|Outpatient Vascular Medicine||1 day per week|
|Inpatient Vascular Medicine||3 months|
|Noninvasive Vascular Laboratory||3 months|
|Thrombosis Clinic and Coagulation Laboratory||1 month|
|Vascular Surgery||1 month|
|Peripheral Angiography and Intervention||1 month|
|Vascular Imaging (computed tomography and magnetic resonance angiography)||1 month|
|Electives (medical genetics, preventive cardiology, rheumatology, stroke neurology, vascular pathology)||1 month|
|Vacation||Interspersed among above rotations (3 weeks)|
Inpatient and outpatient vascular medicine rotations
The inpatient and outpatient vascular medicine consultative rotations are intended to provide the trainee with experience in diagnosis and management of a broad spectrum of vascular disorders, including:
- Aneurysmal disease of the aorta and peripheral arteries
- Arterial entrapment syndromes
- Chronic venous insufficiency and varicose veins
- Complex regional pain syndrome
- Congenital vascular anomalies
- Heritable connective tissue disorders, such as Marfan Syndrome, Loeys-Dietz Syndrome, Ehlers-Danlos Syndrome, Turner Syndrome, and others
- Lower extremity ulceration
- Lymphedema and lipedema
- Non-inflammatory arteriopathies, such as fibromuscular dysplasia, segmental arterial mediolysis, and spontaneous coronary artery dissection
- The systemic manifestations of atherosclerosis, such as peripheral artery disease, renal artery stenosis, mesenteric vascular disease, and extracranial cerebrovascular disease
- Thoracic outlet syndromes
- Thrombophilic disorders
- Vasculitis, such as thromboangitis obliterans, Takayasu arteritis, giant cell arteritis, etc
- Vasospastic diseases such as Raynaud’s phenomenon and other vascular diseases related to temperature, such as pernio and erythromelalgia
- Venous thromboembolism
Trainees will participate in the pre-operative evaluation, risk assessment, and peri-operative management of patients undergoing vascular surgery. Key components of this consultative rotation will include longitudinal outpatient follow-up of inpatients initially encountered for evaluation of acute venous and arterial thromboembolism, peripheral atherosclerotic vascular disease, arteriopathies, and others requiring ongoing surveillance and management.
Noninvasive vascular laboratory rotation
The 3-month noninvasive vascular laboratory rotation will enable the Vascular Medicine fellow to acquire expertise in the full range of noninvasive tests performed to evaluate patients with vascular diseases. These include physiologic studies of the upper and lower extremities (segmental blood pressure measurements, pulse volume recording, Doppler waveform analysis, exercise testing with post-exercise pressure measurements) and vascular ultrasound (carotid duplex, peripheral artery duplex, transcranial Doppler, visceral vascular duplex, and venous duplex). The key component of this rotation will be to acquire the skills necessary to perform and interpret vascular examinations. The Vascular Medicine fellow will learn the principles governing ultrasonography, including ultrasound physics, transducer technology, and ultrasound instrumentation and manipulation; and use these skills to acquire optimal images for duplex ultrasound studies of the carotid arteries, peripheral arteries and bypass grafts, renal arteries, and peripheral veins. The Vascular Medicine fellow will interpret at least 500 studies.
Thrombosis clinic and coagulation laboratory rotation
The 1-month Thrombosis Clinic and Coagulation Laboratory rotation will allow the Vascular Medicine fellow to hone the skills of evaluating and treating patients with venous thromboembolism and/or hypercoagulable disorders. Additionally, the trainee will spend time in the coagulation laboratory, learning about performance and interpretation of thrombophilia testing.
Vascular surgery rotation
The Vascular Medicine fellow will spend 1 month on the Vascular Surgery service. The trainee will participate in the outpatient evaluation and management of vascular surgery patients, round on the inpatient service, and observe vascular surgical procedures in the operating room. The fellow will learn the indications, contraindications, and potential complications of patients undergoing vascular surgery. The fellow will participate in the post-operative care of the vascular surgery patient. The fellow will learn the evaluation and management of wounds, including arterial, venous, and neuropathic ulcers.
Peripheral angiography and intervention rotation
The Vascular Medicine fellow will spend 1 month learning about peripheral angiography and intervention. The fellow will observe and assist in the performance of peripheral angiography and catheter-based endovascular interventions; and learn to interpret diagnostic angiograms. The fellow will develop an understanding of the indications, complications, and limitations of peripheral angiography. The fellow will be exposed to a breadth of procedures, including peripheral angioplasty and stenting, carotid stenting, catheter-based thrombectomy and thrombolysis of the pulmonary arteries and peripheral veins, inferior vena cava filter placement and retrieval, thrombin injection of pseudoaneurysms, and superficial vein ablation. The trainee will learn to differentiate abnormal and normal pathologic states of the aorta, peripheral arterial system, renal and mesenteric vasculature, and carotid and pulmonary circulation.
Vascular imaging rotation
The Vascular Medicine fellow will spend 1 month acquiring fundamental knowledge about vascular magnetic resonance and computed tomographic imaging principles, including acquisition, contrast dosing, post-processing, and interpretation. The trainee will learn to differentiate abnormal and normal pathologic states of the aorta, peripheral arterial system, renal and mesenteric vasculature, and carotid and pulmonary circulation.
The Vascular Medicine fellow will spend 1 month on electives, which best fit their interests and career goals. Possible electives including medical genetics, preventative cardiology (including lipid management), rheumatology, stroke neurology, and vascular pathology.