Vascular Surgery Vascular Surgery Residency and FellowshipResidency and Fellowship

• Established with ACGME approval in 2009

• First Resident, July 2010– PGY-3 Brigitte Smith, MD, University of Wisconsin School of Medicine and

Public Health– PGY-2 Jessica Secor, MD, Boonshoft School of Medicine at Wright State– PGY-1 Elena Rinehardt, MD, University of Washington School of Medicine

• Phasing out 5+2 Fellowship program with Integrated Vascular Residency 0-5.

• Designed to produce surgeons who can provide comprehensive care to the vascular patient and be expected to fully participate in the rapid expansion of the field of vascular surgery, both clinically and academically.

Vascular Surgery FacultyVascular Surgery Faculty

• K. 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, MPH - 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 Vascular Fellowship• Chief of Vascular Surgery, Madison VA Hospital, 1994 – 2011• 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• Chief of Vascular Surgery, Madison VA Hospital, 2011-Present• 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, Gretchen Schwarze, MD, MPHMPH

• 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• Assistant Professor of Surgery• 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 ResidencyResidency

Goals:• Provide incremental, progressive training in core surgery

(CS) and vascular surgery (VS) during the five year program

• 24 months Core Surgery over PGY1-3• 36 months of Vascular Surgery PGY1-5• Three integrated sites: UW Hospital, Wm. S. Middleton

VA Hospital (connected by corridor) and Meriter Hospital (5 minute drive)

Integrated Residency (0-Integrated Residency (0-5)5)

Year 1• 10m Core and 2m Vascular

Year 2 and Year 3• 7m Core and 5m Vascular both years

Year 4 and Year 5• 12m Vascular

Will add one resident each year and phase out 5+2 fellowship

Integrated Residency (0-Integrated Residency (0-5)5)

• Core General Surgery:– General Surgery 7.5 months– Acute Care Surgery 2 months– Critical Care 1 month– Surgical Trauma 1.5 months– General Vascular 3 month– Night Float 2 months

• Core Surgical subspecialties: – Transplantation 3 months – Cardiac Surgery 1 month– Thoracic Surgery 2 months– Plastic Surgery 1 month

24 months

Integrated Residency (0-Integrated Residency (0-5)5)

• Vascular Surgery:– UW Vascular 24 months (an additional 2 months as

Core)– Endovascular 5 months– Vascular Lab 1 month– Vein Care 1 month

• Vascular -related: – Cardiology 1 month– Interventional Nephrology 1 month– Neurology/Stroke 1 month– Elective 1 month– Vascular Imaging 1 month

• 36 months

Weeks

PGY1

PGY2

PGY3

PGY 4

PGY5

2 UW Vascular Transplant Surgery

Vein Care UW Vascular UW Vascular

4 (Core) (Core) (Vascular) Surgery Service Surgery Service 6 Night Float Thoracic Endovascular (Vascular) (Vascular)

8 (Core) (Core) (Vascular) Open and Endovascular

Open and Endovascular

10 Stroke Service Vascular Lab General Surgery

12 (Vascular) (Vascular) (Core)

14 UW General Surgery

Endovascular Meriter General Surgery

16 (Core) (Vascular) (Core)

18 VA General Surgery

Cardiac Surgery 20 (Core) (Core)

22 Cardiology Consult

Endovascular

SICU

24 (Vascular) (Core) (Vascular)

26 Night Float

Interventional Nephrology

Acute Care Surgery

28 (Core) (Vascular) (Core)

30 Meriter General Surgery

Endovascular Elective 32 (Core) (Vascular) (Vascular)

34 Thoracic

36 (Core) Acute Care Surgery

VA Vascular

38 Transplantation (Core) (Vascular)

40 (Core) General Surgery UW General Vascular

42 Plastics (Core) (Core)

44 (Core)

Trauma Surgery

46 UW General Surgery

(Core)

48 (Core) Transplant Surgery

50 UW General Surgery

MR/CT Imaging (Core)

52 (Core) (Vascular)

