Vascular Medicine Fellowship
Inpatient Consultative Service
During this rotation, fellows perform all inpatient vascular medicine consultations during the hours 8 am to 5 pm. All patient consultations (from vascular surgery as well as other services) are seen by and staffed with an on-call vascular medicine faculty member. The inpatient vascular medicine consultative rotations provide trainees with experience in diagnosing and managing a broad spectrum of vascular diseases, including:
- systemic manifestations of atherosclerosis, such asperipheral arterial disease, renal artery stenosis, mesenteric vascular disease, and extracranial cerebrovascular disease;
- aneurysmal disease of the aorta and peripheral arteries;
- vasculitis (including thromboangiitis obliterans, Takayasu arteritis, giant cell arteritis, and other forms of vasculitis, such as cryoglobulinemic vasculitis, vasculitis secondary to connective tissue diseases, drug-induced vasculitis, etc.);
- vasospastic diseases (e.g., Raynaud’s phenomenon);
- thoracic outlet syndromes;
- venous thromboembolism, chronic venous insufficiency, and varicose veins;
- vascular diseases related to temperature (pernio, erythromelalgia);
- leg ulcers;
- congenital vascular anomalies, and uncommon disorders such as fibromuscular dysplasia and arterial entrapment syndromes.
In addition, as part of this rotation trainees participate in the preoperative evaluation, risk assessment, and perioperative management of patients undergoing vascular surgery. They gain experience with identifying and treating risk factors for atherosclerosis (including hypertension, hyperlipidemia and diabetes), and identifying and treating hypercoagulable states.
Vascular Medicine Ambulatory Clinic Rotation
This rotation includes vascular medicine clinics with Drs. Sharma, Singh and Annex. The ambulatory vascular medicine clinics provide trainees with experience in diagnosing and managing a broad spectrum of vascular diseases, as listed under the consultative services rotation. In addition, fellows gain experience with preoperative evaluation and risk assessment; perioperative management of vascular surgery patients; identifying and treating patients with risk factors for atherosclerosis, and identifying and treating hypercoagulable states.
Fellows’ Continuity Vascular Medicine Clinic
One-half day per week, fellows see their own patients and referrals from other healthcare providers. Fellows evaluate and manage a broad range of vascular diseases, including those related to atherosclerosis, thrombosis, chronic venous disease and lymphatic disorders. Primary supervision is provided by vascular medicine faculty member Aditya Sharma, with additional supervision from Brian Annex and Kanwar Singh.
Fellows participate in the outpatient evaluation and management of vascular patients referred to our institution’s vascular surgeons, and observe vascular surgical procedures in the operating room. Trainees become familiar with the indications and contraindications for vascular procedures, and their associated risks and potential complications. They develop an appreciation for the complex nature of vascular surgical procedures, and participate in postoperative care of vascular surgery patients. Trainees observe operations for repair of aortic aneurysms, aortic reconstruction for occlusive disease, infrainguinal bypass and carotid endarterectomy, and other vascular surgical operations.
Vascular Interventions and Interventional Radiology
Trainees spend time in interventional radiology and in the peripheral interventional program in cardiology, observing peripheral angiography and catheter-based endovascular interventions for arterial as well as venous disease. Trainee develop an understanding of indications for and complications and limitations of peripheral angiography, and have an opportunity to review diagnostic angiograms with a peripheral interventionist. In addition, trainees are exposed to peripheral angioplasty, endovascular stents, distal protection devices, stent grafts, filters, catheter-based thrombolysis and thrombectomy, thrombin injection of pseudoaneurysms, sclerotherapy, and superficial vein ablation.
Noninvasive Vascular Laboratory
Trainees are allotted time to read non-invasive vascular studies. During their training, fellows read over one thousand vascular studies, and spend time learning to interpret carotid IMT. They receive hands-on basic training from a technologist in the performance of imaging in the non-invasive vascular laboratory setting.
Noninvasive Vascular Imaging
Fellows receive training in the basics of noninvasive computed tomography (CT) and magnetic resonance (MR) imaging. They also learn how to read and review coronary CT angiography (CTA) and MR angiography (MRA), and the indications and limiting factors for these imaging modalities.
During this rotation, fellows rotate between in-office and consultative inpatient settings, with the aim of gaining exposure to the assessment of patients with acute neurovascular pathologies and to their long-term management by working with vascular neurology faculty members.
During this rotation, fellows see patients who are suspected to have, or have a diagnosis of, vasculitis, and gain experience with its long-term management.
Wound Care and Hyperbaric Medicine
During this rotation, fellows spend time in plastic surgery learning the basics of wound-care management. This includes learning to identify gangrenous wounds, and the criteria for inclusion or exclusion of hyperbaric oxygen therapy in the management of chronic vascular wounds.
Congenital Cardiovascular and Preventive Cardiovascular Medicine
Fellows rotate through Dr. Robert Battle’s clinic, where they gain competence in evaluating and treating patients who have cardiovascular diseases related to connective tissues disorders. Fellows serve on rotations with faculty members Amy Tucker, Christopher Rembold and Angela Taylor, and spend time assessing patients in the prevention clinics.