The SVS Complex Peripheral Vascular Interventions (CPVI) Skills Course has become a fixture on the vascular surgery calendar over the past couple of years. Here, course director Vipul Khetarpaul, MD, gives Marlén Gomez the rundown on how the evolution of endovascular interventions in the lower extremity gave rise to a now standout event.
Over the past, endovascular therapy has undergone significant advancements, particularly in the treatment of peripheral arterial disease (PAD) and chronic limb-threatening ischemia (CLTI). These developments have shifted the focus from achieving visually appealing angiographic results to prioritizing true perfusion and patient-centered outcomes.
The CPVI course, scheduled for Sept. 20–21, in Rosemont, Illinois, reflects this evolution. The two-day, intermediate-to-advanced training program offers hands-on experience through cadaver and benchtop simulation labs, high-impact lectures, and collaborative case-based discussions. The course is designed to equip vascular surgeons with practical skills that can be immediately applied in clinical practice.
Khetarpaul who is an associate professor of surgery at Washington University School of Medicine in St. Louis, explained that imaging technologies such as intravascular ultrasound (IVUS) have become routine. Device innovation has also accelerated, with the introduction of re-entry tools, crossing catheters, drug-coated balloons and covered stents. Access strategies have expanded to include radial and pedal approaches. Techniques such as tibial and pedal loop reconstruction, and selective deep venous arterialization are now commonly used.
“With the addition of new devices and the explosion of technology, the algorithmic approach to these cases has become significantly more complex,” Khetarpaul said. “It requires frequent updates and refreshers.”
The CPVI course was created to address gaps in vascular surgery education. According to Khetarpaul, opportunities for hands-on training in critical techniques like crossing a chronic total occlusion (CTO) , bailout strategies, pedal access and complication management are often limited in standard curriculum of training.
“The complex peripheral intervention skillset is somewhat unique and not every program is able to offer the same level of expertise in this particular aspect of vascular surgery,” said Khetarpaul. “We wanted to create a thoughtful, real-world approach to these difficult scenarios and have faculty share their unbiased insights.”
Since its inception in 2022, the CPVI curriculum has evolved to reflect technological and procedural advancements. The course now includes modules focused on imaging-first decision-making, structured CTO algorithms, distal and alternate access techniques, and deep venous arterialization. The atherectomy toolkit has been expanded to include vessel modification and thrombectomy strategies. Outdated content is retired.
What sets the CPVI course apart from other vascular surgery training programs is its emphasis on real case failures and its device-agnostic approach. The course prioritizes decision-making frameworks over brand preferences. Participants work in small groups, review complications openly and gain hands-on experience in a safe environment that encourages learning through trial and error.
“The faculty is chosen based on their real-world experience,” Khetarpaul said. “Our goal is to help surgeons feel more confident and capable in all aspects of CLTI care so that their treatment plans are based on what serves the patient best.”
Simulation labs and cadaver training play a critical role in enhancing the learning experience. These sessions allow participants to build muscle memory and practice key techniques such as access angles, wire escalation, re-entry, and bailout strategies on real anatomy.
“Participants can use different atherectomy and thrombectomy tools and navigate pedal loops with live faculty interaction, free from industry bias,” Khetarpaul said.
Attendees of previous iterations have reported higher success rates in CTO procedures, increased use of IVUS, and safer approaches to pedal and alternate access. Several institutions have established limb salvage pathways following their surgeons’ participation in the course. One thing that has changed this year is adding in more case-based discussions based on attendee feedback, recognizing their value in surgical learning.
“By equipping surgeons with clarity and confidence, the CPVI course is shaping the next generation of limb salvage leaders,” added Khetarpaul.
To learn more, visit vascular.org/CPVI25.
