Vascular Surgery
Residency and Fellowship
• An ACGME-approved Vascular Surgery Fellowship (5+2)
– Established in 1999 as an ACGME-approved 1-year clinical fellowship
– RRC approval to move to 2-year program (2006-2008)
– All fellows have passed their Board exams on the first attempt
– First Year
• acquiring endovascular skills
• learning the science and the clinical application of the non-invasive
vascular laboratory
• mentored experience in clinical research
– Second Year
• inpatient and outpatient care utilizing traditional open vascular
surgery and endovascular techniques
• Phasing out 5+2 program with Integrated Vascular 0-5.
Vascular Surgery Faculty
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Craig Kent, MD – Chairman, Department of Surgery
Jon Matsumura, MD - Chief, Division of Vascular Surgery
John Hoch, MD - Residency Program Director
Charles Acher, MD - complex open aortic surgery
Girma Tefera, MD - endovascular leader
Gretchen Schwarze, MD - surgical ethicist
William Turnipseed, MD - chronic compartment syndrome
Dai Yamanouchi, MD, PhD - clinician and basic science
research
• Bo Liu, PhD - basic vascular research
K. Craig Kent, MD
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A.R. Curreri Professor
Chairman, Department of Surgery
Residency, UCSF 1981-1986
Vascular Fellowship, Brigham & Women's Hospital
1986-1988
Chief, Combined Columbia and Cornell Division of
Vascular Surgery, New York Presbyterian Hospital
1997-2008
President Society for Vascular Surgery, 2006-2007
Member, Vascular Surgery Board of American Board
of Surgery, 2008-2012
PI on more than 45 Industry Sponsored Clinical trials
PI or co-investigator on 4 active NIH grants
Author of > 233 manuscripts and 44 book chapters
Jon Matsumura, MD
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Professor and Chief, Division of Vascular Surgery
Residency, Northwestern University, 1988-1995
Vascular Fellowship, Northwestern University, 1995-1996
President, Midwestern Vascular Surgery Society, 2009-2010
Chair, SVS Clinical Research Committee, 2007-2009
PI or site PI on 18 industry sponsored Grants
– PI: WL Gore: "Thoracic Aneurysm Graft Corelab", (2001-2009)
– National PI: WL Gore: "Phase II Clinical Trial of the Bifurcated
Excluder Endograft for Treatment of Infrarenal Aortic
Aneurysms”
– International PI: Cook, Inc: “Zenith Thoracic TAA Endovascular
Graft”
- National Co-PI forAbbott Vascular: “Asymptomatic Carotid stenosis, stenting
versus endarterectomy Trial”, 2004- present
Author of more than 70-peer reviewed articles, 34 book chapters and editor of 9
books
John R. Hoch, MD
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Professor of Surgery
Program Director, Vascular Residency and Fellowship
Chief of Vascular Surgery, Madison VA Hospital, 1994 – present
Residency, Thomas Jefferson University, Philadelphia, PA, 1983-1989
Fellow, Vascular Surgery, University of Missouri-Columbia,
Columbia, MO, 1989-1991
Research:
– PI VA Co-op trial #410 and #498
– Industry sponsored clinical trials
– Translational and Education Research
– Chair, UW Anticoagulation Taskforce
Clinical Interests:
– Complex aortic and visceral artery occlusive disease
– Endovascular management of arterial occlusive and aneurysmal
disease
– Less invasive management of varicose vein disease
Charles W. Acher, MD
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Professor of Surgery
Director, Thoracoabdominal Aneurysm Program
Residency, University of Wisconsin, Madison, WI, 1973-1978
Fellowship, GI and Peripheral Vascular Surgery, Gloucestershire Royal
Hospital, Gloucester, England, 1978-1980
Peripheral Vascular Fellow, Baylor College of Medicine, 1982-1983
Clinical and Research interests
– Prevention of ischemic spinal cord injury in repair of TAAs
– Management of Complex Aortic and Visceral artery disease
– Repair of Aortic Arch and Thoracoabdominal Aneurysms by open
and endovascular techniques
Girma Tefera, MD
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Associate Professor of Surgery
Director, UW Limb Salvage Angioplasty and Carotid Stenting
Program
Residency in General Surgery, Howard University Hospital,
Washington, D.C., 1994-1999
Fellowship in Vascular Surgery, University of Wisconsin Hospital
and Clinics, Madison, WI, 1999-2000
Research and Clinical Interests
– Carotid stenting
– Limb salvage angioplasty
– Endovascular aortic stent grafts and angioplasty of peripheral
arteries
Ethiopian Surgical Education Grant
Gretchen Schwarze, MD
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Assistant Professor of Surgery
Harvard Medical School, Boston, MA, 1995
JFK School of Government, Boston, MA, 1995
General Surgery Residency at Mass General, Boston, MA,
2002
Vascular Residency, University of Chicago, 2004
Research and Clinical Interests
– Surgical ethics research
– Developer of the UW Medical School Ethics
Curriculum
– Endovascular specialist
– Surgical education
William Turnipseed, MD
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Professor of Surgery
Former Chief Section of Vascular Surgery
MD, Emory University, Atlanta, GA, 1969
Residency, NIH Academic Trainee, Ohio State University
Hospitals, 1969-1974
Fellowship, Peripheral Vascular Surgery, Ohio State 1974-75
Clinical and Research interests
– Thoracic outlet syndrome management
