Today,
more
than
ever,
Interventional
Radiologists
need
a
solid
foundation
in
vascular
disease.
To
provide
patients
with
optimal
care
to
treat
patients
with
vascular
disease.
It
is
imperative
that
new-generation,
clinical
interventional
radiology
trainees
learn
in
the
ins-and-outs
of
diagnosing,
managing,
and
treating
peripheral
vascular
disease.
The
following
document
was
put
together
to
provide
a
list
of
goals
that
an
IR
trainee
should
meet
while
rotating
through
their
vascular
surgery
rotation.
This
can
also
be
viewed
as
a
compendium
of
goals
that
a
young
IR
physician
should
have
mastery
of
before
even
considering
entering
the
vascular
disease
playing-
field.
Anything
less
than
mastery
will
only
lead
to
suboptimal
patient
care
and
poor
patient
outcomes.
We
hope
this
will
provide
you
a
starting
point.
GENERAL
GOALS
o Vascular
anatomy
Know
arterial
and
venous
vessels
and
major
branches
in
the
upper
extremity,
lower
extremity,
thorax,
abdomen,
neck
and
cranium
including:
Thoracic/abdominal
aorta
Vena
Cava
Subclavian
vessels
Brachial
vessels
Femoral
vessels
Popliteal
and
infra-popliteal
vessels
Cerebral
vessels
Vertebral
vessels
Interpret
and
identify
vessels
and
associated
pathology
during
fluoroscopic
angiography
and
in
CT
angiography
studies
o For
all
peripheral
vascular
diseases
(arterial
occlusive
disease,
TAA,
AAA,
peripheral
aneurysmal
disease,
venous
disease),
know
pathogenesis,
risk
factors,
usual
disease
course,
and
complications
OUT-PATIENT
GOALS
o Peripheral
vascular
occlusive
disease
For
the
following
goals,
ensure
you
know
how
to
do
each
for
the
following
disease
entities:
Aorto-iliac
occlusions
Femoral-popliteal
occlusive
disease
Tibial/pedal
occlusion
Carotid
occlusion
Renal
artery
stenosis
Mesenteric
ischemia
Pathogenesis,
risk
factors,
usual
disease
course,
and
complications
Initial
workup
of
a
patient
with
peripheral
vascular
occlusive
disease
Obtain
a
complete
history/review-of-systems
Perform
an
accurate
physical
exam,
including
a
vascular
exam
Recognize
signs/symptoms
of:
aorto-iliac
disease
femoral-popliteal
disease
tibial/pedal
disease
carotid
disease
renal
artery
stenosis
mesenteric
ischemia
Diagnosing
a
patient
with
peripheral
vascular
occlusive
disease
Non-invasive
exams/physiologic
exams
Ankle-brachial
index/Toe-brachial
index
Segmental
pressures/PVRs
Arterial
duplex
with
waveforms
Non-invasive/anatomic
exams
CT/MR
angiography
Analyzing
and
interpreting
the
results
from
above
Familiarity
with
the
TASC
classification
scheme
for
arterial
occlusions
Familiarity
with
the
Rutherford
classification
for
acute
limb
ischemia
and
critical
limb
ischemia
Medical
management
of
patient
with
peripheral
vascular
occlusive
disease
Know
when
medical
management
is
appropriate
and
when
surgical/endovascular
intervention
is
indicated
Know
indications
of
the
following
medications
commonly
used
in
vascular
medicine
Beta
blockers
ACE
Inhibitors
Statins
Cilostazol
Anticoagulants
o Heparin,
Warfarin,
Enoxaparin,
Lepirudin,
Argatroban,
Bivalirudin,
Dagibatran
Antiplatelets
o Aspirin,
Clopidogrel,
Prasugrel
Diabetes
medications
o Metformin,
Sulfonylureas,
glitazones,
Insulin
Surgical/Interventional
management
of
patient
with
peripheral
vascular
occlusive
disease
Identify
when
operative
management
is
indicated
in
patients
with
peripheral
vascular
disease
for
following
entities:
aorto-iliac,
ilio-femoral,
femoral
and
lower-extremities,
carotid
disease,
mesenteric
ischemia,
renal
artery
stenosis
Be
comfortable
with
the
indications
for
the
different
bypasses
(femoral-femoral
bypass,
axillary-bi-femoral
bypass,
fem-pop,
fem-tib,
etc.)
Identify
when
endovascular
interventions
are
indicated
in
patients
with
peripheral
vascular
disease
for
following
entities:
aorto-iliac,
femoral-popliteal,
tibial/pedal,
carotid
disease,
mesenteric
ischemia,
renal
artery
stenosis
Know
the
pros
and
cons
of
open
surgical
interventions
and
endovascular
interventions
Know
when
different
types
of
amputations
are
indicated
(BKA,
AKA,
TMA,
etc)
Wound
care
Differentiate
different
types
of
wounds
(venous,
arterial,
neurogenic)
Identify
signs
and
symptoms
of
gangrene/sepsis
(wet
vs
dry
gangrene)
Know
the
treatment
options
and
the
management
options
available
PROCEDURAL
GOALS
o General
Skin
closure
/
basic
suturing
Know
how
to
obtain
venous/arterial
access
in
femoral,
brachial,
popliteal,
and
radial
vessels
Know
the
tools
of
the
trade
and
terminology:
catheter
types,
catheter
sizes,
sheaths,
dilators,
balloons,
guidewires,
stent
types
Know
how
to
manipulate
catheter
through
and
past
occlusive
lesions
Demonstrate
knowledge
of
which
catheters
to
use,
and
when
Know
the
general
principles
of
balloon
angioplasty
and
vessel
revascularization
o Procedure
specific
goals
Participate
in
open
surgical
procedures
(bypasses,
fistula
creations,
AAA
repairs,
etc.)
Participate
in,
demonstrate
knowledge
of,
and
recall
the
steps
for
each
of
the
following
procedures:
Endovascular
repair
of
a
AAA
(EVAR)
Fenestrated
endovascular
repair
of
a
AAA
(FEVAR)
Aorto-iliac
occlusion
revascularization
Ilio-femoral
occlusion
revascularization
Lower
limb
revascularization
De-clot
of
dialysis
fistulas
and
grafts
Aneurysm
coiling
Know
the
post-procedural
complications
most
often
seen
following
these
procedures
and
what
steps
can
be
taken
to
minimize
these
complications
Know
how
to
manage
these
patients
post-procedure
and
what
red-flags
to
be
aware
of
for
each
procedure
(i.e.
ensure
patient
has
bilateral
distal
LE
pulses
s/p
an
EVAR)
*Please
see
ICU
Clinical
Goals
for
more
detailed
information
on
in-patient
care