Clinical Experience

Operative Experience
Endovascular Training
Conferences
Vascular Laboratory
On-Call Coverage
Vacations


Operative Experience
The Barnes-Jewish Hospital (BJH) Vascular Surgery Outpatient Clinic had a census in the 2005-2006 academic year of 4,926 patients. The outpatient clinic volume for the last three years was:

The volume of vascular surgery procedures performed at the BJH South Campus has steadily increased 23% over the last three years:

The total number of index case procedures have significantly increased in the last three years with the largest growth seen in endoluminal procedures:

Over the last three years, the Vascular Surgery Service has dramatically increased the endoluminal diagnostic and therapeutic procedures in all anatomical sectors. Carotid endarterectomies are primarily (>95%) performed under cervical block, which is associated with lower cardiopulmonary complications. Furthermore, about 90% of patients are discharged 23 hours after the procedures. Our experience is one of the largest in the world with cervical block anesthesia for carotid endarterectomy. Since September 2003, the vascular surgery service has performed more than 200 carotid stent procedures under the full supervision of vascular surgeons with excellent (published) results.


Endovascular Training
Vascular and general surgery residents participate in all endovascular procedures. The large volume of endovascular procedures at our institution allows the vascular surgery residents, as well as general surgery residents (PGY-IIIs and PGY-Vs), to participate in a wide variety of endovascular procedures. Because of the limited number of carotid stents and thoracic endograft procedures, these are the only two endovascular procedures that are directed to the vascular surgery residents under the supervision of the vascular attending responsible for the case.

The Vascular Surgery Service currently uses four operating rooms five days a week for both open and endovascular cases. Since September 2005, an endovascular suite in the cath lab area at BJH was exclusively assigned five days a week to the Vascular Surgery Service. This cath lab endovascular suite is used for peripheral endoluminal interventions including carotid stenting. The endovascular experiences of the vascular surgery residents since 2001 are listed below:

• These numbers do not include the endovascular procedures performed by the general surgery residents and a foreign vascular resident (non-ACGME position) in 2004-2005.

The endovascular experience in the Vascular Surgery Service is large and broad. About 200 endovascular treatments of aortic and thoracic aneurysms are performed yearly. More than 200 carotid stents have been performed by the Vascular Surgery Service since September 2003 with excellent results (published in the Journal of Vascular Surgery). Similar extensive endovascular experience occurs in the aortoiliac, renal artery and lower extremity anatomic sectors.

Conferences

Because of work hour rules and available operative time, the Vascular Surgery/Interventional Radiology Conference has been changed to a weekly schedule (Monday, 7:00-8:00 a.m.). This joint conference discusses two interesting cases each week with imaging studies and operating room pictures when indicated. The cases are presented by the senior residents in the Vascular Surgery Service and the discussion moderated by a vascular attending. This interactive conference seeks the participation of students, residents and faculty. Throughout the year, there is a basic or clinical science lecture by a faculty member of the Vascular Surgery Section or visiting guest lecturer from other departments or institutions.

The Department of Surgery conducts a General Surgery Conference on Wednesdays, with selected vascular topics, which the vascular surgery residents are required to attend and participate in. This interactive conference also has a case presentation format presented by a general surgery resident and moderated by a vascular surgery attending.

A weekly Morbidity and Mortality Conference (Tuesdays) records all vascular complications. All deaths and selected vascular complications are presented by the resident(s) involved with the case and the discussion allows for the participation by vascular surgery and general surgery residents and faculty.

Vascular Laboratory

The Vascular Laboratory is owned and operated by the Department of Surgery at Washington University School of Medicine. Dr. Sicard and co-director Dr. Brian G. Rubin monitor the clinical (test interpretation) and educational components, as well as the technicians of the clinical vascular laboratory. Vascular laboratory studies are done in two locations: the Center for Advanced Medicine (CAM) and BJH south campuses. The vascular laboratory provides 24/7 service to the entire medical center. The vascular laboratory at the north campus is located at the CAM, eighth floor, adjacent to the Heart and Vascular Center. The non-invasive tests of all outpatients (approximately 60% of the total volume) are performed at the CAM vascular laboratory site. The laboratory employs eight technicians (six of whom are registered vascular technologists - RVTs).

The vascular laboratory has six color duplex scanners plus other appropriate equipment, and performs a full range of diagnostic studies on arterial and venous pathology. The Noninvasive Vascular Laboratory at BJH’s CAM and south campus performed nearly 16,000 procedures in academic years 2004-2005 and 2005-2006. The Noninvasive Vascular Laboratory provides an abundance of clinical material for educational purposes in conferences and daily rounds. Both laboratories (north and south campuses) are accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL). Vascular surgery residents learn interpretation of vascular laboratory studies from all clinical patients during clinical care, rounds and conferences. All vascular surgery residents are encouraged to take the RVT exam at the completion of their training. Beginning in the fall of 2006, the Society for Vascular Surgery (SVS) Education Council will make available to all program directors vascular lab interpretation CDs, which also will be made available to residents. These training modules will prepare vascular surgery residents to take the ARDMS Physician Vascular Interpretation examination at the completion of their training.

On-Call Coverage

The vascular surgery residents, along with the PGY-V resident(s) rotating in the Vascular Surgery Service prepare the call schedule every two months. The vascular surgery residents and PGY-V residents do not take in-house call, but are available for non-trauma vascular emergency procedures that may be referred to the attending(s) they cover during their respective month. The Vascular Surgery Service is in full compliance with the 80-hour work week. Our program (vascular surgery and general surgery residents) are required to enter their work hours in the Graduate Medical Education Management Software, GMEone online, at http://www.gmeone.com/. Barnes-Jewish Hospital/Washington University School of Medicine are currently transitioning to a hospital-wide online call schedule through the AMCOM Software, Inc. program (reflected in the 2006-2007 call schedules).

Vacations

The vascular surgery residents are allowed three weeks vacation. Trips for job interviews or attendance at surgical meetings are a part of the three weeks of vacation. During holidays, the four senior residents in the Vascular Surgery Service (two PGY-V residents, 2 vascular surgery residents or PGY-V resident and two ACGME vascular residents and one foreign vascular resident) alternate service coverage as long as there are always two senior residents during the week (Monday-Friday) in the Vascular Surgery Service available during the day at all times.