– Management of chronic compartment syndrome
Dai Yamanouchi MD, PhD
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Clinical Assistant Professor ‘10Surgical Residency, Saiseikai Maebashi Hospital, Japan, 2001-2002
Research Fellowship, Nagoya University Graduate School of Medicine,
Japan, 2003-2004
Clinical Fellowship in Vascular Surgery, Nagoya University Hospital,
Japan, 2004-2007
Research Fellowship, Weill Cornell Medical College, New York, NY,
2007-2008
Fellowship in Advanced Endovascular Surgery, University of Wisconsin
Madison, Madison, WI, 2009-2010
Research interests:
– pathogenesis of AAA
– restenosis after angioplasty including balloon angioplasty and stent placement
– Development of novel materials for vascular bypass graft
– Gene delivery methods for patients with peripheral arterial disease
Bo Liu, PhD
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MS, Biology, Beijing University, Beijing, China, 1986
PhD, Biochemistry, SUNY Downstate, New York, NY, 1993
Postdoctoral fellow, Signal transduction; protein degradation,
Columbia University, New York, NY, 1994-1996
Postdoctoral fellow, Transcription regulation; signal transduction,
Memorial Sloan-Kettering Cancer Center, New York, NY,
1996-1999
Research: RO1: understand the regulatory mechanisms
underlying \normal functions of vascular smooth muscle cells
(SMCs) and how these regulatory mechanisms malfunction in vascular
diseases
– AAA
– Restenosis
Vascular Surgery
Fellowship Goals
Develop Excellence in:
• Routine and complex open vascular surgery
• Diagnostic arteriography
• Endovascular intervention of aneurysmal and occlusive
disease
• Interpretation of non-invasive vascular laboratory studies
and their limitations
• Clinical research project with faculty mentor
Vascular Surgery
Fellowship Goals
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Competency in the Basic Science and Clinical Curriculum*
Competency as a Teacher
Compliance with the 80-hour work week
Management of the weekly teaching and indication
conferences and monthly Journal Club
*http://apdvs.vascularweb.org/APDVS_Contribution_Pages/New_Curriculum/Clinical/Clinical_Curriculum_INDEX.html
Curriculum
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APDVS curriculum on-line with references
Written curriculum goals and educational objectives
September UCLA Vascular Review Course, first-year fellow
Selected topics presented weekly by residents , faculty,
and invited speakers at Vascular Conf.
• Files with selected references in hard copy filed in
resident’s office
• VSEP/VSAP exam in Fall to direct your reading; Vascular
Surgery Inservice Exam in February.
Structure of First Year
• Daily rounds UW Vascular Service, part of the team
actively involved in patient care
• Non-invasive vascular lab
• Diagnostic arteriography and endovascular interventions
• Venous disease rotation
• Arterio-venous access rotation
• Clinical research and critical thinking
Non-invasive Vascular Lab
• Daily reading at the VA and on a rotational basis at the
University Hospital
– Likely phased out by 2012
– Change to reference cases review format, ie less service
• One-half day, twice per week, hands-on in the lab for a 3month block
• Didactic lectures on CD from SVS/APDVS
• Gain a complete understanding of the indications,
interpretation and limitations of each test.
• Prepared to pass ARDMS RPVI examination during second year
of fellowship
Endovascular Interventions
• Preoperative evaluation of the patient
• Developing a therapeutic plan of endovascular
intervention, in consultation and input of the faculty
• Performance of the endovascular intervention, and follow
up of the patient
• Responsible for endovascular procedures in the UW Cath
lab, VA OR Angio and IR suites
• Participate in weekly VA clinic and Indications conferences
Venous Disease Rotation
• One month rotation at Meriter Hospital
• Rotate into venous clinic
• Office-based and hospital operating room-based
interventions
• Minimally invasive techniques, and the postoperative care
of patients with venous disorders
Arterio-Venous Access Clinic
• Preoperative and postoperative care of patients
requiring complex venous access surgery
• AV access endovascular procedures with Dr. Alex
Yevzlin, interventional nephrologist
• Janet Bellingham, MD provides transplant access
clinic PRN
Clinical Research and
Critical Thinking
• The first-year fellow will be enrolled into classes in our
Institute for Clinical and Translational Research:
– Advanced Short Course Clinical Research
– Scientific Writing workshop
• Prepare the resident for the design, implementation, and
conduct of clinical trials
• Assigned research mentor
• Division will cover meeting costs for presentation
• Weekly didactic lectures
• Monthly Journal Club
Vascular Services
• UW Vascular Service
– 2 Vascular fellows, PG3, PG1 and 2 nurse practitioners
– OR #6 7:30am starts (2 starts alternating between Tuesday
and Thursday)
– Clinic offsite: ½ day per week for second-year, rotating days
• VA Vascular Service
– General Surgery PG4, PG1, PG3 and VA NP
– Clinic on Wednesdays at VA; first-year fellow
– OR #4 7:30am starts
– Endovascular experience in OR, OEC 9800 and IR. New
Operating Room VA angio suite to open VA vascular Call
covered by general surgery residents
Call
• Fellow call is “second call” from home; UW only.
