The first year trainee is involved in four main areas of activity:
Non-invasive vascular laboratory
Basic science research
In both the preliminary and clinical years, the vascular fellow masters basic and advanced endovascular skills through the following curriculum:
The fellow will be instructed in all aspects of endovascular management including basic and advanced catheterization skills, principles of diagnosis, and therapeutic endovascular procedures including angioplasty, stenting, embolization, and endografting.
Endovascular procedures are performed in the operating rooms of all our affiliated institutions using the most modern portable imaging equipment and under the direction of our experienced vascular surgical faculty. The fellow will be exposed to complex cases requiring a combined endovascular and open surgical approach.
The preliminary fellows have primary responsibility for endovascular procedures performed on the Vascular Surgery services at Mercy Hospital, Baltimore Washington Medical Center, and the VA Hospital.
The preliminary fellows have primary responsibility for ultrasound-guided interventions, such as bedside insertion of IVC filters and ultrasound guided treatment of femoral pseudoaneurysms performed at UMMC.
In both years the fellow is involved in our active program of endograft repair of aortic aneurysms.
Non-invasive Vascular Laboratory
Goals and Objectives:
The fellow will acquire knowledge of ultrasound physics as it applies to current established techniques of vascular diagnosis.
The fellow will become familiar with all major forms of instrumentation associated with routine noninvasive vascular diagnosis, including plethysmography, continuous-wave and pulsed Doppler, and Color-flow duplex ultrasound scan technology.
The fellow will learn to perform, supervise, and interpret the results of noninvasive testing modalities performed for major non-cardiac vascular disorders.
The fellow will learn the applications of noninvasive vascular testing in the development of practice guidelines, surveillance, outcome assessment, and clinical research in vascular disorders.
The fellow will learn the administrative skills necessary to serve as a medical director of a noninvasive vascular laboratory.
The fellow will be qualified for certification as a Registered Vascular Technologist (RVT). These goals are achieved through a program of:
- Hands-on experience in the vascular lab.
- Didactic training sessions.
- Clinical applications in a variety of institutional settings with progressive experience and instruction in the interpretation of vascular studies.
This experience includes project selection, literature review, experimental design, data collection, reduction and analysis, presentation skills and manuscript preparation.
Some examples of past and current research include:
Assessment of cerebral ischemia during carotid endarterectomy under regional anesthesia.
Physiology of mechanical compression devices in prevention of deep venous thrombosis.
Clinical utility of duplex Doppler surveillance programs in the management of deep venous thrombosis prophylaxis in high risk neurosurgical and trauma patients.
Role of defects in fibrinolytic proteins in the clinical status of patients with peripheral arterial occlusive disease and in post-operative patients.
Effectiveness of duplex Doppler ultrasound in the selection of patients for renal artery revascularization.
Application of duplex Ultrasound to the evaluation of ocular ischemic syndromes and the assessment of results of carotid revascularization.
Safety and efficacy of bedside, duplex guided deployment of IVC filters in high risk ICU patients.
Clinical Studies of Aortic Endografts.
Study of Acquired Anticoagulants.
Treatment alternatives for femoropopliteal arterial occlusive disease.
Past fellows have had presentations at the annual meetings of the Eastern Vascular Society, Midwest Vascular Surgery Society, Southern Association for Vascular Surgery, Chesapeake Vascular Society, Society for Clinical Vascular Surgery, and the Venous Forum.
Basic Science Research
The goal of this program has been to broaden the fellows' understanding of the physiology and pathophysiology of the vascular system and to increase understanding of the molecular and cellular mechanisms of vascular disease.
The focus of the research program has been the study of flow-mediated remodeling of collateral arteries in a pre-clinical model of hind limb ischemia. Laboratory techniques have included: in-vivo blood flow and hemodynamic measurements, angiography, light histology, in-situ hybridization, mRNA analysis with Northern Analysis and RT-PCR, zymographic assays of metalloproteinase (MMP) activity, and ELISA.
Fellows learn the principles of experimental design, hemodynamic measurements, micro-surgery, basic molecular biology, data analysis and publication skills. This experience has resulted in academic presentations at Vascular Basic Science meetings including: Research Initiatives in Vascular Surgery, Experimental Biology (FASEB), Vascular Biology (American Heart Association), and The Surgical Forum of the American College of Surgeons.