Vascular Surgery FellowshipVascular Surgery Fellowship

Established 1999 as an ACGME-approved one-year clinical Established 1999 as an ACGME-approved one-year clinical fellowshipfellowship

Primary certificate approved in 2006, mandating minimum two Primary certificate approved in 2006, mandating minimum two years of trainingyears of training

RRC approval to move to two-year program (2006-2008)RRC approval to move to two-year program (2006-2008) First YearFirst Year

acquiring endovascular skillsacquiring endovascular skills learning the science and the clinical application of the non-invasive learning the science and the clinical application of the non-invasive

vascular laboratoryvascular laboratory mentored experience in clinical researchmentored experience in clinical research

Second YearSecond Year inpatient and outpatient care utilizing traditional open vascular surgery inpatient and outpatient care utilizing traditional open vascular surgery

and endovascular and endovascular techniquestechniques

Vascular Surgery FacultyVascular Surgery Faculty

Craig Kent, Chairman, Department of Craig Kent, Chairman, Department of SurgerySurgery

William Turnipseed, Section ChiefWilliam Turnipseed, Section Chief John Hoch, Residency Program DirectorJohn Hoch, Residency Program Director Charles Acher, complex aortic surgeryCharles Acher, complex aortic surgery Girma Tefera, endovascular leaderGirma Tefera, endovascular leader Gretchen Schwarze, surgical ethicistGretchen Schwarze, surgical ethicist Matthew Mell, public health researcherMatthew Mell, public health researcher

Craig Kent, MDCraig Kent, MD A.R. Curreri Professor, Chairman, Department of A.R. Curreri Professor, Chairman, Department of

Surgery Surgery Residency UCSF, 1981-1986Residency UCSF, 1981-1986 Vascular Fellowship Brigham & Women's Vascular Fellowship Brigham & Women's

Hospital, 1986-1988Hospital, 1986-1988 Chief, Combined Columbia and Cornell Division Chief, Combined Columbia and Cornell Division

of Vascular Surgery, New York Presbyterian of Vascular Surgery, New York Presbyterian Hospital, 1997-2008Hospital, 1997-2008

President Society For Vascular Surgery, 2006-President Society For Vascular Surgery, 2006-20072007

Member, Vascular Surgery Board of American Member, Vascular Surgery Board of American Board of Surgery, 2008-2012Board of Surgery, 2008-2012

PI on more than 45 Industry Sponsored Clinical PI on more than 45 Industry Sponsored Clinical trialstrials

PI or co-investigator on 4 active NIH grantsPI or co-investigator on 4 active NIH grants Author of 233 manuscripts and 44 book Author of 233 manuscripts and 44 book

chapterschapters

William Turnipseed, MDWilliam Turnipseed, MD

Professor of SurgeryProfessor of Surgery Chief Section of Vascular SurgeryChief Section of Vascular Surgery MD, Emory University, Atlanta, Ga., 1969 MD, Emory University, Atlanta, Ga., 1969 Residency, NIH Academic Trainee, Ohio State Residency, NIH Academic Trainee, Ohio State

University Hospitals, 1969-1974 University Hospitals, 1969-1974 Fellowship, Peripheral Vascular Surgery, Ohio Fellowship, Peripheral Vascular Surgery, Ohio

State University Hospitals, 1974-75State University Hospitals, 1974-75 Clinical and Research interestsClinical and Research interests

Thoracic outlet syndrome managementThoracic outlet syndrome management Management of chronic compartment Management of chronic compartment

syndromesyndrome Stepping down as section chief, 2009Stepping down as section chief, 2009

Charles Acher, MDCharles Acher, MD Professor of SurgeryProfessor of Surgery Director, Thoracoabdominal Aneurysm ProgramDirector, Thoracoabdominal Aneurysm Program Residency, University of Wisconsin, Madison, Wis., Residency, University of Wisconsin, Madison, Wis.,

1973-1978 1973-1978 Fellow, GI and Peripheral Vascular Surgery, Fellow, GI and Peripheral Vascular Surgery,

Gloucestershire Royal Hospital, Gloucester, England, Gloucestershire Royal Hospital, Gloucester, England, 1978-19801978-1980

Peripheral Vascular Fellow, Baylor College of Peripheral Vascular Fellow, Baylor College of Medicine, 1982-1983 Medicine, 1982-1983