Totals 10 mo Core 2 mo Vascular

7mo Core 5 mo Vascular

7 mo Core 5mo Vascular

12 mo Vascular 12 mo Vascular

Core Surgery Training Core Surgery Training PGY 1-3PGY 1-3

• Provide complete foundation of the principles and practices of surgery

• Similar training experiences as categorical general surgery residents• Core Surgery Technical Skills Lab• Instrument identification, knot-tying and suturing • Management and repair of central lines and enteric feeding tubes • Wisconsin Elements of Laparoscopic Surgery (WELS) • Advanced Trauma Life Support (ATLS) • Laparatomy and bowel anastomosis • Principles of Ultrasound – FAST and line placement• Principles of vascular anastomosis

Core Surgery Training Core Surgery Training PGY 1-3PGY 1-3

• Specialized conferences e.g. Trauma• Call during PGY1-3 no greater than 1:3• Excellent working relationship with general surgery

– SCORE curriculum• ABSITE PGY1,2 VSITE PGY 1-5• Resident Evaluation by core faculty

Core Surgery and Core Surgery and Non-Department of Surgery Non-Department of Surgery

FacultyFaculty• Stroke Neurology (Matthew Jensen)• Cardiology and Interventional (Georgio Gimelli)• MR/CT imaging (Thomas Grist)• Cardiothoracic Surgery (Takushi Kohmoto)• Thoracic Surgery (Jim Maloney)• Vascular Access Intervention (Alex Yevzlin)• VA General Surgery (Sharon Weber)• Trauma and Acute Care Surgery (Ann O’Rourke)• Transplantation (Anthony D’Alessandro)• SICU (Ann O’Rourke)• Plastic Surgery (Michael Bentz)

Vascular Surgery RotationsVascular Surgery Rotations

Develop Excellence In:•Routine and complex open vascular surgery•Diagnostic arteriorgraphy•Endovascular intervention of aneurysmal and occlusive disease•Interpretation of non-invasive vascular laboratory studies and their limitations•Clinical research with faculty mentor(s)

Integrated Vascular Integrated Vascular Surgery RotationsSurgery Rotations

• The resident must progressively demonstrate the knowledge and technical ability for the clinical management of diseases of arteries and veins as they progress from the PGY-1 year through the PGY-5 year

• We will develop the teaching and administrative capabilities of the vascular resident as a fundamental goal to produce individuals with the knowledge and superior skills necessary to manage patients with vascular disease

• Develop a pattern of continual education to keep abreast of the developments and improvements in our field to maintain delivery of state of the art care

• The vascular resident will receive adequate didactic and experiential exposure and training in the conception, design, conduct, regulatory monitoring, safety, analysis and reporting of clinical research trials to advance our understanding of vascular disease itself and how to manage patients afflicted with vascular disease

Integrated Vascular Integrated Vascular Surgery RotationsSurgery Rotations

• The resident will show competency in all 6 core competencies for each rotation (Patient Care, Medical Knowledge, Professionalism, Interpersonal and Communication, Systems-based Practice and Practice –based Learning)

• This residency will prepare the resident to function as an independent expert practitioner of vascular surgery and endovascular care at the high level of performance expected of a board certified specialist

• Curriculum– APDVS curriculum on-line with references, both Basic Science and Clinical Curricula* – Written Curriculum Goals and Educational Objectives– September UCLA Vascular Review Course in PGY4 year– RVT or RPVI Exam in PGY3 year– Web-based universal curricula being developed by APDVS– Wednesday Teaching Conference, Monday Basic Science and Didactic Lectures,

Thursday Indications Conference– Monthly Global (Web_ex online) and Local Journal Clubs

Integrated Vascular Integrated Vascular Surgery RotationsSurgery Rotations

• Attendance required on all rotations• Divisional support for meetings at which you present• Prepare the resident for the design, implementation, and conduct

of clinical trials• Assigned research mentor• PGY 4 & 5 present at Surgery Grand Rounds each year

Cardiology Rotation PGY1Cardiology Rotation PGY1• A focused exposure to consultative cardiovascular medicine,

echocardiography and nuclear myocardial perfusion imaging stress testing.

• 2 weeks with the UW Hospital Cardiology Consult Service, and spending 1 week each reading studies in the UW Hospital Echocardiography Laboratory and Nuclear Cardiology Laboratory.

