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Division of Vascular Surgery
Knowledge Objectives
Postgraduate Year Two

Be knowledgeable about all previous objectives.  In addition, after completing your rotation you should be able t

1.         Review and describe the basic clinical manifestations of the following vascular disorders:

            a.         Thromboembolic disease--arterial and venous
            b.         Chronic venous insufficiency and lymphatic obstruction
            c.         Portal hypertension

 2.        Differentiate between the following diagnostic tools available for assessing vascular disease and explain the relative contribution of  each:

            a.         Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA)
            b.         Duplex scanning (ultrasonography)

 3.        Summarize the etiology, pathophysiology, and therapeutic options of specific categories of vascular disease:

            a.         Venous disease

                        (1)       Varicose vein disease
                        (2)       Post-phlebitic syndrome
                        (3)       Portal hypertension

            b.         Lymphatic disease

                        (1)       Anatomy of lymphatic system and lymphatic return
                        (2)       Congenital lymphatic anomalies
                        (3)       Acquired lymphatic disease
                        (4)       Operative procedures for correction of lymphatic disease

            c.         Arterial disease

                        (1)       Aortic and other vascular aneurysms
                        (2)       Atherosclerotic vascular disease
                        (3)       Arterial embolic disease
                        (4)       Extracranial cerebrovascular disease
                        (5)       Visceral ischemic syndromes
                        (6)       Renovascular hypertension
                        (7)       Degenerative arterial disease
                        (8)       Trauma
                        (9)       Arteriovenous fistulas (local and cardiac hemodynamic effects)

 4.        Describe the natural history of medically-treated vascular disease in the following categories:

            a.         Carotid arterial stenosis
            b.         Abdominal aortic aneurysm
            c.         Chronic femoral artery occlusion

 5.        Describe the role of anticoagulant agents, including antiplatelet agents, in the management of patients with vascular disease.

 6.        Analyze the role of the endothelium in atherosclerosis, thrombosis, and thrombolysis.

 7.        Discuss the principles of and contraindications for anticoagulation and thrombolytic therapy.

 8.        Describe the surgically correctable causes of hypertension and their diagnostic modalities.

 9.        Discuss the mechanics of action and the therapeutic role of the following pharmacologic types of agents:

            a.         Vasopressors
            b.         Anticoagulants
            c.         Vasodilators          
            d.         Antiplatelet agents    
            e.         Adrenergic blocking agents  
            f.          Thrombolytics

10.       Demonstrate knowledge of the general principles of vascular surgical technique including:

            a.         Vascular control and suturing
            b.         Endarterectomy
            c.         Angioplasty
            d.         Bypass grafting

11.       Discuss clotting factors and how they interact including hypercoagulable states and coagulopathies.

12.       Discuss the role of the following factors in maintaining homeostasis in the coagulation pathways:

            a.         Protein S                    
            b.         Platelet granules
            c.         Protein C                    
            d.         Endothelial cell
            e.         Platelets                     
            f.          Antithrombin III