Clinical and Research interestsClinical and Research interests Prevention of ischemic spinal cord injury in repair Prevention of ischemic spinal cord injury in repair

of TAAsof TAAs Management of Complex Aortic and Visceral artery Management of Complex Aortic and Visceral artery

diseasedisease Repair of Aortic Arch and Thoracoabdominal Repair of Aortic Arch and Thoracoabdominal

Aneurysms by open and endovascular techniquesAneurysms by open and endovascular techniques

John R. Hoch, MDJohn R. Hoch, MD Professor of SurgeryProfessor of Surgery Program Director Vascular Residency, 1999 - presentProgram Director Vascular Residency, 1999 - present Chief Vascular Surgery, VA Hospital, 1994 – presentChief Vascular Surgery, VA Hospital, 1994 – present Residency, Thomas Jefferson University, Philadelphia, Penn., 1983-Residency, Thomas Jefferson University, Philadelphia, Penn., 1983-

1989 1989 Fellow, Vascular Surgery, University of Missouri-Columbia, Columbia, Fellow, Vascular Surgery, University of Missouri-Columbia, Columbia,

Mo., 1989-1991Mo., 1989-1991 Research:Research:

PI VA Co-op trial #410 and #498PI VA Co-op trial #410 and #498 Industry sponsored clinical trialsIndustry sponsored clinical trials Translational researchTranslational research

Clinical Interests:Clinical Interests: Complex aortic and visceral artery occlusive diseaseComplex aortic and visceral artery occlusive disease Endovascular management of arterial occlusive and aneurysmal Endovascular management of arterial occlusive and aneurysmal

diseasedisease Less invasive management of varicose vein diseaseLess invasive management of varicose vein disease

Girma Tefera, MDGirma Tefera, MD Associate Professor of SurgeryAssociate Professor of Surgery Director, UW Limb Salvage Angioplasty and Carotid Director, UW Limb Salvage Angioplasty and Carotid

Stenting ProgramStenting Program Residency in General Surgery, Howard University Residency in General Surgery, Howard University

Hospital, Washington, D.C., 1994-1999 Hospital, Washington, D.C., 1994-1999 Fellowship in Vascular Surgery, University of Fellowship in Vascular Surgery, University of

Wisconsin Hospital and Clinics, Madison, Wis., 1999-Wisconsin Hospital and Clinics, Madison, Wis., 1999-20002000

Research and Clinical InterestsResearch and Clinical Interests Carotid stentingCarotid stenting Limb salvage angioplastyLimb salvage angioplasty Endovascular aortic stent grafts and angioplasty of Endovascular aortic stent grafts and angioplasty of

peripheral arteries peripheral arteries Thoacoabdominal aneurysm repair by open and Thoacoabdominal aneurysm repair by open and

endovascular meansendovascular means Developer and Manager of Vascular Surgery DatabaseDeveloper and Manager of Vascular Surgery Database

Gretchen Schwarze, MDGretchen Schwarze, MD

Assistant Professor of SurgeryAssistant Professor of Surgery MD, Harvard Medical School, 1995MD, Harvard Medical School, 1995 John F. Kennedy School of Government, 1995John F. Kennedy School of Government, 1995 Mass General, General Surgery Residency, Mass General, General Surgery Residency,

20022002 University of Chicago Vascular Residency, University of Chicago Vascular Residency,

20042004 Research and Clinical InterestsResearch and Clinical Interests

Surgical ethics researchSurgical ethics research Developer of the UW School of Medicine and Public Health Ethics Developer of the UW School of Medicine and Public Health Ethics

CurriculumCurriculum Endovascular specialistEndovascular specialist Surgical educationSurgical education

Matthew Mell, MDMatthew Mell, MD Assistant Professor of SurgeryAssistant Professor of Surgery General Surgery, Stanford, 1987-1992General Surgery, Stanford, 1987-1992 Transplant, Stanford, 1992-1993Transplant, Stanford, 1992-1993 Senior Surgeon, The Permanente Senior Surgeon, The Permanente

Medical Group, Hayward, Calif. 1993-Medical Group, Hayward, Calif. 1993-20052005

Vascular Residency, University of Vascular Residency, University of Wisconsin, 2005-2006Wisconsin, 2005-2006

Director, third- and fourth-year medical Director, third- and fourth-year medical student rotations in vascular surgerystudent rotations in vascular surgery

