Specific Objectives
MEDICAL EXPERT
Knowledge
At the end of the rotation, the resident will have sufficient knowledge in the following domains:
- Anatomy and physiology of the arterial system, including carotid, aorta and peripheral arterial vascular tree.
- Pathophysiology of atherosclerosis and natural history of carotid artery disease, aortic occlusive and non-occlusive disease as well as peripheral arterial disease.
- Working knowledge of the coagulation cascade and vascular biology.
- Knowledge of the medical treatment of carotid artery disease and peripheral artery disease as well as the complications thereof, including chronic ulcers and diabetic foot.
- Working knowledge of the medical management of the disease affecting vascular patients, such as coronary artery disease, diabetes, hypertension and renal dysfunction.
- Knowledge of the indications and contra-indications of surgical interventions for carotid artery, aortic aneurysm and non-occlusive disease, chronic lower extremity occlusive disease.
- Working knowledge of the indications and contra-indications to endovascular therapy for peripheral artery disease, aortic disease and carotid.
- Working knowledge of the use of fluoroscopy and principles of radiation safety.
- Working knowledge and results for conduit selection, including biological and synthetic grafts as well as endovascular graft.
- Working knowledge of the results of procedures over time.
- Working knowledge of the principles and management of vascular trauma.
- Working knowledge of the diagnosis and investigative modalities used in Vascular Surgery, including plethysmography, angiography and Doppler imaging.
Clinical Skills
- Be able to obtain an adequate history and physical examination for the vascular patient with special emphasis on identifying carotid bruits, pulses, aneurysms of the abdomen, femoral, popliteal, posterior tibial and dorsalis pedis pulses.
- Be able to identify acute ischemic syndromes of the cerebral, abdominal and peripheral circulation.
- Be able to interpret diagnostic modalities, such as plethysmography, angiography and Doppler ultrasound in the treatment and management of vascular patients.
Technical Skills
- Be able to expose safely and adequately in an open fashion the carotid artery, the axillary artery, the brachial artery, the femoral artery and femoral vein, and popliteal artery.
- Be able to open the abdomen and expose the infra-renal aorta safely and adequately for open aortic aneurysm repair.
- Understand the principles of a retroperitoneal approach.
- Be able to perform thrombectomy on an acutely ischemic upper extremity and lower extremity using balloon thrombectomy and surgical bypass.
- Be able to perform patch angioplasty of the femoral artery and profunda.
- Be able to perform fem-fem crossover graft, including appropriate sizing of graft and anastomosis.
- Be able to perform at least the proximal anastomosis of the fem-pop distal graft, and perhaps the popliteal portion of the anastomosis.
- Be able to use both an in situ and reverse saphenous vein as well as synthetic conduits for this procedure.
- Be able to perform an axillary anastomosis, and understand in assisting the principles of an axillary femoral bypass.
- Be able to first assist in a thoraco-abdominal aneurysm repair, and perform left heart support during the procedure such as left atrial femoral artery Biomedicus pump support.
- Be able to cannulate femoral artery and placement of catheters for endovascular stenting.
- Be able to evaluate the appropriateness of placing an endovascular stent, at least first assist in the deployment of endovascular stents in the abdominal aorta and thoracic aorta.
- Become completely familiar with all of the complications related to endovascular stent placement and its therapeutic management such as limb ischemia, bleeding, migration, aortic rupture, and organ ischemia, specifically subclavian occlusion.
- Become familiar with the newer stenting procedures such as carotid artery stents, and if possible first assist in one of them.
- Understand the principles of carotid stenting, including the indications and contra-indications.
COMMUNICATOR
- Be able to communicate effectively with patients and their families with respect to medical conditions, including assessing operative risk for patients undergoing vascular procedures and communicating this with the family.
- Be able to interact effectively with other health care professionals, realizing that Vascular Surgery is part of a larger problem with atherosclerosis affecting no only one organ system but the whole body, therefore being able to communicate important information to other health care professionals and consultants.
- Be able to document the patient’s condition and progress accurately with emphasis on the relevant issues.
- Be able to perform diligent history and physical examinations legibly in the charts, including O.R. protocols as well as important complications, which might arise with the patients.
COLLABORATOR
- Be able to identify the vascular surgeon’s perspective on cardiovascular disease to better appreciate when to consult a vascular surgeon and to understand when cardiovascular surgeons are needed to be consulted on vascular surgery patients.
- Be able to contribute effectively to interdisciplinary team activities.
- Be able to consult appropriately other health care professionals who are required in treating vascular surgery patients appropriately.
MANAGER
- Be able to use information technology to optimize patient care.
- Be able to use health care resources cost effectively.
- Be able to work efficiently and effectively.
HEALTH ADVOCATE
- Be able to educate and counsel patients with families regarding smoking sensation, exercise, nutrition and other risk factors to optimize the patient’s cardiovascular risk of atherosclerosis.
SCHOLAR
- Be able to critically appraise sources of medical information.
- Be able to educate patients and their families regarding their medical condition.
- Be able to teach medical students if needed as well as other residents and other health care professionals, specifically regarding surgical aspects of cardiovascular disease and indications for surgical interventions.
- Be able and available to present patients at Rounds or on other subject of Grand Rounds at the discretion of the attending vascular surgeon.
PROFESSIONAL
- Be able to apply knowledge of the professional codes and norms of behavior that govern the behavior of physicians in clinical practice.
- Be able to apply knowledge of the legal codes and norms of behavior that govern the behavior of physicians in clinical practice.
- Be able to recognize and resolve ethical issues as they arise in clinical practice.
- Be able to recognize and deal with unprofessional behavior in clinical practice.