VASCULAR SURGERY CORE CURRICULUM: V-CORE

Each content area, where applicable, will be organized as follows:

DISEASES AND CONDITIONS

  1. Definition
  2. Epidemiology
  3. Etiology
  4. Pathology / Pathophysiology
  5. Signs and symptoms
  6. Differential Diagnosis
  7. Diagnosis
  1. History and Physical examination
  2. Appropriate Tests / Imaging
  1. Treatment Options
  1. No treatment
  2. Prognosis
  3. Outcomes
  4. Medical Management
  5. Interventions
  6. Anatomy

a. Endovascular

- Access site(s)

- Arterial path to intervention

b. Open: surgical exposures and options

  1. Endovascular Surgery

a. guide wires

b. sheaths / catheters

c. balloons

d. stents

e. stent grafts

f. thrombolysis – lytic agents

g. other. – laser, atherectomy, cryotherapy

  1. Minimally Invasive Techniques

a. laparoscopic surgery

b. combined endovascular / open surgery

  1. Open Surgery

a. thromboembolectomy

b. endarterectomy

c. direct repair – i.e. aneurysmorrhaphy

d. patch angioplasty

e. bypass

- in-line anatomic bypass

- extra-anatomic bypass

- conduit

1. vein

2. graft

a. prosthetic

b. other

  1. Complications
  2. Acute graft occlusion
  3. Graft stenosis and Graft degeneration

A.Myointimal hyperplasia

B.fabric tears

C.graft aneurysm formation

  1. Infections

a. wound

b. graft

  1. Others

a. cerebrovascular accident

b. pneumonia

c. PE

d. paralysis

e. mesenteric ischemia

f. renal failure

g. limb loss

h. bleeding

i. death

  1. Prognosis / Outcomes
  2. Basic Science (where applicable)

Every section highlighted in yellow will have an editor.

VASCULAR MEDICINE

  1. Diabetes Mellitus
  2. Hemoglobin A1C levels
  3. Oral agents
  4. Injectable insulin; insulin pumps for DM 1
  5. Pre-op
  6. Sliding scale
  7. Hypertension

A. Medications – po / IV

  1. Hypercholesterolemia
  2. HDL / LDL – ratios for treatment
  3. Oral agents –
  4. Mechanisms of action
  5. Goals
  6. Complications
  7. Tobacco Use
  8. Cessation programs
  9. Medications
  10. Risk Reduction
  11. Pre-operative screening
  12. Cardiac work-up

a. EKG

b. Echocardiography

c. Stress testing – echo / nuclear

  1. Pulmonary
  2. COPD
  3. PFTs
  1. Medical Management of Peripheral Arterial Disease (PAD)
  2. Chronic Kidney Disease
  3. Increased Creatinine

1. Management for endovascular and open surgery

  1. Post-op management – acute / chronic
  1. Hypercoagulable States
  2. Work-up – panel of tests
  3. Treatment / Management
  4. Pre-op
  5. Intra-op

3. Post-op

IX. Antibiotic therapy: The Basics

X.Erectile Dysfunction

A.DDx – arterial, venous, neurological, psychological

B.Diagnosis

  1. Treatment

XI.Non-Atherosclerotic Diseases

  1. Raynaud’s Syndrome
  2. Vasculitis (Takayasu, GCA, Behcet)
  3. Arteriopathies
  4. Marfan’s syndrome
  5. Ehlers-Danlos syndrome
  6. Cystic medial necrosis
  7. Pseudoxanthoma elasticum
  8. Arterial magna syndrome
  9. Congenital Conditions
  10. Abdominal coarctation
  11. Persistent sciatic artery
  12. Popliteal entrapment syndrome
  13. Fibromuscular dysplasia
  14. Adventitial cystic disease
  15. Compartment syndrome
  16. Homocystinuria
  1. Embryology of the Vascular System: The Basics