• Will function on each service in a role equivalent to a first year cardiovascular medicine fellow

Neurology/Stroke PGY1Neurology/Stroke PGY1• Rapid and appropriate triage, diagnosis, and management of

acute stroke patients in a variety of clinical settings• Appropriate clinical care of neurological and medical issues in

these patients after the acute phase• Good coordination of care between the various services involved

in the care of these patients.• One month on the combined UWHC/VAH service which consists

of a vascular neurology faculty member, a neurology or neurosurgery resident, and medical students.

• The vascular surgery resident would join the team in addition to a neurology or neurosurgery resident, and receive direct supervision and teaching from the vascular neurology attending

Non-invasive Vascular Non-invasive Vascular Lab Rotation PGY2Lab Rotation PGY2

• Daily reading at the VA and at the University Hospital; no night call

• Daily hands-on participation in UW vascular lab with time spent in UW West clinic and VA vascular labs

• Didactic lectures on CD from SVS/APDVS• Gain a complete understanding of the indications,

interpretation and limitations of each test.• Prepared to pass ARDMS examination during third year of

residency

Endovascular Rotations PGY2 Endovascular Rotations PGY2 and PGY3and PGY3

• 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 Angio suite and OR under the guidance of vascular surgery faculty.

• Participate in weekly VA and UW clinics• Initial exposure during PGY1 UW vascular rotation• PGY4 and PGY5 continue to perform endovascular cases as

part of the daily care of UW vascular service patients

Venous Disease Rotation PGY3Venous Disease Rotation PGY3

• 1 month rotation at Meriter Hospital• Venous clinic at Meriter, UW West, and Transformations• Office-based and hospital operating room-based

interventions• Minimally invasive techniques, and the postoperative care

of patients with venous disorders

Interventional Nephrology PGY2 Interventional Nephrology PGY2

• Demonstrate an understanding of the general principles outlined in the Dialysis Outcomes Quality Initiative for Vascular Access (DOQI).

• Demonstrate basic understanding of the pathophysiology of arteriovenous access failure .

• Demonstrate basic understanding of the pathophysiology of renovascular disease failure including the typical clinical presentation, noninvasive renovascular evaluation and indications, outcomes and complications or renal artery PTA and stenting.

• One month rotation in the cardiac catheterization laboratory, with the resident working side-by-side and under the supervision of the attending interventional nephrology faculty.

• The rotation will include time in clinics as well as in the peripheral catherization lab at the UWHC and the IR suite of the Wm. S. Middleton VA Hospital in Madison.

Vascular Imaging Vascular Imaging Rotation PGY2 Rotation PGY2

• Demonstrate an understanding of the principles and practice of modern vascular cross sectional imaging using computed tomography and magnetic resonance imaging.

• Understand principles of radiation safety• Understand the roles of CTA, MRA and MRV in the evaluation of

vascular pathology• The PGY-2 vascular resident will rotate for 1 month on the Vascular

Imaging Service which includes CT and MR vascular imaging. • The supervising faculty will include vascular radiologists with

expertise in vascular CT and MR imaging. • The resident will attend educational conferences in radiology on CT

and MR imaging and radiation safety.

Vascular Surgery Elective Vascular Surgery Elective PGY3PGY3

• To allow the resident one month of elective time in the third year to conduct vascular research or pursue additional training in open vascular procedures, endovascular techniques at Theda Clark Medical Center in Neenah, WI.

• The PGY-3 resident will work with the Program Director and Chair of the Division of Vascular Surgery to identify programs of interest either within the University of Wisconsin system, or elsewhere in the United States.

• Rotating at another institution will allow the resident to compare differences in how vascular care is provided and how different systems function.

• Such an elective would allow the resident to be exposed to procedures not currently performed at the University of Wisconsin, such as fenestrated or branched aortic endografts.

• Another option would be for the resident to travel abroad, in order to gain insight into global health issues. Institutional involvement with international centers of vascular care has the potential to provide our residents with valuable opportunities for cross-cultural exchange of knowledge and experience.

