Residency Level:



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 |Operations/Procedures |

|BROAD |ESSENTIAL − UNCOMMON |

|• Acute limb ischemia |• Embolectomy/thrombectomy artery |

|• Peripheral arterial emboli |• Above knee amputation |

|• Acute arterial thrombosis |• Below knee amputation |

|• Compartment syndromes |• Toe amputation |

|• Diabetic foot infections |CATEGORY 18: VASCULAR − ARTERIAL |

| |DISEASE |

|FOCUSED | |

|• Cerebrovascular occlusive disease |COMPLEX |

|• Aortoiliac occlusive disease |• Aorto-iliac/femoral bypass |

|• Chronic visceral occlusive disease |• Ilio-iliac/femoral bypass |

|• Renal artery occlusive disease |• Femoral-popliteal bypass |

|• Femoropopliteal occlusive disease |• Profunda endarterectomy |

|• Infrapopliteal occlusive disease |• Infrapopliteal bypass |

|• Upper extremity occlusive disease |• Other endarterectomy |

|• Buerger disease |• Composite leg bypass graft |

|• Fibromuscular dysplasia |• Revise/re-do lower extremity bypass |

|• Cystic medial necrosis |• Arm bypass, endarterectomy, repair |

|• Behcet disease |• Celiac/SMA endarterectomy/bypass |

|• Aortic aneurysms |• Renal endarterectomy/bypass |

|•Visceral arterial aneurysms |• Femoral-femoral bypass |

|• Peripheral arterial aneurysms |• Axillo-femoral bypass |

|• Aortic dissection |• Axillo-popliteal-tibial bypass |

|• Claudication |• Transmetatarsal amputation |

|• Hypercoagulable syndromes |• Upper extremity amputation |

|• Carotid body tumors |• Disarticulation |

|•Vascular graft infections |• Elective repair infrarenal aortoiliac aneurysm |

|• Aortic thrombosis |• Repair femoral aneurysm |

|• Thoracic outlet syndrome |• 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 |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|•Venous thrombosis/embolism |•Venous insufficiency and operation for varicose veins |

|• Thrombophlebitis, including suppurative |• Sclerotherapy, peripheral vein |

|•Venous stasis and chronic venous insufficiency |• Insertion vena caval filter |

|•Varicose veins |COMPLEX |

| |•Venous embolectomy/thrombectomy |

| |•Venous reconstruction |

| |• Non-reconstructive venous ulcer operation |

| |• Repair arteriovenous malformation |

|SCORE CURRICULUM CATEGORY 20: VASCULAR − ACCESS |

|Diseases/Conditions |Operations/Procedures |

|BROAD |ESSENTIAL − COMMON |

|• Percutaneous vascular access for dialysis |• Percutaneous vascular access |

| |• Arteriovenous graft/fistula |

| |• Revision arteriovenous access |

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