Conception and design: JJ
Analysis and interpretation: JJ, PO, BR, LS
Data collection: JJ, PO
Writing the article: JJ
Critical revision of the article: JJ, PO, BR, LS
Final approval of the article: JJ, PO, BR, LS
Statistical analysis: JJ, PO
Obtained funding: Not applicable
Overall responsibility: JJ
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Submitted Sep 13, 2011; accepted Nov 10, 2011.
Additional material for this article may be found online
Dr Julie Ann Freischlag (Baltimore, Md). I had a question
about risk factor modiﬁcation and prevalence of disease, such as we
think there is going to be more diabetes and more obesity but the
impact of less smoking and perhaps better control of lipids. How
do you even try to attempt that in your analysis? Is there a way we
can look at that?
Dr Jeffrey Jim. I think it is probably impossible to account for
something like that. We started by looking at trends and changes,
such as improvement in medical therapy over the past decade,
which were accounted for in the calculations. However, there is a
lot that we cannot predict about the future. Certainly, these
include new techniques or even new medical therapy that may
completely eliminate atherosclerosis if we get lucky.
Dr Matthew Mell (Stanford, Calif). It seems from your data
that major open vascular procedures decreased over time, yet
percutaneous procedural volumes increased. Did you consider the
impact of other specialties’ offering percutaneous treatment and
the proportion of patients cared for by vascular surgeons on future
Dr Jim. I will start off by saying that shortage of providers is
not something that will be unique to vascular surgery. The Amer-
ican College of Cardiology has also noted this and published a
report recommending an increase in training positions. There are
many published studies showing vascular surgeons perhaps are
already performing less than half of the peripheral interventions. If
we do not increase the total workforce, the market share of the
vascular surgeons will only continue to decrease.
Dr Jonathan Beard (Shefﬁeld, United Kingdom). The Na-
tional Vascular Registry in the United Kingdom has shown exactly
what you have shown, a fall in major open vascular procedures and
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