2 Yr Fellowship in Vascular Surgery

The traditional 2 Yr Fellowship in Vascular Surgery at the University of North Carolina

Introduction

The training program for vascular surgeons at the University of North Carolina has a long and distinguished history, having graduated its first fellow in 1978.  The fellowship program has historically consisted of a year of research followed by a predominantly clinical year.  Beginning in July of 2005, the training program was increased to a two-year clinical program.  Currently all clinical responsibilities are at the University of North Carolina Hospitals in Chapel Hill

The University of North Carolina Vascular Surgery Fellowship is an RRC-accredited two-year program leading to eligibility for a certificate of Special Qualifications in Vascular Surgery granted by the American Board of Surgery.  One fellow is selected per year via the National Resident Matching Program.  The training program is designed both for individuals preparing for an academic career as well as those intending to enter private practice.  Applicants generally apply during their fourth clinical year of a General Surgery residency.  Prior to beginning the fellowship, one must be board eligible or board certified in general surgery.

The training program encompasses the assessment, diagnosis, and treatment of pathologies involving the arterial, venous and lymphatic systems, as well as various other procedures such as spine exposures.  The spectrum of clinical cases ranges from the fundamental traditional cases to the exceptionally complex open operations and percutaneous procedures.

How to Apply

Applications to the UNC vascular surgery 2 yr program will be processed through the Electronic Residency Application Service (ERAS).  Applications will go through the National Resident Matching Program (NRMP).  Links to these websites are provided below.

Questions about the fellowship or application status should be directed to our Fellowship Coordinator Debbie Alberti: 919-966-3392

Overview

The vascular surgery residency is divided into two rotations.  One rotation is categorized as the “open” service.  On this rotation the vascular resident’s primary responsibility is caring for all inpatients.  Training is provided for the evaluation of vascular patients, ordering and interpreting diagnostic tests, medical management of vascular disease, developing technical expertise, and maturing sound surgical judgment.  Other responsibilities include managing the operative schedule, instructing the general surgery residents and medical students on service, presenting at a weekly vascular conference, and running a “fellow’s” outpatient clinic one day a week.

The second rotation is categorized as the “percutaneous” service.  On this service the vascular resident will spend 4-5 days a week in a dedicated state-of-the art angiogram suite performing a wide variety of diagnostic and interventional procedures under the supervision and direction of an attending in Vascular Surgery.  The resident on this service will also dedicate one day/week either to clinical research or interpreting examinations in the peripheral vascular lab.  Upon completion of the two years, fellows are expected to have completed the required number of peripheral vascular lab interpretations to take the Registered Physician in Vascular Interpretation (RPVI) exam.

Rotations between services will alternate in a three-month rotation, thereby giving the resident a complete experience in each of the clinical years.

Description of Clinical Experience

Operative

While the operative experience has evolved to reflect the evolution of minimally invasive techniques, the vascular resident can expect to be the primary surgeon in a full range of open vascular procedures including complex thoracic and abdominal aortic reconstructions, cerebrovascular, mesenteric and peripheral arterial revascularizations, varicose vein procedures, dialysis access creation and revision, repair of traumatic injuries, access for spine surgery, and extremity amputations.

Endovascular

Endovascular and percutaenous interventions are becoming an increasing proportion of procedures performed.  Previous vascular residents have finished their training having performed over 400 endovascular therapeutic arterial and venous interventions including balloon angioplasty, stenting, and endoluminal bypasses, Silverhawk atherectomy, laser atherectomy, sub-intimal recanalization, cryoplasty, embolizations, thrombolysis, and vena cava filters.  Procedures are routinely performed in peripheral, central, mesenteric, renal, and carotid vascular systems.

Residents will also participate in the extensive evaluation, pre-procedural planning, and implantation of both thoracic and infrarenal aortic stent-grafts.  This includes those devices approved by the FDA as well as those under investigation.  Residents will also gain experience with hybrid “debranching” procedures and fenestrated devices.

Clinical Research

The Division has an active clinical trials program, and its vast case volume offers ample opportunity for conducting prospective and retrospective clinical studies.  The vascular resident is expected to participate in research projects leading to presentations at national meetings and to write peer-reviewed publications.

Conferences and Seminars

There are two major teaching conferences during the week: Wednesday morning between 7:30 and 8:30 AM and Friday morning between 7:30 and 9 AM. This is protected time for the trainees with no cases going on during this time.

Friday Morning Vascular Conference: At this weekly Friday morning conference, the vascular surgery resident will be responsible for presentation of cases and review of the literature pertaining to the full spectrum of vascular surgery topics.  Special focus will be given to preoperative evaluation, surgical decision-making and planning, and interpretation of exams.  Additionally, pre and postoperative cases will be reviewed as well as morbidity and mortality that occurs on the service.

Morbidity and Mortality Conference:  All morbidity and mortality occurring on the vascular service will be presented at our Wednesday morning conference.

Non-invasive Vascular Laboratory Conference:  The peripheral vascular lab technologists will lead this bi-weekly Wednesday morning conference.  The primary focus is on the interpretation of laboratory studies and will include vascular laboratory technologists and the medical director of the laboratory.

Journal Club: This will occur monthly at one of the Friday Morning Conferences.  Attendings will select journal articles to discuss.

Quality Initiative Conference: This will occur 

monthly and we will discuss methods to improve outcomes in our procedures.  We are active participants in the Carolinas Group of the SVS Vascular Quality Initiative.

Research Meeting: We will have a monthly research meeting to go over both clinical trials as well as research projects that the faculty and residents are participating in.

Annual Symposia:  At least one formal conference hosted by the UNC division of Vascular Surgery is held each year at Pinehurst, NC.  UNC vascular surgeons, interventional radiologists, neurologists, and hematologists as well as national figures in the field of vascular surgery participate as invited speakers.  www.endovasculartherapies.com

On-Call Coverage

The resident on the “open” services shares on-call responsibilities with the resident on the “percutaneous” service, averaging one night in two.  A senior general resident is in house at night for initial evaluation of vascular consults.  Guidelines for the 80-hour work-week are strictly adhered to.

Vascular Laboratory

The peripheral vascular lab is an integral part of the vascular surgery training.  The lab performs a wide variety of studies involving peripheral, mesenteric, renal, and cerebrovascular.  The lab is ICAVL accredited and employs 6 full-time and 2 part-time technologists.  Over 13,000 procedures are performed each year, all of which are interpreted by the Division of Vascular Surgery.  There is a weekly PVL conference focusing on ultrasound technology and physics, interpretation and clinical application.  The vascular resident will be expected to become proficient in these areas and be qualified to take the Registered Physician in Vascular Interpretation (RPVI) Exam upon completion of residency.