– Fellows rotate every other weekend; every 3rd during week
– PG3 assigned to UW vascular service shares second call with
fellows. When the PG3 is on weekend first call, the faculty will
not call in the fellow except for “index” cases.
• First call for UW Vascular Service by intern assigned to Sunday to
Friday night float for vascular.
• PG1 and PG3 assigned to vascular for day shift, takes call Saturdays
8:30am- 10:30pm and Sunday 8:30am to 6pm; PA or PG3 covers
first call Saturday nights
• Trauma/ED night float team covers ED admissions
Clinical Coverage in First Year
• First-year vascular fellow rounds with the University Service
daily
• Daily responsibility in cath lab (415 diagnostic and 288
endovascular interventions) but also >200 open cases in the
first year
• Cover of clinical services when second-year vascular fellow or
the VA PG4 out on vacation (6 weeks)
• VA Vascular Clinic, organize and attend
– The first-year vascular fellow will act as a consultant for the
PG4, and will be responsible for many percutaneous cases
in VA IR suite and VA EVAR cases and Carotid stents.
• Optional participation in basic science vascular lab/meetings
• Noninvasive lab
Second Year of Training
• Second-year vascular fellow runs UW vascular service; general surgery
PG4 runs the VA vascular service.
UW Service
– Vascular fellows, PG3, PG1 and 2 nurse practitioners
– UW West Clinic ½ day per week; VA clinic when available
– OR #6 7:30am starts (2 on Tuesday and Thursday alternating)
– Endovascular experience in operating room and in cath lab
(Wednesday mornings)
– New UW Endovascular OR
Conferences / Teaching
• Weekly Wednesday Teaching Conference
– 30-minute didactic lecture by vascular and guest faculty members
– PG4 and PG3 give one didactic lecture during 10-wk rotation
– Vascular fellows each give a didactic lecture about every 8 wks
– Morbidity/Mortality Weekly
– 1-2 interesting cases if time allows
• Weekly Thursday Vascular Indications Conference
– Preoperative presentation of patients requiring endovascular and
open procedures, review of non-invasive studies
– Two vascular fellows and VA PG4 present cases with faculty.
Conferences / Teaching
• Weekly Monday AM Conference
– Basic science didactic lecture bi-monthly
– Monthly clinical research conference
– Clinical curriculum / competencies talks
• Monthly local Journal Club
• Monthly global Journal Club (Web-Ex)
• Summer Core Competencies Lectures
• Monthly M&M Vascular case presentation before Grand
Rounds
Conferences / Teaching
• Surgery Grand Rounds
– Each vascular fellow is assigned one Grand Rounds per
year
• Third and fourth-year medical students rotate on service as
electives
• Attend SVS meeting second year; attend any meeting at
which you are presenting
• First-year resident attends UCLA Vascular Basic Science
Review Conference
• Summer Core Competency Lectures
• Purchase your lead at start of first year
Resident Evaluation
• Fellow performance evaluation
– Semi-annual
– Faculty
– 360 evaluation by nursing (floor and OR), cath lab
personnel, NPs and support staff
– February Inservice Exam (VSITE)
– Quality Improvement Project
• Anonymous evaluation of fellows, residents, program and
faculty by computer input (MEDHUB)
Routine and Complex Open Vascular
Surgery Cases 2008-2010
UW Fellow
Abdominal
National Ave.
Percentile
147
58
98%
21
13
88%
Cerebrovascular
45
59
45%
Peripheral
125
109
67%
Complex
184
87
97%
Mesenteric
9
1
97%
TAA
30
5
98%
EVAR
70
70
50%
Total Operations
567
600
45%
Open AAA
Endovascular Experience 2008-2010
UW Fellow
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National Ave.
Percentile
Diagnostic
416
414
57%
Therapeutic
288
270
62%
Endografts
70
70
50%
Limb Salvage Angioplasty Program
Carotid Stent Program
Thoracic Endograft Program
Site for Gore Tag Clinical Trials TEVAR for Trauma, Dissection, TAA
ACT I and CHOICE Carotid Stent trials
80-Hour Work Week
Questions?