L. Lopes1,2, M. Gonzalez-Urquijo3,4, L. Marine4, J. Vargas4, D. Chikiar5, V. Viteri-Pérez6, M. Fabiani3 1Northwestern University, Vascular Surgery, Chicago, IL, USA 2Federal University of Minas Gerais, Surgery, Belo Horizonte, MG, Brazil 3Tecnologico de Monterrey School of Medicine and Health Sciences, Surgery, Monterrey, Nuevo León, Mexico 4Pontificia Universidad Catolica de Chile, Cirugía Vascular Y Endovascular, Santiago, Región Metropolitana de Santiago, Chile 5Hospital Central de San Isidro Dr Melchor Angel Posse, Buenos Aires, BUENOS AIRES, Argentina 6Hospital de Especialidades Carlos Andrade Marín, Quito, PICHINCHA, Ecuador
Introduction: Despite the global rise in vascular disease, there is a significant shortage of vascular surgeons, particularly in the North and South Americas. To address this gap, it is essential to understand the distribution of vascular surgery training positions and the pathways to becoming a vascular surgeon across the American continent. This study aims to report the current status of vascular surgery training in the Americas.
Methods: A cross-sectional analysis of vascular surgery training programs was conducted using data from government, postgraduate medical schools, and national medical associations' websites in 35 North and South American countries between November 2023 and February 2024. For each country offering vascular surgery training, we documented the number of trainee positions (total and per capita) by modality: integrated vascular residency versus vascular surgery fellowship. We also recorded the number of training institutions, the duration of training, and whether completion of a general surgery residency was required before starting vascular training. Additionally, we assessed the presence of national vascular societies and vascular surgery board exams. Quantitative data were reported as medians and ranges, with frequencies expressed as percentages.
Results: There are 707 annual vascular surgery training positions offered by 367 institutions across the Americas. Of the 35 countries analyzed, 17 (48.5%) offer vascular surgery as an independent specialty. Peru is the only country that combines vascular training with cardiothoracic surgery. Seventeen countries (48.5%) lack vascular surgery training programs, including Guatemala, Haiti, Honduras, and Nicaragua, all with populations exceeding 5 million. Brazil offers the most positions (292, 41.4%), followed by the U.S. (214, 30.3%) and Mexico (69, 9.8%). Cuba has the highest number of positions per capita (0.393 per 100,000), followed by Brazil (0.134) and Uruguay (0.087). Thirteen (72.2%) of the 18 countries offering training have integrated vascular surgery residencies with a median duration of 5 years. Brazil, Chile, the Dominican Republic, El Salvador, and Venezuela require prior general surgery training, with a median residency duration of 3 years and a vascular fellowship of 2 years. All countries with vascular surgery training have a national vascular society, and only Brazil, Canada, Mexico, and the U.S. have board exams.
Conclusion: This is the first comprehensive report on vascular surgery education in the Americas. The prevalence of integrated residencies and national societies underscores the establishment of vascular surgery as an independent specialty. However, training opportunities remain limited, with disparities in access across countries. The variety of pathways and scarcity of board exams raise concerns about training standardization. Expanding vascular surgery training in the Americas is essential to combat the growing burden of vascular diseases.