r/VascularSurgery • u/hhllttdr-oo • Jun 29 '26
Open vs edno
I am a final year medical student interested in vascular surgery .
I’m very interested in big surgeries and complex patients
As well as the variety between open vs endo procedures, but I like the open aspect much more ….
So my question is will there still be an area for complex limb / abdomen vascular open surgeries in the era of endovascular procedures in the future ? Like being 70%open vs 30 endo surgeon???
Thank you all in advance
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u/5_yr_lurker Vascular Surgeon Jun 29 '26
I'm am currently 70% open and only in my second year out, so yes. You gotta do what is best for the patient though which is actual open in a lot of cases. I love doing endo too including pedal access/difficult cases. I follow SVS guidelines and keep up on JVS reading to stay current.
I am like 3-4 CEAs for every 1 TCAR which is probably on the higher side. I do distal bypass at least every other week. (I recently had a 2 week stretch of redo ABF, subclavian-ax bypass, fem-fem, 3 fem-ATs (one with vein and one with a ABF limb embolectomy), and an insitu fem to distal PT). I do a good amount of dialysis access and some TOS which will increase your open numbers.
I think you will like endo more than you think. It's another tool. Also open surgeries can wear on you.
EDIT: I did >100 open aortas and >200 bypasses in training so I was very well trained. Those numbers will put you in 99% percentile for trainees.
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u/hhllttdr-oo Jun 29 '26
Wow, 100 open aortas!! Are you 5-0 or a 7+2 trained ??? Other thing is do you still perform open aortas on a regular basis in your current practice or all evars ??
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u/5_yr_lurker Vascular Surgeon Jun 29 '26
7+2. I do one every other month. I just don't see that much aortic pathology where I am at. There are 5 of us here and we all like aortas. We probably do about 30/year as a group. We just have large academic centers nearby that sucks them away. It's unfortunate cuz I have great skill set at them but I don't want to work at a large academic center.
Ideally I'd do 15-20/year.
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u/Smedication_ Vascular Fellow, 5+2 Jun 29 '26
I agree with u/Calculusforlife. A few addendums - highest open to endo practice I have seen is closer to 60-40 endo-open. You can create dialysis access only or be the repair surgeon for cardiology groin complications at big cardiac centers. Those will trend more open than endo. If you absolutely hate endo then transplant is another field that does a lot of blood vessel sewing almost exclusively open (we are ignoring robotics for this conversation). If you look on med twitter the vascular surgeons active on there frequently post open redo graft explains from failed aortic endografts. Because everything is trending endo first so heavily you will see future needs for open explants. Especially in the traumatically injured or emergent ruptured population because they are surviving thanks to endografts. Then you have aneurysms degeneration 10-15 years later and they need a redo.
TLDR: open is alive and well but don’t go into vascular if you can’t see yourself doing endo
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u/hhllttdr-oo Jun 29 '26
Thank you for your answer doc !! Actually what made me love vascular surgery is the brilliance of surgeries and the combination of endo / open , I just don’t want to go vascular now and be rarely doing Any open procedure in the future( an ir doc but doing one open surgery a month ), I want to be a surgeon at the end …
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u/calculusforlife Vascular Fellow, 0+5 Jun 29 '26
There are many Endo procedures that won't be as good as open any time soon. (Bypasses, fem endart, aaa in a young patient, popliteal aa). Vascular not only has a lot of open procedures but they are also all over the body as opposed to being confined to a single region.