. Results: Retrospective data showed 135 patients with mean age 28.8 + 11.5 years (14-63) most of which were males (127 of 135). Limb salvage rate and mortality was 74.8% and 4.4%, respectively. Complications occurred in 38/135 (28.1%) cases with wound infection (18%) and myonecrosis (6.7%) on top. No complications were seen in 71.9% cases. Factors leading to poor outcome/complications were GCS <12 (p=0.01), referred case (p=0.04), significant bleeding (p=0.004), Hb <9 at presentation (p=0.001), bone fracture (p=0.01), involvement of lower limb and late presentation (p=0.003). Conclusion: Late presentation in hospital is the major modifiable factor improvement of which can lead to better outcome, apart from the early and proper surgical intervention. In shortage of vascular surgeons, general surgeons can substitute vascular surgeons.

Zentralblatt für Chirurgie, 1997

This training process relies on a two step approach: 1. Self reflection and building awareness of one's own positionality; and I now realize I am not alone in my field and there is so much outside support I can access. I know that if a student or family has a need I do not know how to meet, I now can access resources to help.

International Congress Series, 2004

We have some problems getting younger doctors to specialize in vascular surgery. The reasons for this are not completely clear. Some of them feel that the number of open operations is decreasing and that more and more of the treatment is done by endovascular techniques. Although the surgeons are involved in this work in Norway there is an uncertainty about the future. Furthermore, a more systematic training in endovascular surgery seems necessary. This is a very important problem that we should discuss, and we suppose the problem is the same in many other European countries. Economical factors may also pay a role for the younger doctors when they plan their future. GP's are in general earning a lot more than those who are employed at hospitals and there are very little differences in salary between junior doctors and senior colleagues who have been in the hospital for decades putting a lot of effort into clinical work, administration and teaching.