CRITICAL CARE –

A.General: homeostasis; fluid and electrolyte management; blood transfusions; metabolism and feeding; malnutrition/nutrition; surgical aspects of diabetes; management of hyper and hypoglycemia; hemodynamic monitoring, mechanical ventilation; anticoagulation; management of shock; management of systemic sepsis; SIRS, surgical infections, antibiotic therapy; wound healing; immune response to surgery and its complications

B.Intracranial/Neurologic-cerebrovascular: intracranial hemorrhage, mass lesions, hydrocephalus, seizures, hyperperfusion syndrome, cerebral edema, acute stroke (including lytic therapy)

C.General

D.Cardiac: arrhythmias; CHF; diastolic dysfunction; acute coronary syndromes; non STEMI; valvular disease (AS, MR); echocardiography; Swan-Ganz catheterization and management

E.Pulmonary: basic airway management; ventilator management; PE; acute pulmonary failure; ARDS; pneumonia/sepsis; COPD and emphysema, acute exacerbation; bronchodilators

F.Hepatic: cirrhosis; jaundice; shock liver; coagulopathy; variceal hemorrhage

G.GI: small bowel obstruction and perforation; ulcer disease (perf, penetration); stress gastritis; colon obstruction and pseudo-obstruction; Ogilvie’s syndrome; volvulus; small bowel ischemia; ischemic colitis; clostridium difficile colitis

H.Renal: acute renal failure; RRT; volume overload; hypovolemia

I.Extremity: DVT; compartment syndrome; rhabdomyolysis

J.Skin and soft tissue: gangrene (dry, wet synergistic); necrotizing fasciitis; skin, soft tissue, and wound infections; venous, arterial, and other ulcers

K.Heme: management of acute bleeding and clotting disorders; hypercoagulable states; HITT

VASCULAR SURGERY

All sections include treatment of acute and chronic disease as well as follow-up and re-interventions for recurrent symptoms and/or disease.

  1. Cerebrovascular Editor:
  2. Carotid
  3. Occlusive disease – emboli (TIA, AF, CVA), occlusion

a. Management of asymptomatic and symptomatic disease based on percentage of stenosis

  1. Dissection
  2. Aneurysm
  3. Carotid body tumor
  1. Vertebral
  2. VBI
  3. Embolic disease
  4. Intra-cranial
  5. Circle of Willis
  6. components
  7. complete versus incomplete and implications
  8. Concomitant diseases (Aneurysm, AVM, occlusive diseases)FMD
  1. Thoracic Aorta