Clinical and Research InterestsClinical and Research Interests Complex aortic disease and its management Complex aortic disease and its management

by open and endovascular techniquesby open and endovascular techniques Public Health and Vascular Disease researchPublic Health and Vascular Disease research Surgical educationSurgical education

Vascular Surgery Fellowship GoalsVascular Surgery Fellowship Goals

Develop Excellence in:Develop Excellence in: Routine and complex open vascular surgeryRoutine and complex open vascular surgery Diagnostic arteriographyDiagnostic arteriography Endovascular intervention of aneurysmal and Endovascular intervention of aneurysmal and

occlusive diseaseocclusive disease Interpretation of non-invasive vascular Interpretation of non-invasive vascular

laboratory studies and their limitationslaboratory studies and their limitations Clinical research project with faculty mentorClinical research project with faculty mentor

Vascular Surgery Fellowship GoalsVascular Surgery Fellowship Goals

Competency in the basic science and Competency in the basic science and clinical curriculumclinical curriculum**

Competency as a teacherCompetency as a teacher Compliance with the 80-hour work weekCompliance with the 80-hour work week Management of the weekly teaching and Management of the weekly teaching and

indication conferences and monthly indication conferences and monthly Journal ClubJournal Club

*http://apdvs.vascularweb.org/APDVS_Contribution_Pages/New_Curriculum/Clinical/Clinical_Curriculum_INDEX.html

CurriculumCurriculum

APDVS curriculum online with referencesAPDVS curriculum online with references Written Curriculum Goals and Educational Written Curriculum Goals and Educational

Objectives Objectives September UCLA Vascular Review Course, first September UCLA Vascular Review Course, first

yearyear Selected topics presented weekly by residents, Selected topics presented weekly by residents,

faculty, and invited speakers at Vascular faculty, and invited speakers at Vascular ConferenceConference

Files with selected references in hard copy filed Files with selected references in hard copy filed in resident’s officein resident’s office

VSEP exam in Fall to direct your reading; VSEP exam in Fall to direct your reading; Vascular Surgery Inservice Exam in February.Vascular Surgery Inservice Exam in February.

Structure of First YearStructure of First Year

Daily rounds Daily rounds Non-invasive vascular labNon-invasive vascular lab Diagnostic arteriography and Diagnostic arteriography and

endovascular interventionsendovascular interventions Venous disease rotationVenous disease rotation Arterio-venous access rotationArterio-venous access rotation Clinical research and critical thinkingClinical research and critical thinking

Non-invasive Vascular LabNon-invasive Vascular Lab

Daily reading at the VA and on a rotational basis Daily reading at the VA and on a rotational basis at the University Hospitalat the University Hospital

One-half day per week hands-on in the lab first One-half day per week hands-on in the lab first six monthssix months

Didactic lectures on CDDidactic lectures on CD Gain a complete understanding of the Gain a complete understanding of the

indications, interpretation and limitations of indications, interpretation and limitations of each testeach test

Prepared to pass ARDMS examination during Prepared to pass ARDMS examination during second year of residencysecond year of residency

Endovascular InterventionsEndovascular Interventions Preoperative evaluation of the patientPreoperative evaluation of the patient Developing a therapeutic plan of endovascular Developing a therapeutic plan of endovascular

intervention, in consultation and input of the intervention, in consultation and input of the facultyfaculty

Performance of the endovascular intervention, Performance of the endovascular intervention, and follow up of the patientand follow up of the patient

Responsible for endovascular procedures in the Responsible for endovascular procedures in the UW Cath lab, and VA OR.UW Cath lab, and VA OR.

Participate in weekly VA clinic and indications Participate in weekly VA clinic and indications conferences and monthly endovascular Q&A conferences and monthly endovascular Q&A conferences; quarterly city-wide endovascular conferences; quarterly city-wide endovascular forum dinner meetingforum dinner meeting

Venous Disease RotationVenous Disease Rotation

One month rotation at Meriter HospitalOne month rotation at Meriter Hospital Rotate into venous clinicRotate into venous clinic Office-based and hospital operating Office-based and hospital operating

room-based interventionsroom-based interventions Minimally invasive techniques, and the Minimally invasive techniques, and the

postoperative care of patients with postoperative care of patients with venous disordersvenous disorders

Arterio-Venous Access ClinicArterio-Venous Access Clinic

Pre-operative and post operative care of Pre-operative and post operative care of patients requiring complex venous access patients requiring complex venous access surgerysurgery

