Journal of Vascular and Endovascular Therapy

Editorial

It is difficult for vascular surgeons to recognize patterns associated with bad outcomes because they occur infrequently even in a busy practice. This makes quality improvement difficult and suggests the need for collaborative registries that can analyze thousands of patients to discern and incent best practices. Hertzer and colleagues first demonstrated the feasibility of a regional vascular registry in 1979 and emphasized that we must measure our performance in order to improve it [1]. By the 1990’s, several European vascular registries were established and were organized as the VASCUNET collaboration of registries under the European Society of Vascular and Endovascular Surgery in 1997 [2]. In 2002, the first US regional vascular quality improvement registry was started in New England [3], and this expanded to become the Vascular Quality Initiative (VQI) of the Society for Vascular Surgery in 2011 [4].

Benefiting from this rich background, the International Consortium of Vascular Registries (ICVR) was organized as a global collaboration of 13 national registries from VASCUNET and VQI [5]. It has infrastructure support from the Medical Device Epidemiology Network (MDEpiNet) [6], a US based public private partnership sponsored by the FDA to promote the use of real-world evidence for medical device evaluation. The ICVR aims to improve the quality of vascular care by exchanging information among many countries by analyzing and reporting on variation in treatment type, patient selection and device performance. ICVR meets biannually with representatives from Australia, Denmark, Finland, France, Germany, Hungary, Iceland, Japan, Netherlands, New Zealand, Spain, Sweden, Switzerland, United Kingdom and United States. Recent projects analysing>30,000 AAA and 60,000 carotid procedures showed substantial variation in treatment type and patient selection by country, with opportunity to reach more uniform care [7,8]. Current projects are focusing on outcome and device evaluation.

After attending the recent ICVR meeting in New York City, I am motivated to initiate a quality improvement registry in Brazil, and hope that other South American countries will follow. It can be challenging to start a national registry, but lessons from ICVR countries suggest that we start with limited data collection for 1-2 treatment types and expand this gradually. Surgeons are keenly interested in benchmark reports that anonymously compare their results with others, since all want to see what and how they can improve. It is my hope to launch this in several Brazilian centres in 2019 and invite all interested surgeons to contact me.

References

1. Plecha FR, Avellone JC, Beven EG, DePalma RG, Hertzer NR (1979) A computerized vascular registry: Experience of the Cleveland Vascular Society. Surgery 86: 826-835.
2. Mitchell D, Venermo M, Mani K, Bjorck M, Troëng T, et al. (2015) Quality improvement in vascular surgery: The role of comparative audit and vascunet. Eur J Vasc Endovasc Surg 49: 1-3.
3. Cronenwett JL, Likosky DS, Russell MT, Eldrup-Jorgensen J, Stanley AC, et al. (2007) A regional registry for quality assurance and improvement: the vascular study group of northern new england (VSGNNE). J Vasc Surg 46: 1093-1101.
4. Cronenwett JL, Kraiss LW, Cambria RP (2012) The society for vascular surgery vascular quality initiative. J Vasc Surg 55: 1529-1537.
5. Sedrakyan A, Cronenwett JL, Venermo M, Kraiss L, Marinac-Dabic D, et al. (2017) An international vascular registry infrastructure for medical device evaluation and surveillance. J Vasc Surg 65:1220-1222.
6. Krucoff MW, Sedrakyan A, Normand SL (2015) Bridging unmet medical device ecosystem needs with strategically coordinated registries networks. JAMA 314: 1691-1692.
7. Beck AW, Sedrakyan A, Mao J, Venermo M, Faizer R, et al. (2016) International consortium of vascular registries. Variations in abdominal aortic aneurysm care: A report from the international consortium of vascular registries. Circulation 134: 1948-1958.
8. Venermo M, Wang G, Sedrakyan A, Mao J, Eldrup N, et al. (2017) Editor's choice-carotid stenosis treatment: variation in international practice patterns. Eur J Vasc Endovasc Surg 53: 511-519.