A. Aortic Arch Disease – vasculitis

B.Ascending Thoracic Aorta – aneurysmal disease

C.Descending Thoracic Aorta

  1. Aneurysmal disease
  2. Dissection
  3. Trauma – pseudo aneurysm
  4. Occlusive disease – emboli
  5. Intramural hematoma
  6. Penetrating aortic ulcer
  1. Upper Extremity
  2. Occlusive disease – ischemia and emboli
  3. Aneurysmal disease
  4. Thoracic Outlet Syndrome: arterial, venous, neurogenic
  5. Mesenteric: Celiac / SMA
  6. Entrapment/compression: Median arcuate ligament syndrome
  7. Occlusive disease – mesenteric ischemia
  8. chronic arterial
  9. acute arterial
  10. SMV thrombosis
  11. Aneurysms
  12. Dissection
  13. Renal Artery
  14. Occlusive disease
  15. Hypertension
  16. Renal insufficiency
  17. FMD
  18. Aneurysms
  19. Peripheral
  20. Hilar
  21. Abdominal Aorta – including supra-celiac, supra-renal and infra-renal
  22. Aneurysms
  23. Elective
  24. Ruptured
  25. Infected
  26. Fistula (caval and enteric)
  27. Emboli
  28. Thrombosis
  1. Arteritis
  1. Iliac Arteries
  2. Aneurysms – CIA, IIA
  3. FMD
  4. Aorto-iliac Occlusive Disease – combined disease with treatment options
  5. Lower Extremity
  6. Occlusive disease (acute versus chronic)
  7. Emboli
  8. Claudication
  9. Limb threatening ischemia (CLI)
  10. Aneurysms
  11. Femoral
  12. Popliteal
  13. Pseudo aneurysms – with and without infection
  14. Portal Hypertension
  15. Wound Care Management
  16. Wound types – ulcers
  17. Venous
  18. Arterial
  19. Diabetic
  20. Neuropathic
  21. Infectious
  22. Traumatic
  23. Malignant
  24. Hypertensive
  25. Other – Rheumatic, sickle cell, inflammatory (pyoderma),
  26. Debridement
  27. Dressings – including VACs
  28. HBO
  29. Whirlpool
  30. Allografts, xenografts, skin grafts, and other methods/materials for coverage
  31. Tissue flaps and free flaps
  32. Wound care center
  33. Venous Disease
  34. Coagulation Cascade
  35. DVT and Venous thromboembolism
  36. Chronic venous insufficiency
  37. Varicose veins – Management
  38. Medical
  39. Sclerotherapy
  40. Endovascular
  41. Open surgical
  42. Angio-access
  43. Indications – ESRD, nutrition
  44. AVF vs AVG
  45. Salvage and Maintenance
  46. Catheters
  47. Complications (steal, infection, pseudoaneurysm)
  48. Lymphatic Disease – Primary and Secondary
  49. Vascular Trauma
  50. Evaluation – non-arteriographic and arteriographic
  51. Penetrating Injuries
  52. Carotid
  53. Vertebral
  54. Upper / Lower Extremities
  55. Thoracic Aorta
  56. Abdomen – celiac, SMA, renal arteries, iliac arteries, etc
  57. Blunt Injuries
  58. Carotid and Vertebral
  59. Upper / Lower Extremities
  60. Thoracic
  61. Abdominal Arteries
  62. Orthopedic Injuries – i.e. posterior dislocation of the knee
  63. Concomitant Venous Injuries – to repair or not to repair
  64. Complications
  65. Of Catheterization manipulization
  66. Reperfusion syndrome
  67. Compartment syndrome
  68. Spinal exposures
  1. Amputations
  2. Appropriate Amputation Levels
  3. Toe and TMA
  4. Through knee amputations
  5. AKA
  6. BKA
  7. Hip disarticulation
  8. Upper extremity amputations

VASCULAR IMAGING AND PHYSIOLOGIC TESTING.

A.Non-invasive Vascular Laboratory

  1. Fundamental hemodynamics
  2. Carotid / Vertebral
  3. Upper / Lower Extremity – Duplex and Physiologic
  4. Renal / Mesenteric
  5. Venous – DVT, venous mapping
  6. Abdominal – aorta, EVAR follow-up
  7. Aneurysm – AAA, femoral, Popliteal
  8. Pseudo-aneurysm diagnosis and treatment (compression and injection)
  9. Vascular bypass / stent follow-up imaging and velocities
  10. AV Access follow-up

B.Axial imaging:

1.CT / CTA – cross sectional and 3D reconstruction – computer remodeling and interpretation

2.MR / MRA – cross sectional and 3D imaging and interpretation

D.Angiography:

1. techniques and interpretation

a.Arch and carotids

b.Vertebrals

c.Intra-cranial

d.Upper / Lower Extremity

e.Thoracic Aorta

f.Celiac / SMA

g.Renals

h.Abdominal Aorta and Iliacs

i.Endoleaks

j.Venous – extremities, IVC (Filters), AV Access

.2.Intra-Operative Imaging - Duplex, Angiography

3.IVUS, TEE

4.Radiation Safety: The Basics

MISCELLANEOUS:

  1. Basis of Contract Negotiations
  2. Practice Management
  3. Coding and Billing

______

OPERATIONS AND PROCEDURES –

Including Endovascular and Open Surgical (2008 CPT Code Book on Pages 157 to 180)

We also need to include amputations, skin grafts, etc, which are elsewhere in CPT book.

Should we use RRC Case Log format, or CPT Code Book? I would favor the latter.