AV access endovascular procedures with Dr. AV access endovascular procedures with Dr. Alex Yevzlin, interventional nephrologistsAlex Yevzlin, interventional nephrologists

Yolanda Becker’s clinic PRNYolanda Becker’s clinic PRN

Clinical Research and Critical ThinkingClinical Research and Critical Thinking

The first-year resident will be enrolled in two The first-year resident will be enrolled in two classes: classes: 1. Biostatistics and Medical Informatics1. Biostatistics and Medical Informatics 2. Introduction To Clinical Trials2. Introduction To Clinical Trials

Prepare the resident for the design, Prepare the resident for the design, implementation, and conduct of clinical trialsimplementation, and conduct of clinical trials

Assigned research mentorAssigned research mentor Database managerDatabase manager Section will cover meeting costs for presentationSection will cover meeting costs for presentation Weekly didactic lecture, monthly Journal ClubWeekly didactic lecture, monthly Journal Club

Clinical Coverage in First YearClinical Coverage in First Year

Call is from home, backing up an intern who is on in-Call is from home, backing up an intern who is on in-house first callhouse first call

Approximately every third night during the week and Approximately every third night during the week and every other weekend call and rounding responsibilitiesevery other weekend call and rounding responsibilities

First-year vascular fellow rounds with the UW Hospital First-year vascular fellow rounds with the UW Hospital Service dailyService daily

Cover of clinical services when second-year vascular Cover of clinical services when second-year vascular resident or the VA PGY-4 out on vacation (6 weeks)resident or the VA PGY-4 out on vacation (6 weeks)

Optional participation in basic science vascular Optional participation in basic science vascular lab/meetings lab/meetings

The first-year vascular fellow will act as a consultant for The first-year vascular fellow will act as a consultant for the PGY-4, and will be responsible for many the PGY-4, and will be responsible for many percutaneous and open VA endovascular cases if percutaneous and open VA endovascular cases if scheduling permits.scheduling permits.

Second Year of TrainingSecond Year of Training Second-year vascular fellow runs UW vascular Second-year vascular fellow runs UW vascular

service; general surgery PGY-4 runs the VA vascular service; general surgery PGY-4 runs the VA vascular service.service.

UW ServiceUW Service PGY-3, PGY-1 and two nurse practitionersPGY-3, PGY-1 and two nurse practitioners Clinic on Wednesdays at VA; Dr. Kent has clinic Clinic on Wednesdays at VA; Dr. Kent has clinic

Monday afternoons in the UW HospitalMonday afternoons in the UW Hospital OR #5, 7:30 a.m. starts (two on Tuesday)OR #5, 7:30 a.m. starts (two on Tuesday) Endovascular experience in operating room and Endovascular experience in operating room and

periodically in cath lab (Wednesday mornings)periodically in cath lab (Wednesday mornings)

Second Year of TrainingSecond Year of Training VA Service VA Service

General Surgery PGY-4, PGY-1, PGY-3 and VA NPGeneral Surgery PGY-4, PGY-1, PGY-3 and VA NP Clinic on Wednesdays at VAClinic on Wednesdays at VA OR #4, 7:30 a.m. startsOR #4, 7:30 a.m. starts Endovascular experience in OR, OEC 9800. New Endovascular experience in OR, OEC 9800. New

construction of an Operating Room VA angio suite construction of an Operating Room VA angio suite to begin Fall 2009.to begin Fall 2009.

The first-year vascular fellow will act as a consultant for The first-year vascular fellow will act as a consultant for the PGY-4, and will be responsible for most the PGY-4, and will be responsible for most percutaneous and open VA endovascular cases.percutaneous and open VA endovascular cases.

Second Year of TrainingSecond Year of Training Call:Call:

Approximately every third night from home Approximately every third night from home during the week, backing up the intern who is in during the week, backing up the intern who is in house. The general surgery night float admits house. The general surgery night float admits vascular patients from the ER.vascular patients from the ER.