Cardiac Surgery Rotation PGY2Cardiac Surgery Rotation PGY2

• 1 month Rotation on the University Cardiac surgery rotation with CT Residents

• The vascular resident participates in the pre- and post-operative management of patients on the Cardiac service

• The PGY-2 will be responsible in managing pre- and post-operative cardiac surgery patients– Pericardial window– Thoracotomy and Median sternotomy– Cardiac canulation for cardiopulmonary bypass– First assist on coronary artery bypass and valve replacement

UW Vascular Rotation Clinical UW Vascular Rotation Clinical ResponsibilitiesResponsibilities

• Vascular PGY5 and PGY4– GenSurg PGY3 (at times vascular PGY3)– PGY 1 usually 2 interns– 2 nurse practitioners on the floor

• OR 6-7 7:30 starts• New Zeego Angio Operating Suite• Open general vascular, complex open and hybrid

procedures• Endovascular diagnostic and therapeutic interventions in

OR and cath lab, staffed by vascular surgery faculty• Vascular Clinic Wednesdays at VA and UW

UW Vascular ServiceUW Vascular Service• Call is from Home:

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

– The vascular faculty member on call backs up the PG3 when they are on first call

– The vascular PGY4 and PGY5 are on call and have rounding duties every other weekend

– When the PG3 is on weekend first call, the faculty will not call in the vascular senior resident except for “index” cases, allowing greater vascular exposure for the PG3…New Weekend Midlevel

VA Vascular ServiceVA Vascular Service• General Surgery PG4, PG1, PG3 and VA NP• Clinic on Wednesdays at VA• OR 4 7:30am starts• Endovascular experience in OR, OEC 9800. New

construction of Zeego Angio Operating Room to be finished 2012.

• The PGY4 vascular resident will act as a consultant for the general surgery PGY4, and will be responsible for some percutaneous and open VA endovascular cases.

• Vascular PGY2 and PGY3 residents on Endovascular rotation will perform some cases at the VA

Resident EvaluationResident Evaluation• Resident performance evaluation

– Faculty at end of each Rotation– Semi-annual Review– 360 evaluation by nursing (floor and OR), cath lab

personnel, NP’s and support staff– February In-service Exam (VSITE)– Quality Improvement Project

• Anonymous evaluation of program and faculty by computer input

Routine and Complex Open Vascular Surgery Cases Vascular Fellow 2009-

2011UW Fellow

National Ave.

Percentile

Abdominal 86 55 90%

Open AAA 19 12 92%

Cerebrovascular

41 57 35%

Peripheral 93 99 45%

Complex 114 86 80%

Mesenteric

9 1 97%

TEVAR 19 12 80%

Open TAA 8 3 88%

EVAR 108 74 82%

Total Operations

(Primary and Secondary)

1117 1130 49%

Fellow Endovascular Experience 2009-2011

• Limb Salvage Angioplasty Program• Carotid Stent Program (3 post-marketing trials allowing treatment of asymptomatic

and symptomatic patients with critical ICA stenosis)• Thoracic Endograft Program (Fenestrated program beginning in 2012)• Site for Gore Tag Clinical Trials TEVAR for Trauma, Dissection, TAA• ACT I, FREEDOOM and CHOICE Carotid Stent trials• Plasmin Acute Ischemia Trial• Drug Eluding Balloon SFA PTA Trial

UW Fellow National Ave.

Percentile

Diagnostic 440 381 72%

Therapeutic 236 269 48%

Endografts 108 74 82%

Clinical Research and Critical Clinical Research and Critical ThinkingThinking• Faculty mentor assigned PGY1 year

– Resident advocate• PGY1:

– Present once in Vascular conference– Case report or retrospective review article

• PGY2– Initiate clinical study involving imaging– Attend AAS Fundamentals of Surgical Research Course

• PGY3– Retrospective Review – Quality Improvement paper– Introduction to Clinical Trials Course– Initiate Prospective study

• PGY4– Retrospective paper– Prospective study continues– Should be presenting at regional or national meeting

• PGY5– Complete projects initiated in prior years– Should be presenting at national meeting

80-Hour Work Week

Questions?Questions?

Integrated Vascular Integrated Vascular Residency RotationsResidency Rotations

Integrated Vascular Residency Integrated Vascular Residency RotationsRotations