Rotations

Rotations will be at the following sites:

  • University of Minnesota Medical Center, Fairview
  • Department of Veterans Affairs
  • Fairview Southdale Hospital
  • Abbott Northwestern Hospital

Vascular Surgery Year 1

The first year in the Vascular Surgery Fellowship will include 4 three-month block rotations.

July/August/September - Site 1

July/August/September - Site 1

Site 1 – University of Minnesota Medical Center, Fairview (UMN)
Vascular Surgery Inpatient/Outpatient Rotation

Objectives:

  • Describe human arterial and venous anatomy related regional anatomy
  • Describe basic arterial and venous hemodynamics
  • Discuss the anatomy, pathology, and pathophysiology of the arterial wall.
  • Assess patients’ vascular system using appropriate skills in the history-taking and clinical examination.
  • Explain the physiologic and organic manifestations of vascular disease, such as renvascular hypertension, portal hypertension and renal failure.
  • Develop an understanding of the inventory in a vascular lab and the indications for use of each.
  • Develop understanding of angiographic equipment and associated computers.
  • Participate in faculty office/clinic patient visits weekly.
  • Learn to treat more difficult AAA and thoracic aneurysm stent grafts
  • Perform more complex thrombolysis procedures
  • Outline the fundamental elements of medical management of the vascular patient, including the role of risk assessment and preventive measures.
  • Perform duplex scanning, peripheral arterial evaluations and interpreting arterial and venous exams including physics, hemodynamics, and quality control.
  • Perform necessary qualifying activities towards taking the Registered Physician in Vascular Interpretation exam.

The above educational and skills objectives will be taught through a combination of:

  • Didactic lecture
  • Direct supervision of patient care
  • Reading
  • Literature review
  • Industry simulators
  • Animal/surgical skills lab

October/November/December - Site 2

October/November/December - Site 2

Site 2 – Veterans Affairs Medical Center (VAMC)
Vascular Surgery Inpatient/Outpatient Rotation

Objectives:

  • Describe the hemodynamics and pathophysiology of specific clinical symptoms:
    Claudication
    Transient ischemic attack (TIA)
    Stroke
    Mesenteric angina
    Angina pectoris
    Renovascular hypertension
    Arteriovenous (AV) fistula
  • Explain the concept of critical arterial stenosis
  • Determine a plan for assessment of operative risk in these categories:
    Cardiac
    Pulmonary
    Renal
    Metabolic
    Levels of anesthetic risk
  • Describe the use of adjunctive measures such as:
    Antibiotics
    Anticoagulants
    Thrombolytic agents
    Anti-platelet agents
  • Learn advanced endovascular techniques including renal, splenic vessels, tibial and carotid artery interventions.
  • Learn techniques such as atherectomy, cryoplasty, laser atherectomy
  • Learn to treat more difficult AAA and thoracic aneurysm stent grafts Perform more complex thrombolysis procedures
  • Summarize principles for the preoperative assessment and postoperative care of patients undergoing major vascular surgical procedures.
  • Learn interventions for vascular access for hemodialysis (i.e. balloon angioplasty of access, etc)
  • Learn peripheral angioplasty for PVD

The above educational and skills objectives will be taught through a combination of:

  • Didactic lecture
  • Direct supervision of patient care
  • Reading
  • Literature review

January/February/March - Site 3

January/February/March - Site 3

Site 3 – Fairview Southdale Hospital (FSD)
Vascular Surgery Inpatient/Outpatient Rotation

Objectives:

