Evaluating the role of endovascular simulation training in enhancing surgical performance metrics and patient outcomes in vascular surgery: A scoping review

<h2>ABSTRACT</h2><h3>Objective</h3> To assess the effectiveness of endovascular simulation training in enhancing surgical performance metrics and its influence on patient outcomes in vascular surgery. <h3>Methods</h3> A scoping review was conducted to explore the impact of simulation-based training in vascular surgery, with a specific focus on procedural metrics such as fluoroscopy time, radiation exposure, and contrast volume, as well as patient outcomes including perioperative complications, morbidity, and mortality. Comprehensive searches of Scopus, OVID Medline, and OVID Embase were performed using structured query strings encompassing terms related to endovascular simulation, training methods, and measurable clinical and procedural outcomes. Screening and selection adhered to the PRISMA-ScR guidelines. Studies were included if they assessed simulation-based training for endovascular procedures and reported measurable technical and patient-centered outcomes; reviews, commentaries, and studies not involving endovascular simulation or relevant metrics were excluded. Data were extracted on study characteristics, simulation modalities, clinical endpoints, and procedural performance metrics, and the findings were synthesized to identify trends in the literature. <h3>Results</h3> Six studies met the inclusion criteria, utilizing a variety of simulation modalities, including virtual reality, 3D-printed models, and patient-specific rehearsal. Simulation training was associated with significant improvements in procedural metrics during real and simulated procedures, including reductions in fluoroscopy time, procedure duration, radiation exposure, and contrast volume. Improvements in technical proficiency and operator confidence were consistently observed across studies. However, the evidence linking simulation to direct patient-specific outcomes, such as reduced perioperative complications or mortality, was limited. While two studies demonstrated statistically significant improvements in clinical outcomes, others showed trends without statistical significance, and two studies found no measurable impact on patient outcomes. <h3>Conclusions</h3> Simulation-based training enhances procedural efficiency, technical performance, and operator confidence in vascular surgery. However, direct evidence linking simulation training to improved patient outcomes remains inconclusive. Future research should focus on high-quality, multicenter randomized controlled trials with standardized outcome measures to better establish the clinical value of simulation training and inform its widespread integration into vascular surgery education and training programs.