Curriculum

Fellows will be required to participate in both in-patient and out-patient management of our vascular disease patients, as well as patients who present in the emergency department and intensive care unit.

Inpatient Clinical Consultation

Our training program will allow the trainee to participate in the inpatient consultation service. Fellows will come across a variety of vascular diseases while evaluating inpatients during vascular medicine consultations and are expected to perform the following:

• Obtain a history of the patient's presentation;
• Perform a physical examination;
• Actively participate in the interpretation of the noninvasive test data, including ankle brachial index and duplex ultrasound studies.

The attending and fellow will discuss and review all important aspects of the case including physical examination, laboratory and non-invasive study data.

Fellows will learn how to integrate the entire patient’s history including:

• Entire medical/clinical presentation
• Non-invasive study data to make accurate diagnoses and appropriate clinical decisions
• Further invasive evaluation of the patient and therapeutic interventions.

Through the comprehensive clinical evaluation, the attending and fellow will discuss the various procedural methods including:

• Percutaneous versus surgical versus medical therapy
• Written consultation will be provided addressing the pertinent issues relevant to the patient

Outpatient Service

We offer the opportunity for fellows to gain insight into and become experts on outpatient vascular medicine services by observing attending staff at least one day per week in the outpatient setting. Our training program will allow the trainee to acquire knowledge and involvement of evaluation and management of patients in the clinic setting. Fellows will develop the knowledge of outpatient follow-up and we will evaluate patients with peripheral vascular and cardiovascular disease treated with drugs, percutaneous interventions or surgery as dictated by their condition.

Wound Care Management
Fellows will round at wound care clinic. They will be up to date on current evidence-based education in the area of skin and wound care management. They will be able to accurately assess, document, identify and plan appropriate and comprehensive patient treatment plans for wound management.

Percutaneous Vascular Procedures/Intervention
Our program will allow fellows to continue their development of vascular angiographic and interventional skills which will be an important aspect for the fellows. Fellows will gain insight and skills of angiography and catheter-based interventions in the peripheral vasculature through the guidance of the attending responsible for the procedure. Fellows will be able to participate at all times with procedural and clinical aspects of interventional cardiology and be trained in appropriate percutaneous invasive techniques including:

• Procedural care of patients
• Follow-up with patients they cared for clinically either in outpatient or inpatient setting to improve symptoms
• Reverse critical ischemia
• Avert or limit extent of vascular bypass surgery necessary in patients with peripheral vascular disease

The program will focus on training the fellow with various techniques of gaining safe and secure access including the:

• Contralateral Femoral Artery Approach
• Antegrade common femoral approach
• Retrograde common femoral artery approach
• Popliteal artery access
• Radial and brachial access

Fellows will continue to learn the appropriate interventional approaches for percutaneous treatment of target lesions in various peripheral arteries including:

• External iliac
• Common femoral artery
• Superficial femoral artery
• Tibial vessels
• Renal artery
• Subclavian artery and carotid artery

We offer the opportunity for fellows to gain knowledge and vascular imaging expertise through various techniques applied for visualization of various vascular beds. The program will focus on teaching the radiographic views to evaluate:

• The arch of the aorta and the great vessels including the brachiocephalic arteries
• The abdominal aorta and branches including the mesenteric and renal arteries
• Iliac arteries and arteries of the lower extremities
• Abdominal aortic aneurysm
• Venous angiogram

Our training program will allow the trainee to acquire knowledge of the best techniques to visualize:

• Carotid bifurcation
• Origin of the renal and mesenteric arteries
• The common iliac bifurcation and common femoral bifurcation;
• Which are predilection sites for atherosclerotic disease

We offer the opportunity for fellows to acquire the knowledge to use the proper diagnostic catheters and angiographic views to identify the following:

• Sites of atherosclerotic obstruction
• Delineate the severity of the stenosis
• Determine if the patient is suitable for surgery and/or percutaneous intervention.

Our training program will allow the trainee to gain insight and knowledge in the proper selection and use in:

• Guiding catheters
• Guidewires
• Balloon catheters
• Stents designed for the peripheral vasculature

The program will focus training the trainee on the performance of the critical manipulations applied in peripheral vascular interventions including:

• Aortoiliac intervention
• Femoral-popliteal intervention
• Infrapopliteal intervention
• Renal artery intervention
• Subclavian and innominate intervention
• Extracranial carotid artery intervention
• Venous stenting and ablation procedures
• Endovascular repair of AAA

Fellows will gain insight into and become experts in the development of the impact of patient characteristics, target vessel location, and lesion morphology on the success rate of percutaneous interventions. Our training program will allow the trainee to understand the strengths and limitations of differing percutaneous interventional approaches including:

• Balloon angioplasty
• Balloon expandable stents
• Self-expanding stents
• Other commonly used interventional devices will be discussed by the attending and fellow

Fellows will continue to gain insight into the management of mechanical complications of peripheral vascular interventions including:

• Dissection
• Thrombosis
• Spasm
• Perforation
• Peripheral vessel occlusion