  • Differentiate between acute arterial and acute deep venous occlusion.
  • Learn to treat more difficult AAA and thoracic aneurysm stent grafts.
  • Differentiate between the following diagnostic tools available for assessing vascular disease and explain the relative contribution of each:
    Angiography
    Computer axial topographic (CAT) scanning
    Ultrasound
    Magnetic resonance imaging (MRI)
  • Summarize the pathophysiology, clinical manifestations, and therapeutic options of specific categories of vascular disease:
    Thromboembolic disease
    Pulmonary embolism
    Atherosclerosis and its related disorders
    Occlusive disease
    Aneurysmal disease
    Interaction of cardiovascular and pulmonary systems
  • Discuss basic principles of Doppler ultrasound for performing bedside arterial and venous Doppler testing.
  • Outline the principles of non-invasive laboratory diagnosis; including a description of the role and limitations of the vascular laboratory.
    ABI/waveforms
    Carotid duplex
    Venous duplex
    PPG/LRR venous
    Graft flow studies
  • Outline the fundamental elements of medical management of the vascular patient, including the role of risk assessment and preventive measures.
  • Learn techniques for percutaneous venous ablation.
  • Perform duplex scanning, peripheral arterial evaluations and interpreting arterial and venous exams including physics, hemodynamics, and quality control

The above knowledge and skills will be taught through a combination of:

  • Direct supervision
  • Didactic lecture
  • Reading
  • Literature review

April/May/June - Site 4

April/May/June - Site 4

Site 4 – Abbott Northwestern Hospital (ANW)
Vascular Surgery Inpatient/Outpatient Rotation

Objectives:

  • Describe life-threatening signs of vascular disease and indicate when immediate intervention is required.
  • Understand how to successfully access different arterial sites (femoral, brachial, axillary).
  • Learn basic wire/catheter skills.
  • Apply catheter and wire skills to peripheral vascular pathology (iliac, superficial femoral and popliteal arteries).
  • Receive initial instruction on thrombolysis for acute thrombosis of arteries and veins including use of percutaneous thrombectomy.
  • Participate with faculty in clinic/office patient visits weekly.
  • Learn advanced endovascular techniques including renal, splenic vessels, tibial and carotid artery interventions.
  • Learn techniques such as atherectomy, cryoplasty, laser atherectomy.
  • Learn to treat more difficult AAA and thoracic aneurysm stent grafts.
  • Perform more complex thrombolysis procedures.
  • Learn interventions for vascular access for hemodialysis (i.e. balloon angioplasty of access, etc).
  • Learn peripheral angioplasty for PVD.
  • Outline the principles of care for ischemic limbs.
  • Perform necessary qualifying activities towards taking the Registered Physician in Vascular Interpretation exam.

The above knowledge and skills will be taught through a combination of:

  • Didactic lecture
  • Direct supervision of patient care
  • Reading
  • Literature review

Vascular Surgery Year 2

The second year will consist of 4 three-month block rotations.

July/August/September - Site 1

July/August/September - Site 1

Site 1 – University of Minnesota Medical Center, Fairview (UMN)
Vascular Surgery Inpatient/Outpatient Rotation

Objectives:

  • Review and describe the basic clinical manifestations of the following vascular disorders:
    Thromboembolic disease-arterial and venous
    Chronic venous insufficiency and lymphatic obstruction
    Portal hypertension
  • Describe the natural history of medically-treated vascular disease in the following categories:
    Carotid arterial stenosis
    Abdominal aortic aneurysm
    Chronic femoral artery occlusion
  • Analyze the role of the endothelium in atherosclerosis, thrombosis, and thrombolysis.
  • Discuss clotting factors and how they interact, including hypercoagulable states and coagulopathies.
  • Explain the risk: reward ratios of surgical care for patients with vascular disease.
  • Demonstrate awareness of the costs associated with providing surgical care to patients with vascular disorders.
  • Describe the pathogenesis and complications of aneurysmal disease.
  • Categorize the prevention and management of operative and postoperative complications, including graft infections, ischemic bowel, graft thrombosis, and extremity ischemia.
  • Discuss alternative operative procedure for the management of portal hypertension.
  • Review critical factors for decision making in vascular surgery:
    Risk: reward ratio
    Morbidity and mortality probability
    Preoperative and postoperative assessment
    Non-invasive laboratories, duplex scanning
    Role of advanced radiologic techniques: Angioplasty, CT scanning, MRI/MRA imaging
  • Participate in all consults on the Vascular Service.
  • Round daily with the Vascular Surgery Service.
  • Accompany attending staff to their clinic/office at least weekly for instruction in the pre and post surgical care of the vascular patient.
  • Organize the weekly Vascular Conference and M & M.
  • Perform advanced “open” cases such as aneurysm repair (thoracic and aortic), cerebral vascular, open peripheral vascular surgeries, thoracic outlet surgery and amputations
  • Learn advanced endovascular techniques including aortic, thoracic, renal, splenic vessels, tibial and carotid artery interventions.

