Surgical Rotation: Vascular Surgery

Residency Level: PGY 4

Surgical Rotation: Vascular Surgery

Length of Rotation: Two Months

Goals and Objectives

Patient care:

·  Master the evaluation and preoperative assessment, postoperative care and nonoperative care of the vascular surgery patient

·  Master the management skills required to independently evaluate the vascular surgery patient, develop your own plan for the patient and communication of the plan to the appropriate level of supervision

·  Diagnosis and management of the complex vascular patient with multi-level inflow obstruction

·  Diagnosis and management of extra-anatomic bypass procedures and distal fem-tibial bypass procedures

·  Diagnosis and management of post-procedure complications, i.e. graft infection, graft thrombosis

·  Operative management of extra-cranial carotid occlusive disease

·  Take ownership in care of the patient

·  Master mechanisms and criteria for endovascular surgical interventions

·  Diagnostic evaluation of arterial disease, including the role of duplex scanning, angiography, CT Scanning and MRI

·  Care of the patient with venous disease and venous stasis disease

·  Clear and timely documentation of daily progress notes

·  Develop a strong work ethic

·  Develop appropriate safe hand offs

·  Master the ability to care for vascular surgery emergencies in the role as the senior surgical resident on call

Technical skill:

·  After obtaining skill set and with appropriate supervision perform major vascular procedures, intra-abdominal and peripheral for occlusive and aneurysmal disease, including endo-vascular techniques

·  Peri operative management of the complex and/or complicated vascular patient

·  With appropriate supervision perform major vascular reconstructive procedures

·  With appropriate supervision perform vascular access procedures, procedures for venous disease

·  With appropriate supervision perform vascular anastomoses.

·  Learn to master Doppler evaluation for arterial and venous disease

Medical knowledge:

·  Pathophysiology of arterial occlusive and aneurysm disease and venous insufficiency

·  Demonstrate evidence of continued increase in vascular surgery core knowledge from basic surgical texts, additional readings and the SCORE curriculum as noted below

·  Anatomy, physiology, hemodynamics of the arterial and venous systems

·  Obtain a broad knowledge base of vascular surgery and other surgical specialties

·  Study and prepare for the ABSITE

·  Anatomy and physiology of the arterial and venous systems

Practice-based learning and improvement:

·  Participate actively in M and M conferences, daily chief conferences and journal clubs

·  Understand and when possible participate in SCOAP projects

·  Learn to critically read the literature

·  Master the IT resources available to you to develop a commitment to lifelong learning and education

Interpersonal and communication skills:

·  Develop the appropriate skills to provide efficient, concise, patient presentations

·  Master text paging, emailing, etc.

·  Develop strong doctor patient relationships using counseling and education of patients and their families

·  Learn to master EPIC to provide proper documentation in the electronic medical record

·  Learn to properly consult other specialty services in a professional manner

Professionalism:

·  Respect every patient regardless of social or other circumstances

·  Log cases appropriately

·  Log your duty hours using My Evaluations appropriately and in a timely fashion

·  Complete all required clinical and residency documents in a timely fashion

·  Demonstrate sensitivity to age, gender and culture of patients and other members of the health care delivery team

·  Learn to be punctual

·  Always exemplify professional attire, appropriate grooming and hygiene

·  Demonstrate honesty, integrity and leadership skills

Systems-based practice:

·  Demonstrate the effective communication with referring physicians throughout the Swedish health care system

·  Keep patients’ safety foremost while discharging patients in a timely fashion

·  Demonstrate time management and organizational skills while adhering to work hour regulations

·  Gain an understanding of the importance of discharge planning and the writing of timely discharge orders to the overall throughput of patients in our system

SCORE CURRICULUM CATEGORY 18: VASCULAR − ARTERIAL DISEASE
Diseases/Conditions
BROAD
• Acute limb ischemia
• Peripheral arterial emboli
• Acute arterial thrombosis
• Compartment syndromes
• Diabetic foot infections
FOCUSED
• Cerebrovascular occlusive disease
• Aortoiliac occlusive disease
• Chronic visceral occlusive disease
• Renal artery occlusive disease
• Femoropopliteal occlusive disease
• Infrapopliteal occlusive disease
• Upper extremity occlusive disease
• Buerger disease
• Fibromuscular dysplasia
• Cystic medial necrosis
• Behcet disease
• Aortic aneurysms
•Visceral arterial aneurysms
• Peripheral arterial aneurysms
• Aortic dissection
• Claudication
• Hypercoagulable syndromes
• Carotid body tumors
•Vascular graft infections
• Aortic thrombosis
• Thoracic outlet syndrome / Operations/Procedures
ESSENTIAL − UNCOMMON
• Embolectomy/thrombectomy artery
• Above knee amputation
• Below knee amputation
• Toe amputation
CATEGORY 18: VASCULAR − ARTERIAL
DISEASE
COMPLEX
• Aorto-iliac/femoral bypass
• Ilio-iliac/femoral bypass
• Femoral-popliteal bypass
• Profunda endarterectomy
• Infrapopliteal bypass
• Other endarterectomy
• Composite leg bypass graft
• Revise/re-do lower extremity bypass
• Arm bypass, endarterectomy, repair
• Celiac/SMA endarterectomy/bypass
• Renal endarterectomy/bypass
• Femoral-femoral bypass
• Axillo-femoral bypass
• Axillo-popliteal-tibial bypass
• Transmetatarsal amputation
• Upper extremity amputation
• Disarticulation
• Elective repair infrarenal aortoiliac aneurysm
• Repair femoral aneurysm
• Repair popliteal aneurysm
• Repair suprarenal abdominal aortic aneurysm
• Repair thoracoabdominal aortic aneurysm
• Repair thoracic aorticaneurysm
• Carotid endarterectomy
• Reoperative carotid surgery
• Excise carotid body tumor
• Direct repair aortic arch branches for CNS symptoms
•Vertebral artery operation
•Vascular ultrasound
• Angioscopy
• Balloon angioplasty
• Transcatheter stent
• Other endovascular graft
• Endovascular repair aortic aneurysm
• Endovascular repair other aneurysm
• Endovascular thrombolysis
• Pseudoaneurysm repair/injection
• Explore post-op bleed, thrombosis, infection
• Graft thrombectomy/revision
• Excise infected vascular graft
• Repair graft-enteric fistula
• Sympathectomy
• Harvest arm vein
• Thoracic outlet decompression
• Repair ruptured aortic aneurysm
SCORE CURRICULUM CATEGORY 19: VASCULAR − VENOUS
Diseases/Conditions
BROAD
•Venous thrombosis/embolism
• Thrombophlebitis, including suppurative
•Venous stasis and chronic venous insufficiency
•Varicose veins / Operations/Procedures
ESSENTIAL − COMMON
•Venous insufficiency and operation for varicose veins
• Sclerotherapy, peripheral vein
• Insertion vena caval filter
COMPLEX
•Venous embolectomy/thrombectomy
•Venous reconstruction
• Non-reconstructive venous ulcer operation
• Repair arteriovenous malformation
SCORE CURRICULUM CATEGORY 20: VASCULAR − ACCESS
Diseases/Conditions
BROAD
• Percutaneous vascular access for dialysis / Operations/Procedures
ESSENTIAL − COMMON
• Percutaneous vascular access
• Arteriovenous graft/fistula
• Revision arteriovenous access