The Brighton Vascular Access Fellowship
Renal vascular access surgery is an expanding and vital service provision for vascular surgery units nationally well as internationally. The incidence of end stage renal disease is increasing and renal replacement therapy provisions will have to evolve to accommodate this growth and increased burden in the NHS (2% of the national annual budget), linked principally due to the epidemic of Type 2 Diabetes we are currently experiencing.
Renal Access Surgery offers another skill set to the modern vascular specialist, which builds and cements the necessary required skill sets. The figures show that this is an area of medicine that needs investment and improvement to reach an acceptable target of patients on haemodialysis being dialysed through a native fistula or a graft of 80%. Training throughout Europe is inconsistent and experience is largely dependent on the units that a trainee has worked in.
Aim of the fellowship
To offer a novel, one-to-one tuition in the provision of the full range of renal access procedures, clinically, planning and surveillance imaging (duplex), surgical and interventional radiology over a sixteen day programme, spread over an eight week duration. The fellowship is targeting higher surgical trainees as well as newly appointed consultant surgeons with a desired interest.
An article in 2008 Annals of Surgery demonstrated primary fistulae failure was 34% lower in surgeons who have created at least 25 fistulae throughout their training. Also choice of access was heavily influenced by trainee exposure (Dialysis Outcomes Practice Patterns Study (Dopps)). The Brighton Kidney Unit possesses 450 patients on dialysis (catchment area 1.2million) and undertakes 300 haemodialysis procedures per annum by two renal access surgeons with three operative sessions per week, delivering the full range of procedures, open and interventional with a one stop clinic per week.
Assessment of competence
Following the Vascular Society of Great Britain & Ireland Vascular 2012 Document, Standards for Vascular Training and the Intercollegiate Surgical Curriculum Project, we use their work-based assessments. Assessment are via structured interviews, procedure-based analysis, and formal external evaluation of competence over the fellowship duration, both continuously and prospectively. Competitive entry is via curriculum vitae and a structured reference for hired surgical trainees and those possessing completion certificate training.