The learning and skills objectives noted above will be accomplished through:

  • Direct supervision
  • Didactic lecture
  • Reading

October/November/December - Site 2

October/November/December - Site 2

Site 2 – Veterans Affairs Medical Center (VAMC)
Vascular Surgery Inpatient/Outpatient Rotation

Objectives:

  • Summarize the etiology, pathophysiology, and therapeutic options of specific categories of vascular disease:
    Arterial disease
    Aortic and other vascular aneurysm
    Atherosclerotic vascular disease
    Arterial embolic disease
    Extracranial cerebrovascular disease
    Visceral ischemic syndromes
    Renovascular hypertension
    Degenerative arterial disease
    Trauma
    Arteriovenous fistulas (local and cardiac hemodynamic effects)
  • Describe the surgically correctable causes of hypertension and their diagnostic modalities.
  • Demonstrate knowledge of the general principles of vascular surgical technique including:
    Vascular control and suturing
    Endarterectomy
    Angioplasty
    Bypass grafting
  • Discuss the principles of angiography to include the following considerations: 
    Indications and complications (including contrast-induced renal failure)
    Review principles and techniques of intraoperative angiography
    Review principles and techniques of emergency room angiography
  • Differentiate between different operative approaches to the vascular system to include:
    Incisions and exposure
    Handling of vascular tissues
    Principles of vascular bypass grafting
    Emergency vascular surgery
    Re-operative vascular surgery
    Principles of endarterectomy
  • Outline the indications for operations for claudication, abdominal aortic aneurysm, carotid stenosis and amputation.
  • Outline the manifestation of failing peripheral vascular grafts.
  • Analyze alternative measures for the diagnosis and management of renovascular hypertension.
  • Apply the decision making process in analyzing complex vascular diseases, including
    Cerebrovascular problems
    Mesenteric vascular disease
    Renovascular disease
    Aneurysmal disease
    Lower extremity arterial occlusion
    Venous disease
  • Summarize complications of common major vascular procedures such as:
    Carotid endarterectomy
    Aortic reconstruction
    Lower extremity vascular reconstruction
  • Participate in all consults on the Vascular Service.
  • Round daily with the Vascular Surgery Service.
  • Accompany attending staff to their clinic/office at least weekly for instruction in the pre and post surgical care of the vascular patient.
  • Organize the weekly Vascular Conference and M & M.
  • Perform advanced “open” cases such as aneurysm repair (thoracic and aortic), cerebral vascular, open peripheral vascular surgeries, thoracic outlet surgery and amputations.
  • Learn advanced endovascular techniques including aortic, thoracic, renal, splenic vessels, tibial and carotid artery interventions.

The learning and skills objectives noted above will be accomplished through:

  • Direct supervision
  • Didactic lecture
  • Reading

January/February/March - Site 3

January/February/March - Site 3

Site 3 – Fairview Southdale Hospital (FSD)
Vascular Surgery Inpatient/Outpatient Rotation

Objectives:

