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Department of surgery

Division of Vascular Surgery Fellowship Program

 

Educational objectives for the Vascular Surgery Fellowship Program are as follows:

Junior Level


Knowledge

  1. Identify and name the parts of the aorta and its first order branches.
  2. Explain the basic physiology of the circulation, including the relation of pressure, flow and resistance, and the factors that affect regional blood flow.
  3. Describe the basic histology of the arterial wall.
  4. Explain the fundamental differences between arterial and venous physiology in regard to pressure, flow, and capacitance.
  5. Explain basic concepts of atherosclerosis, including pathology, pathogenesis and risk factors.
  6. Describe the basic gross pathology of arterial aneurysms.
  7. Explain the basic concepts of the doppler effect and how it can be applied to the study of blood flow. Be able to define the term “duplex ultrasound”.
  8. Understand basic theory and practice of vascular imaging, especially ultrasound and contrast-angiography.
  9. Broadly describe the surgical exposures for carotid endarterectomy, abdominal aortic surgery, and lower extremity bypass.
  10. Describe common postoperative complications in the vascular patient, including factors that predispose to these events.
  11. Describe the management of these common complications.
  12. Describe the presenting signs and symptoms and initial management of ruptured aortic aneurysm, acute limb ischemia, and major vascular trauma.
  13. Describe the fundamental principles of lower limb amputation surgery, including basic anatomy, indications, amputation levels, postoperative care, and outcome
  14. Understand and be able to describe the basic clinical features of the diseases listed below. These features include the basic pathophysiology, common symptoms and signs, useful diagnostic tests, broadly-stated treatment options, and prognosis with and without treatment.
    • Abdominal aortic aneurysm
    • Carotid artery stenosis
    • Arteriosclerosis of the extremity arteries with claudication, rest pain or tissue necrosis
    • Diabetic foot disease
    • Renal artery stenosis
    • Mesenteric ischemia, acute and chronic
    • Acute arterial occlusion
    • Deep vein thrombosis
    • Chronic venous insufficiency of the legs


Skills

  1. Perform and record a careful and accurate general physical examination.
  2. Perform and record a careful and accurate vascular examination, including palpation of pulses, use of the doppler and measurement of brachial and ankle systolic pressures; also include accurate description of any deformities, wounds and lesions.
  3. Develop oral communication skills in presenting patient histories and narratives in a manner that is thorough but concise and relevant.
  4. Tie two-handed knots with different types of suture.
  5. Demonstrate proper scrubbing and sterile technique.
  6. Identify common surgical instruments with standard nomenclature.
  7. Demonstrate proper handling and use of these instruments.
  8. Demonstrate gentle tissue handling and principles of surgical exposure.
  9. Be able to obtain hemostasis in a wound of low complexity.
  10. Perform a precise, anatomic, layered wound closure.
  11. Demonstrate the ability to act as a first assistant for vascular surgical procedures.
  12. Perform selected surgical procedures with supervision, using a variety of techniques taught by different faculty.
  13. Perform wound dressings with “clean” technique.
  14. Perform debridement of wounds and lesions.
  15. Demonstrate the ability to provide pre- and post-operative bedside care to the vascular surgery patient.
  16. Demonstrate the ability to interact with patients and their families in a manner that is professional, knowledgeable and compassionate.
  17. Show the ability to obtain and record a thorough history from a patient with vascular disease, including:
    • History of present illness, including onset of symptoms, time course, character and quality, aggravating and alleviating factors
    • Past medical and surgical history, including medications and allergies
    • Relevant family and social history
    • Review of systems


