Organization of angiosurgical assistance

1.Trainees must demonstrate competence. The degree of competence: 1. Has observed 2. Can do with assistance 3. Can do almost all – may need some assistance. 4. Competent to do without assistance, including complications. By the end of training program candidates should achieve the appropriate level 2 for complex procedures , 3 for average procedures, 4 for day case procedures (for minimum number of cases detailed in the trainee’s log-book. Structure of the education curriculum. The first two years of an integrated vascular training program should be devoted to a core surgical training, followed by at least three years of specific training in vascular and endovascular surgery (e.g. 2+3 program) The following didactic aims should be considered: -Open vascular procedures *arterial reconstructions for the aneurysms and occlusive disease *venous surgical procedures (e.g. varicose veins, venous leg ulceration) *major and minor limb amputation *surgical management of chronic wounds *treatment of vascular compression syndromes - Endovascular procedures *percutaneous transluminal balloon and stent angioplasty *intraoperative endovascular (hybrid) repair of iliac and femoro-popliteo-crural vessels *endovascular aneurysm repair of thoracic (TEVAR) and abdominal aortic aneurysms (EVAR) *Endovenous obliteration of varicose veins *catheter – directed lysis of arterial and venous occlusion. - Diagnostic procedures: *ankle brachial pressure index (ABPI) assessment *measurement of walking distance and speed in patient with peripheral artery disease *B-mode sonography and color-coded Duplex Sonography plethysmography *Evaluation of magnetic resonance (MR) angiography (MRA), computed tomography (CT) angiographies (CTA), digital subtraction angiography (DSA) and phlebography *assessment of cardiovascular risk factors, evaluation of diagnostic procedures (e.g. ECG, exercise ECG) -Non-invasive procedures, adjuvant medical therapy *management of thrombophilia, deep venous thrombosis and other venous pathologies (e.g. post-thrombotic syndrome), inflammatory vascular disease *intravenous treatment with vasodilator drugs, *anticoagulant therapy, *comprehensive (non-surgical) wound management, *adjuvant medical therapy (e.g. treatment of hypertension, hyperlipidemia) Core surgical training. In the first section (e.g. 2 years) of the training, the trainee should take core surgical training in the general surgery, but also in intensive care. The core surgical training should deliver specialty – specific competencies that allow progress to a higher surgical training. Basic, intermediate and advanced training level. The special training in vascular surgery takes 3 years (in 2+3 program) and can be based on the logbook of the European Section and Board of Vascular Surgery: all aspects of in-patient and out-patient care as well as postoperative care. *In the basic the trainee learns to access various vascular regions as well as to master basic vascular reconstruction and suture techniques (e.g. embolectomy/thrombectomy, patch plasty). The endovascular basic training (e.g. percutaneous transluminal angioplasty with or without stent placement in the iliofemoral vascular axis) is likewise a fundamental component of the basic curriculum as well as the education in diagnostic techniques. It is recommendable that the candidates take part in particular courses using simulators. *An intermediate training level which involves more complex reconstructive procedures, such as anatomic (extra-anatomic bypasses, open and/or remote arterectomies and various patching procedures in patient with stenotic or aneurysmal vascular disease. Candidates should be trained in vascular access surgery. *The final training years should focus on advanced vascular and endovascular procedures for all types of vascular pathology. These procedures include the open and endovascular repair of abdominal and thoracic aortic aneurysms, treatment of visceral and renal artery stenotic/occlusive disease, management of supra-aortic vessel pathology and reconstruction/endovascular repair of very distal ( e.g. crural/pedal) arteries. Trainees should be able to diagnose and manage peri– and post-procedural complications, such as graft infections. An “ideal educational curriculum” should encompass a structured academic education for novice vascular surgeons trained in university hospitals.

1.I. Vascular and Endovascular surgical core activity covers elective and emergency procedures and their pre-,peri- and postoperative aspects Preoperative and postoperative care. *Screening programs: screening of the knowledge about abdominal aortic aneurysms (AAA). *Laboratory tests: knowledge of the hematological, immunological, biochemical and histo-pathological changes that accompany vascular disease. Ability to interpret and relate such knowledge and results to clinical scenarios *Knowledge of indications for and basic interpretation of imaging techniques such as conventional x-rays, sonography, Doppler sonography, CT/MRI/PET scans and radio-isotope techniques in the investigation of the vascular surgical diseases. Understanding of security measures in Radiology, knowledge of radiation –indications for sparing in x-ray investigations. *Endoscopic techniques. Knowledge of the indications and technical skills required for employing various endoscopic techniques such as gastrointestinal, for diagnostic and therapeutic purposes. Emergency surgery. Care of critically ill vascular patient with underlying conditions including coordinated multidisciplinary management. Clinical assessment of more or less severely injured vascular patient and understanding of the disorders, caused by trauma: thermal injuries, hemorrhage and shock. II. Vascular and Endovascular surgery *Abdominal Aortic aneurysms *Peripheral vascular Occlusive Disease (Acute and Chronic), acute peripheral ischemia. *Renal artery disease *Visceral ischemia: acute, chronic mesenteric ischemia *Carotid artery disease *Innominate subclavian and vertebrobasilar arterial disease *Thoracic outlet syndrome *Diabetic foot *Lymphedema *Congenital vascular diseases - Basic science: anatomy, physiology, pathology and natural history of diseases -Diagnostic evaluation, screening and imaging -Treatment III. Miscellaneous: cardiac disease, pulmonary disease, coagulation disorders, vascular access, sympathectomy

1.To discuss the indications for primary and secondary vascular revascularization for brachiocervical, abdominal aorta and branches, lower limb arterial occlusive and aneurysmal diseases, deep vein and lymphatic vessels. Outcome (complications, graft infection and patient survival).