The vascular faculty member on call backs up The vascular faculty member on call backs up the PGY-3 when they are on first callthe PGY-3 when they are on first call

The vascular fellows are on call and have The vascular fellows are on call and have rounding duties every other weekendrounding duties every other weekend

When the PGY-3 is on weekend first call, the When the PGY-3 is on weekend first call, the faculty will not call in the fellow except for faculty will not call in the fellow except for “index” cases, allowing greater vascular “index” cases, allowing greater vascular exposure for the PGY-3exposure for the PGY-3

Conferences / TeachingConferences / Teaching Weekly Wednesday Teaching ConferenceWeekly Wednesday Teaching Conference

30-minute didactic lecture by vascular and guest faculty members30-minute didactic lecture by vascular and guest faculty members PGY-4 and PGY-3 give one didactic lecture during 10-week rotationPGY-4 and PGY-3 give one didactic lecture during 10-week rotation Vascular fellows each give a didactic lecture every eight weeksVascular fellows each give a didactic lecture every eight weeks Morbidity/Mortality WeeklyMorbidity/Mortality Weekly 1-2 interesting cases if time allows1-2 interesting cases if time allows

Weekly Thursday Vascular Indications ConferenceWeekly Thursday Vascular Indications Conference Pre-operative presentation of patients requiring endovascular and Pre-operative presentation of patients requiring endovascular and

open proceduresopen procedures Two vascular fellows and VA PGY-4 present with faculty.Two vascular fellows and VA PGY-4 present with faculty.

Monthly Journal ClubMonthly Journal Club Monthly Endovascular Q&AMonthly Endovascular Q&A Quarterly City-wide Endovascular ForumQuarterly City-wide Endovascular Forum

Conferences / TeachingConferences / Teaching

Grand Rounds Grand Rounds Each vascular fellow is assigned one grand rounds Each vascular fellow is assigned one grand rounds

presentation per yearpresentation per year

All third-year medical students rotate in VA ClinicAll third-year medical students rotate in VA Clinic Additional third-year medical students complete a two-Additional third-year medical students complete a two-

week rotations and fourth-years do month long week rotations and fourth-years do month long electiveselectives

Attend SVS meeting second year; attend any Attend SVS meeting second year; attend any meeting at which you are presentingmeeting at which you are presenting

First-year resident attends UCLA Vascular Basic First-year resident attends UCLA Vascular Basic Science Review ConferenceScience Review Conference

Summer Core Competency LecturesSummer Core Competency Lectures

Resident EvaluationResident Evaluation Fellow performance evaluationFellow performance evaluation

Every four monthsEvery four months FacultyFaculty 360-degree evaluation by nursing (floor and 360-degree evaluation by nursing (floor and

OR), cath lab personnel, NPs and support OR), cath lab personnel, NPs and support staffstaff

February Inservice Exam (VSITE)February Inservice Exam (VSITE) Quality Improvement ProjectQuality Improvement Project

Anonymous evaluation of program and Anonymous evaluation of program and faculty by computer inputfaculty by computer input

Routine and complex open vascular surgery cases Routine and complex open vascular surgery cases 2007-20082007-2008

UW FellowUW Fellow Nat’l AverageNat’l Average PercentilePercentile

AbdominalAbdominal 167 65 98%167 65 98% Open AAA 44 16 98%Open AAA 44 16 98%

Cerebrovascular Cerebrovascular 37 37 54 54 22% 22% PeripheralPeripheral 100 100 101 58% 101 58% ComplexComplex 200 200 85 85 97% 97%

Mesenterics 5 Mesenterics 5 4 64% 4 64% TAATAA 35 5 96% 35 5 96%

Endografts 106 71 81%Endografts 106 71 81% Total Open 504Total Open 504 305 93% 305 93%

Endovascular ExperienceEndovascular Experience UW FellowUW Fellow Nat’l AverageNat’l Average

PercentagePercentage Diagnostic 82 (615) 95 (382) 50%Diagnostic 82 (615) 95 (382) 50% Therapeutic 239 (487) 151 (255) 80%Therapeutic 239 (487) 151 (255) 80% Endografts 76 (106) 55 (71) 80%Endografts 76 (106) 55 (71) 80%

First number is primary recorded procedure, the number ( ) is First number is primary recorded procedure, the number ( ) is secondary recorded procedures (Both are recorded for the RRC for secondary recorded procedures (Both are recorded for the RRC for Surgery)Surgery)

Limb Salvage Angioplasty ProgramLimb Salvage Angioplasty Program Carotid Stenting ProgramCarotid Stenting Program Thoracic Endograft Program Thoracic Endograft Program

80-Hour Work Week

Questions?Questions?