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Division of Vascular Surgery

Knowledge Objectives 3rd and 4th year medical students

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Division of Vascular Surgery
Knowledge Objectives
Postgraduate Year Four/Five

Prior to your rotation you should be knowledgeable about all previous objectives.  In addition, you should be able t

1.         Review and describe the basic clinical manifestations of congenital vascular diseases

 2.        Summarize the etiology, diagnosis, and therapeutic options of specific categories of vascular disease:

            a.         Arterial disease

                        (1)       Inflammatory vascular disease and vasculitis
                        (2)       Arteriovenous fistulas or  malformations
                        (3)       Neurovascular compression syndromes (thoracic outlet syndrome)

            b.         Miscellaneous

                        (1)       Tumors
                        (2)       Sympathetic nervous system (e.g. causalgia, reflex sympathetic dystrophy)

3.         Discuss the principles of angiography to include the following considerations:

            a.         Indications and complications (including contrast-induced renal failure)
            b.         Review principles and techniques of intraoperative angiography
            c.         Review principles and techniques of emergency room angiography

 4.        Explain the risk:reward ratios of surgical care for patients with vascular disease.

 5.        Demonstrate awareness of the costs associated with providing surgical care to patients with vascular disorders.

 6.        Differentiate between different operative approaches to the vascular system to include:

            a.         Incisions and exposure
            b.         Handling of vascular tissues
            c.         Principles of vascular bypass grafting
            d.         Emergency vascular surgery
            e.         Reoperative vascular surgery
            f.          Principles of endarterectomy

 7.        Illustrate the operative exposure of the major vessels, including:

            a.         Aortic arch                 
            b.         Suprarenal aorta
            c.         Proximal subclavian              
            d.         Infrarenal aorta
            e.         Carotid artery            
            f.          Femoral artery
            g.         Descending thoracic aorta     
            h.         Popliteal artery

 8.        Outline the indications for operations for claudication, abdominal aortic aneurysm, carotid stenosis, and amputation.

 9.        Describe the indications for balloon angioplasty and vascular stent placement with risks and complications.

10.       Describe the pathogenesis and complications of aneurysmal disease.

11.       Summarize the etiology, microbiology, and treatment of diabetic foot infection.

12.       Categorize the prevention and management of operative and postoperative complications, including graft infections, ischemic bowel, graft thrombosis, and extremity ischemia.

13.       Outline the manifestation of failing peripheral vascular grafts.

14        Discuss the principles of reoperative vascular surgery.

15.       Outline procedure for managing vascular surgical emergencies such as acute tissue ischemia or major hemorrhage (traumatic or ruptured aneurysm).

16.       Demonstrate a basic knowledge of the various types of graft and suture material available.

17.       Analyze alternative measures for the diagnosis and management of renovascular hypertension.

18.       Discuss alternative operative procedure for the management of portal hypertension.

19.       Summarize the surgical techniques available for managing the following vascular disorders:

            a.         Abdominal aortic bypass or aneurysmectomy
            b.         Carotid stenosis
            c.         Femoral-popliteal occlusion
            d.         Tibial artery occlusion

20.       Analyze the management of complex vascular problems considering the following factors:

            a.         Morbidity and mortality
            b.         Advanced surgical techniques

                        (1)       Endoscopy
                        (2)       Microvascular techniques
                        (3)       Endoluminal grafting

21.       Review critical factors for decision making in vascular surgery:

            a.         Risk:reward ratio
            b.         Morbidity and mortality probability
            c.         Preoperative and postoperative assessment
            d.         Noninvasive laboratories, duplex scanning
            e.         Role of advanced radiologic techniques: Angioplasty, CT scanning, MRI/MRA imaging

22.       Apply the decision making process in analyzing complex vascular diseases, including the following:

            a.         Cerebrovascular problems
            b.         Mesenteric vascular disease
            c.         Renovascular disease
            d.         Aneurysmal disease
            e.         Lower extremity arterial occlusion
            f.          Venous disease

23.       Outline the management of prosthetic graft infections, including:

            a.         Diagnosis
            b.         Use of alternate routes for revascularization
            c.         Use of alternative graft materials

24.       Summarize complications of common major vascular procedures such as:

            a.         Carotid endarterectomy
            b.         Aortic reconstruction
            c.         Lower extremity vascular reconstruction


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