  • Summarize the etiology, pathophysiology, and therapeutic options of specific categories of vascular disease:
    Varicose vein disease
    Post-phlebitic syndrome
    Portal hypertension
    Anatomy of lymphatic system and lymphatic return
    Congenital lymphatic anomalies
    Acquired lymphatic disease
    Operative procedures for correction of lymphatic disease
  • Describe the role of anticoagulant agents, including antiplatelet agents, in the management of patients with vascular disease.
  • Summarize the etiology, diagnosis, and therapeutic options of specific categories of vascular disease: 
    Inflammatory vascular disease and vasculitis
    Arteriovenous fistulas or malformations
    Neurovascular compression syndromes (thoracic outlet syndrome)
    Tumors
    Sympathetic nervous system (e.g. causalgia, reflex sympathetic dystrophy)
  • Summarize the etiology, microbiology, and treatment of diabetic foot infection.
  • Outline procedure for managing vascular surgical emergencies such as acute tissue ischemic or major hemorrhage (traumatic or ruptured aneurysm).
  • Summarize the surgical techniques available for managing the following vascular disorders:
    Abdominal aortic bypass or aneurysectomy
    Carotid stenosis
    Femoral-popliteal occlusion
    Tibial artery occlusion
  • Outline the management of prosthetic graft infections, including:
    Diagnosis
    Use of alternate routes for revascularization
    Use of alternative graft materials
  • Participate in all consults on the Vascular Service.
  • Round daily with the Vascular Surgery Service.
  • Accompany attending staff to their clinic/office at least weekly for instruction in the pre and post surgical care of the vascular patient.
  • Organize the weekly Vascular Conference and M & M.
  • Perform advanced “open” cases such as aneurysm repair (thoracic and aortic), cerebral vascular, open peripheral vascular surgeries, thoracic outlet surgery and amputations
  • Learn advanced endovascular techniques including aortic, thoracic, renal, splenic vessels, tibial and carotid artery interventions.
  • Learn open venous stripping for varicose veins

The learning and skills objectives noted above will be accomplished through:

  • Direct supervision
  • Didactic lecture
  • Reading

April/May/June - Site 4

April/May/June - Site 4

Site 4 - Abbott Northwestern Hospital (ANW)
Vascular Surgery Inpatient/Outpatient Rotation

Objectives:

  • Differentiate between the following diagnostic tools available for assessing vascular disease and explain the relative contribution of each:
    Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA)
    Duplex scanning (ultrasonography)
  • Discuss the principles of and contraindications for anticoagulation and thrombolytic therapy.
  • Discuss the mechanics of action and the therapeutic role of the following pharmacologic types of agents:
    Vasopressors
    Vasodilators
    Adrenergic blocking agents
    Anticoagulants
    Antiplatelet agents
    Thrombolytics
  • Discuss the role of the following factors in maintaining homeostasis in the coagulation pathways: 
    Protein S
    Protein C
    Platelets
    Platelet granules
    Endothelial cells
    Antithrombin III
  • Review and describe the basic clinical manifestations of the following vascular disorders: Congenital vascular disease
  • Illustrate the operative exposure of the major vessels, including:
    Aortic arch
    Proximal subclavian
    Carotid artery
    Descending thoracic aorta
    Suprarenal aorta
    Infrarenal aorta
    Femoral artery
    Popliteal arterial
  • Describe the indications for balloon angioplasty and vascular stent placement with risks and complications.
  • Discuss the principles of preoperative vascular surgery.
  • Demonstrate a basic knowledge of the various types of graft and suture material available.
  • Analyze the management of complex vascular problems considering the following factors:
    Morbidity and mortality
    Advanced surgical techniques
    Endoscopy
    Microvascular techniques
    Endoluminal grafting
  • Participate in all consults on the Vascular Service.
  • Round daily with the Vascular Surgery Service.
  • Accompany attendings to their patient clinic/office at least weekly for instruction in the pre and post surgical care of the vascular patient.
  • Organize the weekly Vascular Conference and M & M.
  • Perform advanced “open” cases such as aneurysm repair (thoracic and aortic), cerebral vascular, open peripheral vascular surgeries, thoracic outlet surgery and amputations.
  • Learn advanced endovascular techniques including aortic, thoracic, renal, splenic vessels, tibial and carotid artery interventions.

The learning and skills objectives noted above will be accomplished through:

  • Direct supervision
  • Didactic lecture
  • Reading