Senior Level/Chief



Knowledge

  1. Mastery of all objectives at the “Junior Level”.
  2. Describe the anatomy of the aorta in greater detail, and identify all first- and second-order branches; describe the collateral pathways for the major vessels of the trunk and extremities.
  3. Understand arterial structure and function at the level of a standard textbook such as Rutherford.
  4. Understand normal arterial and venous hemodynamics at a descriptive level, including Poiseuille’s Law.
  5. Describe the hemodynamic effects of vascular stenosis, occlusion, and collateral flow.
  6. Recognize theories regarding the etiology and pathogenesis of atherosclerosis, and of aneurysmal disease.
  7. Describe the histopathology of the atherosclerotic plaque and of arterial aneurysms.
  8. Compare and contrast different vascular imaging modalities, including duplex ultrasound, CT, MRA, and digital subtraction angiography.
  9. Be able to construct a thorough differential diagnosis for common disorders such as extremity pain, extremity swelling, ulceration, skin discoloration, soft tissue infections; also for abdominal pain; also for peripheral neuoropathies and transient ischemic attacks.
  10. For those diseases listed above in #14, demonstrate a more advanced grasp of the clinical features, to include risk factors, typical and atypical presentations, specific diagnostic algorithms, detailed treatment options, and the effects of co-morbidities on outcome.
  11. Be able to manage nonsurgical problems in the outpatient setting: venous ulcers, claudication, the swollen leg, and the small aneurysm.
  12. Recognize the critical importance of chronic surveillance in the care of the patient with peripheral vascular disease and in the follow-up of vascular grafts.
  13. Describe the steps in the preoperative evaluation of the vascular surgery patient.
  14. Understand and explain treatment priorities in the patient with diffuse vascular disease.
  15. Describe detailed steps in surgical exposure for carotid endarterectomy, abdominal aortic surgery, renal and mesenteric bypass, and lower extremity bypass; identify important anatomic landmarks and adjacent structures that must be preserved in these procedures.
  16. Know the management algorithms in detail for vascular emergencies such as ruptured AAA, acute limb ischemia, and major vascular injury.
  17. Demonstrate an intermediate to advanced comprehension of postoperative care of the vascular patient, including the management of bleeding, hypovolemic shock, myocardial ischemia, respiratory failure, renal insufficiency, major and minor infections, and vascular graft thrombosis.
  18. Describe the principles of vascular access surgery, especially in regard to end stage renal disease.
  19. Possess a general knowledge of the clinical features of non-atherosclerotic vascular diseases such as fibromuscular dysplasia, Buerger’s disease, and giant cell arteritis.
  20. Develop a detailed and versatile knowledge of wound management, especially in the diabetic and/or ischemic extremity.

Skills

  1. Possess all those skills required at the Junior Level.
  2. Demonstrate progressive ability to obtain and record a detailed history from complex vascular patients, including nuances that allow one to differentiate vascular from non-vascular syndromes.
  3. Be able to present a complex case history and/or clinical narrative in a manner that is professional, well-organized, concise, articulate and informative.
  4. Demonstrate progressive growth in time-management skills and in the handling of multiple priorities.
  5. Demonstrate an intermediate to advanced ability to assimilate, process and interpret clinical information in order to make medical decisions.
  6. Identify commonly used vascular clamps and differentiate their uses.
  7. Demonstrate skill in the proper positioning, preparation and draping of patients for vascular surgical procedures.
  8. Describe and perform the steps in the exposure of the major arteries of the trunk and extremities.
  9. Demonstrate progressive skill in isolating and controlling major arteries and veins.
  10. Demonstrate skill in handling and suturing blood vessels.
  11. Demonstrate the ability to perform end-to-end and end-to-side vascular anastomoses.
  12. Demonstrate some facility with common catheter-guidewire techniques.
  13. Develop a high level of skill in first assisting with vascular procedures.
  14. Perform major vascular reconstructive procedures with appropriate supervision: carotid endarterectomy, aortic aneurysm repair, aortobifemoral bypass, lower extremity bypass, vascular access
  15. Develop an advanced knowledge of inpatient care of the vascular patient, and demonstrate the ability to apply those skills in the emergency department, intensive care unit, and regular nursing units.