Vascular Surgery Vascular Surgery Residency and FellowshipResidency 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 FacultyVascular Surgery Faculty

• 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, MDK. Craig Kent, MD• 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, MDJon Matsumura, MD• 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, MDJohn R. Hoch, MD• 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, MDCharles W. Acher, MD• 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, MDGirma Tefera, MD• 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, MDGretchen Schwarze, MD• 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, MDWilliam Turnipseed, MD• 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, PhDDai Yamanouchi MD, PhD• Clinical Assistant Professor ‘10-• Surgical 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, PhDBo Liu, PhD• 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 Vascular Surgery Fellowship GoalsFellowship 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 Vascular Surgery Fellowship GoalsFellowship Goals

• 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

CurriculumCurriculum• 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 YearStructure 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 Non-invasive Vascular LabLab

• 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 3-month 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 Endovascular InterventionsInterventions

• 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 Venous Disease RotationRotation

• 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 ClinicArterio-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 Clinical Research and Critical ThinkingCritical 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 ServicesVascular 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

CallCall• 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 Clinical Coverage in First YearYear• 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 TrainingSecond 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 / TeachingConferences / 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 / TeachingConferences / 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 / TeachingConferences / 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 EvaluationResident 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 Routine and Complex Open Vascular Surgery Cases 2008-Vascular Surgery Cases 2008-

20102010UW Fellow National Ave. Percentile

Abdominal 147 58 98%

Open AAA 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%

Endovascular Experience 2008-Endovascular Experience 2008-20102010

• 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

UW Fellow National Ave. Percentile

Diagnostic 416 414 57%

Therapeutic 288 270 62%

Endografts 70 70 50%

80-Hour Work Week

Questions?Questions?