Vascunet seeks to come under ESVS umbrella


Vascunet, the vascular registries collaborators’group, met during the ESVS 2002 meeting in Istanbul. Last year only around five countries gave presentations, however, this year there were 15 country presentations, which indicates the increase in interest in national registries. There was also debate about whether Vascunet should now become part of the ESVS.

Vascunet has created a working committee, whose membership comprises primarily of national registry chairmen. At the meeting there was a debate over whether Vascunet should now become a permanent body under the ESVS. Many saw advantages in this, as Vascunet would become recognised by the ESVS – leading potentially to financial and organisational support.

The Dane Lief Panduro Jensen, a member of the organising committee, remarked on the increasing European pressure for transparency and presentation of results, and that this was an integral part of scientific work these days. He also stated that there is now more commitment to registries than there has ever been before.

He explained to Vascular News the reasons for the increase in interest in registries. He said that there were several factors at work:

  • “A growing awareness among surgeons, that the result produced in daily practice seldom lives up to the excellent results in the literature in randomised controlled trials. The obvious reason for this is that in the randomised control trials (RCT) patients are highly selected, with strict exclusion and inclusion criteria, which is not the case in daily practice. This has led to a need for having data on results in daily practice, a monitoring system, which can help in fine tuning it and to serve as a warning system in case of problems.

  • “The public (patients, politicians, media etc.) are increasingly demanding transparency in the health sector. One thing is the average results from internationally studies, but what are the exact results at the local institution, where patients are to be admitted, where politicians handle the funding etc? Is the quality satisfactory? Surgeons have to deliver this answer to the public, in greater and greater detail. Figures are hard to get and even harder to interpret. A clinical database can deliver some/many of the answers, if data is presented after thorough analysis by a professional in the area of interest.

  • “Registries have become possible, with the advanced information technology.
  • He then went on to detail why Vascunet is seeking a closer connection with the ESVS. “Until now, Vascunet has served as an informal forum for discussion among surgeons involved in vascular registries. But there is a need for more formal exchange of experiences, introducing methods of analysis etc, to aid the development in all countries. There is also the demand for growing transparency to be faced, which makes vascular registries an area of interest to all vascular surgeons, not only the dedicated ones. “It therefore seems natural to seek a more formal structure, in the form of a permanent working group (much like the Eurostar collaboration), and with a tighter connection to the scientific society,”said Jensen. “At our last meeting it was suggested that UEMS also could be the organisation to connect to. We therefore agreed that a more formal request would be made both to ESVS and UEMS, to discuss where our connection most naturally should be placed. Right now a suggestion of rules for a more formal collaboration in Vascunet is at discussion in each registry/country, later this formal request will be put forward to ESVS/UEMS.

    Finally, Jensen explained to Vascular News how he expected the use of registries to evolve. “I am certain that the importance will grow in the future, as a means for documenting the area of vascular surgery. Hopefully in the future we will have electronic patient records, thus aiding the collection of data, making the vascular registry merely a registry for analysis. Methods will evolve further, allowing for more detailed and meaningful analysis also for both colleagues and the public. It is of extreme importance that this process is in the hands of the profession itself, to avoid the publication of unreliably data, of which we have seen so many examples, also from the health authorities.

    During the Q&A session of the Vascunet meeting in Istanbul, Professor Palombo from Turin, Italy, mentioned that in France the ministry of health has established a committee that is looking at the results of surgeons and units, although this committee does not comprise any vascular surgeons. His warning was that vascular surgeons should recognise the need to “get organised, to audit their own procedures at both an individual and unit level, otherwise this power will be taken away from them.

    During the meeting, there was also mention that the cardiac surgeons have used registry data to show that their procedure results have not worsened if you take into account risk stratification and that outcomes should really reflect the difficulty of the procedure. For instance coronary assisted bypass grafts (CABG) have been done on an increasingly elderly population of patients that are more difficult to manage. Risk stratification is very important if surgeons are to be able to defend their own results. At the European Association for Cardio-thoracic Surgery Congress, earlier in the year, it was indicated that soon there might be one example of a national government, the UK, demanding the presentation of individual data – certain areas becoming scrutinised on an individual operator basis.