The acquisition of the technical skills, knowledge, and attitudes necessary for the successful management of patients with complex vascular disorders requires a high level of commitment and dedication from all involved in the process.  The educational goals of the Vascular Surgery Residency Program at the UAMS College of Medicine are intended to clearly delineate the specific responsibilities of both fellows and teaching faculty.  These objectives have been developed in conjunction with all members of the teaching faculty, previous vascular surgery fellows, and the Association of Program Directors in Vascular Surgery (APDVS).

One of the strengths of the program is the combination of excellent endovascular training and simultaneous extensive experience in complex open vascular surgery.  The vascular fellow at the end of our two-year fellowship typically has 400-500 combined open and endovascular cases.

During this two-year clinical vascular surgery fellowship, the vascular fellow’s time is divided equally, with six-month rotations, between the UAMS Medical Center and the CAVHS hospital.  The University has a typical referral pattern of a tertiary care center where very complex procedures are performed.  The vascular fellow is exposed to a variety of complex vascular reconstructions, involving various vascular beds, with cases involving a combined open and endovascular approach.  The experience at the VA hospital is rich in "bread-and-butter" vascular cases as well as index cases, such as renal and visceral bypasses, thoracoabdominal aneurysm, and re-do lower extremity reconstructions.

Endovascular Surgery

• At the start, the vascular fellow will become familiar with basic endovascular skills, including:
• Obtaining percutaneous arterial access
• Differentiating hydrophilic from standard guidewires
• Understanding the use of guides and sheathsv
• Performing routine diagnostic arteriograms of the selected arterial beds, including carotid arteries, visceral arteries, aorta, and runoff
• Becoming familiar with commercial endografts

After a few months of basic endovascular training, the vascular fellow will be performing and assisting on advanced endovascular interventions, such as:

• Cerebral diagnostic and therapeutic intervention (carotid stent)
• Percutaneous atherectomy
• Percutaneous catheter-directed lysis
• Catheter-directed mechanical thrombolysis (AngioJet)
• Endografts for abdominal aortic aneurysm (Zenith, Gore, AneuRx)
• Thoracic aortic endografting
• Visceral angiogram/angioplasty (renal, SMA, etc.)
• Infragenticulate subintimal angioplasty
• Intraoperative lytic therapy with isolated limb perfusion
• Aortoiliac and femoral angiography
• Coil embolization
  

Open Vascular Surgery

During both UAMS and CAVHS rotations, you will have extensive experience in open vascular surgery.  Exposure to a variety of basic and complex open vascular cases is present at both hospitals.

Vascular Laboratory

Experience in the vascular diagnostic laboratory is an essential component of an overall training program in vascular surgery.  During the course of the fellowship, you will expand your knowledge regarding vascular diagnostic tests, the wide range of diagnostic principles, and limitations of each technique.  You will be asked to sign off on vascular studies at the CAVHS after you have gained sufficient experience.  You will be supervised in this process by the director of the vascular lab at both hospitals.  Your experience will allow you to do the following:

• Accurately order appropriate diagnostic tests for the entire spectrum of vascular disorders
• Understand the role of carotid duplex in evaluation of asymptomatic and symptomatic carotid artery disease
• Interpret the result obtained by carotid duplex, including ultrasound image and Doppler velocities
• Discuss the limitations of carotid duplex
• Understand the use of duplex in evaluation of visceral vessels
• Understand the noninvasive test to investigate the extremity arteries
  

Basic Science/Research

You should expand your understanding of the basic science that underlies the practice of vascular surgery.  While a dedicated basic science/research experience is not a component of the resident curriculum, an opportunity for research and basic science is available through a fully-funded vascular research lab.  The following topics in vascular surgery have been identified by the APDVS:

• Anatomy
• Arterial Wall Biology
• Nonatherosclerotic conditions
• Ischemia-related organ dysfunction
• Introduction to cell biology
• Vascular Laboratory
• Hemodynamics
• Atherosclerosis
• Coagulation
• Biostatistics, epidemiology, and biomedical ethics

University of Arkansas for Medical Sciences
UAMS Vascular Center
4301 West Markham, Slot# 562
Little Rock, Arkansas 72205