Curriculum

The training programs in Vascular Surgery at the University of Buffalo comprise a balance of all the clinical and academic components of:

• Endovascular diagnostics and therapeutics
• Noninvasive vascular testing with ultrasound-based therapeutics
• Clinical and basic research
• Open surgical procedures

These activities are carried out in the Kaleida Health System, the Buffalo VA Medical Center, and the Sisters of Charity Hospital. Trainees are exposed to a wide variety of care-delivery systems and clinical practice structures.

Vascular residents rotate at the Gates Vascular Institute, the Buffalo VA Medical Center, and Sisters of Charity Hospital. Vascular Residents also rotate at the Erie County Medical Center, Buffalo General Medical Center and Millard Fillmore Suburban Hospital. Vascular Residents' experiences includes 24 months of core surgical experience, in additional to the medical management of vascular disease, non-invasive lab training, endovascular and open vascular surgical experiences. Non-vascular rotations also include cardiology, neurosurgery/stroke team, vein center, radiology/imaging, cardiothoracic and non-invasive vascular lab.

The vascular fellow or senior resident is the leader on a service that is supported by junior-level general surgical residents and junior vascular residents. Nurse practitioners are present on vascular services at all sites as well. The vascular fellows and residents perform all categories of major vascular surgical procedures under the direct supervision of the attending staff. Surgical case totals are generally balanced with regard to case mix (e.g. carotid, aortic, extremities. Case mix includes:

• Carotid endarterectomy and stenting, including redo surgeries
• Open suprarenal and thoracoabdominal aortic surgery
• Visceral artery reconstructions
• Open infrarenal aortic surgery for occlusive or aneurysmal disease
• Infrainguinal vascular reconstructions, including reoperative surgery
• Diagnostic and therapeutic endovascular intervention for PAD- including aggressive tibial interventions and thrombolysis
• TEVAR, EVAR and PEVAR with frequent involvement in ongoing trials The clinical curriculum includes:
• Refinement of inpatient management skills for pre- and post-operative patients on the Vascular Surgery Service
• Outpatient evaluation of patients with known or suspected vascular disorders in the vascular surgeons office
• Didactic conference and lecture programs
• Teaching general surgical residents and medical students
• Completion of research activity
• Instruction on the development of evidenced-based treatments, quality outcomes assessments, practice guidelines, and other practice management skills

The vascular resident and fellow master basic and advanced endovascular skills through the following activities at all sites:

• The resident will be instructed in endovascular management including basic and advanced catheterization skills, principles of diagnostic and therapeutic procedures including angioplasty, stenting, thrombolystic therapy, embolization, and endografting
• Endovascular procedures are performed in the angiography suite or operating rooms dependent on procedure and hospital
• Trainees have experience with all approved endograft and stent graft devices available, as well as with some devices that are in clinical trials
• Upon completion of the training program, the vascular resident will have both the skills and experience to qualify for independent performance of all approved percutaneous interventions and aortic endografting based upon all current established credentialing guidelines

The vascular resident serves as the leader in the clinical management of all inpatients on the teaching Vascular Surgery service at all institutions. The vascular resident is assisted by first and second year general surgical residents or vascular residents, as well as by NPs on all services. The senior resident and fellow are never on the same service.

The vascular resident participates in the weekly outpatient clinical activities at the offices of the vascular faculty. The resident examines and evaluates patients and confers with the attending staff to plan further diagnostic evaluation and treatment.

The resident is responsible for choosing case presentations for the weekly main Vascular Conference, and coordinating preparations and topics of educational materials, in conjunction with the program director, for discussion. The resident is also responsible for write-ups for M & M or complications. Conferences include weekly Vascular Grand rounds, General Surgery Grand Rounds (for Residents), M & M, Didactic Lecture Series, monthly Journal Clubs, annual Cadaver Lab, annual Western New York Vascular Symposium, monthly Western New York Vascular Association meetings, and Vascular Lab QA and Journal cCubs.

• The trainee learns ultrasound-guided interventions
• The trainee acquires knowledge of ultrasound physics as it applies to current established techniques of vascular diagnosis
• The trainee becomes 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 trainee learns to perform, supervise, and interpret the results of noninvasive testing modalities performed for major non-cardiac vascular disorders
• The trainee learns the applications of noninvasive vascular testing in the development of practice guidelines, surveillance, outcome assessment, and clinical research in vascular disorders
• The trainee learns the administrative skills necessary to serve as a medical director of a noninvasive vascular laboratory
• The trainee obtains certification with the RVPI degree

The goal of the research component is to enhance the residents understanding of research methodology, to stimulate translational research, and to enhance the understanding of vascular biology and cellular mechanisms of disease. Residents have participated in various research projects dependant on their future goals and interests.

This experience includes project selection, literature review, experimental design, data collection, analysis, presentation skills and manuscript preparation. Trainees participate in both Quality Improvement and routine research projects.

Past residents and fellows have had presentations at the annual meetings of the Society of Vascular Surgery, Eastern Vascular Society, Society for Clinical Vascular Surgery, ISCVS, ACS and the Venous Forum.

The Division supports travel and expenses for residents to present scholarly material to meetings of all major vascular societies.

On call responsibilities are shared among the fellows and vascular residents, and conform to current New York State and ACGME guidelines. Long-range pagers are provided, and call is taken from home for all senior level trainees. Vascular residents share call with General Surgery residents during the core surgery rotations. During non-core rotations in the first three years, residents share in home call with senior trainee backup support. Residents have a total of 4 weeks of vacation time each year, with health, prescription, vision and dental insurance for individual or family, life insurance and disability insurance.