Operative trends in endovascular and open procedures among vascular fellows

<h2>Abstract</h2><h3>Objective</h3> Over the past decade, there has been a growing adoption of endovascular approaches for treating vascular pathologies. This shift toward minimally invasive techniques has raised concerns about declining open surgical case volumes for vascular surgery fellows, particularly in procedures such as aortic aneurysm repair. This study aimed to analyze trends in both open and endovascular case volumes across major vascular procedure categories, including aortic aneurysm, lower extremity arterial disease, abdominal occlusive disease, and cerebrovascular disease, among graduating vascular surgery fellows. <h3>Methods</h3> National case log data from the Accreditation Council for Graduate Medical Education were collected for 5 + 2 vascular surgery fellowship graduates from 2007 to 2024. Trends in open and endovascular operative volumes were assessed using linear regression analysis. <h3>Results</h3> From 2007 to 2024, the number of graduating vascular fellows increased from 94 to 133 across 100 programs. The average number of major cases per fellow rose by +5.1 ± 0.45 cases/year (R² = 0.89; <i>P</i> < .001). Endovascular cases, including aneurysm repair, lower extremity revascularization, cerebrovascular, and abdominal occlusive interventions, increased by +5.6 ± 0.44 cases/year (R² = 0.92; <i>P</i> < .001). In contrast, open surgical case volumes across the same categories showed no significant trend with a change of −0.30 ± 0.20 cases/year (R² = 0.16; <i>P</i> = .109). <h3>Conclusions</h3> Graduating vascular surgery fellows are performing an increasing number of endovascular procedures, whereas open surgical volumes have remained stable. Continued monitoring of case trends is warranted to ensure fellows achieve competency in both endovascular and open techniques for independent practice.