The Division of Vascular Surgery offers two clinical years of fellowship training with electives in hematology, interventional radiology, and the Blood Flow Laboratory.
The Society of Vascular Surgery published five essential components of vascular surgery. These objectives have been incorporated into the curriculum at Northwestern.
Clinical Evaluation
Performance and interpretation of history, physical examination, and risk factor assessment. This includes medical management of vascular disorders.
Non-Invasive and Invasive Testing
Interpretation of arterial waveforms, ankle-brachial indices, duplex ultrasonography, computed tomography, magnetic resonance imaging/angiography, and contrast angiography.
Indications/Techniques of Open Surgery
Open operative treatment of both peripheral arterial and venous disorders, including congenital, occlusive, aneurysmal, and inflammatory diseases. This should encompass all named peripheral vessels with the exception of intracranial vessels, ascending aortic arch pathology, and intracardiac vessels.
Indications/Techniques of Endovascular Interventions
Endovascular interventions should include all peripheral arterial and venous pathology except intracranial and intracardiac vessels. Interventional techniques include balloon angioplasty, stenting, stent graft and vena cava filter placement, and thrombolysis.
Perioperative Critical Care Management
Preoperative and postoperative evaluation and management of vascular patients in an intensive care setting. Performance and interpretation of central venous and pulmonary catheters for hemodynamic monitoring.
Four clinical fellows rotate between the primary teaching facilities—Northwestern Memorial Hospital (NMH) and the Jesse Brown VA Medical Center—each year. Tour of duty is divided into blocks during which the fellows rotate between these two sites. Northwestern vascular surgery faculty members and residents in the general surgery program staff each service. Both services provide the full spectrum of training in vascular surgery.
An excellent case mix is provided throughout the year and as a result all fellows can expect to complete their training with 200–250 major vascular operations in addition to 100–150 percutaneous interventions. Historically, graduating fellows have passed the Vascular Surgery Board exams on the first attempt with scores well above the national average, obtained certification as a RPVI, and have sufficient experience to obtain endovascular privileges at their hospitals.
Opened in May 1999, NMH is a two-million-square-foot hospital in the heart of downtown Chicago. This medical center, located one block east of Michigan Avenue, includes the 17-story Feinberg Inpatient Pavilion and the 22-story Galter Outpatient Pavilion.
The vascular surgery service is fortunate to have an inpatient floor and an intensive care unit dedicated to the care of its patients. An advanced nurse specialist and a nurse practitioner also support the service. Operating room time is available to the service on a daily basis in two rooms equipped for major vascular operations—left-heat bypass assisted thoracoabdominal aortic aneurysm repair—as well as advanced endoluminal interventions in an established endovascular suite. The accredited blood flow laboratory, run by vascular surgery, performs 60–80 noninvasive studies daily encompassing arterial and venous Doppler exams, carotid duplex, transcranial doppler, and photoplethysmography.
The Vascular Surgery Clinic at NMH is open five days a week and staffed by the full-time faculty members of the division. Housed on the 19th floor of the Galter Pavilion, the clinic is supported by two nurses and two additional support staff essential in scheduling and obtaining pre-operative clearance.
The Jesse Brown VA Medical Center, located 10 minutes from NMH, has developed an integrated vascular surgery service between Northwestern University and the University of Illinois. As a result, vascular surgery faculty members and surgical residents from both institutions staff this joint service. Operating room time is available four days a week. The rooms are fully equipped for all major vascular and endovascular surgery cases. This service includes all major aortic reconstructions, aortic endoluminal stent grafts, as well as carotid, renal, iliac, and SFA interventions. Vascular surgeons run the vascular laboratory and perform both arterial and venous Doppler studies on a daily basis.
Fellows in vascular surgery are expected to participate in research programs consisting of research in outcomes and health policy, and clinical studies and trials.
The vascular service is keeping pace with the rapid development in endovascular surgery. Faculty members serve as principal investigators in several FDA-approved multicenter clinical trials on devices for thoracic and infrarenal aortic aneurysms. The division also is a trial site for a carotid angioplasty and stent. Other clinical research focuses on drug studies, noninvasive tests, gene therapy, and new vascular prosthetic materials.
Clinical Research
The Vascular Surgery Division is engaged in a number of clinical projects, in which all fellows are encouraged to partake:
- The division maintains active enrollment in several clinical and basic science studies. We are actively enrolling patients in a trial sponsored by the National Institutes of Health (NIH) study for carotid angioplasty and stenting. The goal of this study is to demonstrate the effectiveness of percutaneous carotid angioplasty and stenting with an embolic protection device compared to a contemporary group of patients treated with standard carotid endarterectomy. We are also working in correlation with the Department of Preventive Cardiology in evaluating the effects of blood fat reducing drugs (statins) on the progression of carotid plaque. Also, collaboration continues with the Section of Magnetic Resonance Imaging Technology and its advances with carotid imaging.
- Follow-up continues in patients to evaluate safety and effectiveness of endovascular grafts for the treatment of abdominal aortic aneurysms. Also, a clinical research trial will be starting in fall 2004 to evaluate the safety and effectiveness of endovascular treatment for descending thoracic aneurysms. The clinical research office also serves as a core lab for receiving and analyzing radiographic studies performed as a part of this multi-center Phase II trial comparing the use of this descending thoracic endoprosthesis to open surgical repair.
- Recruitment continues for a clinical study to evaluate the effectiveness of plavix versus placebo on a background of standard care including aspirin in maintaining patency of lower limb arteries after angioplasty.
- An ongoing study follows patients who have undergone peripheral bypass involving a study medication that is applied to the vein graft ex vivo under 6 psi for 10 minutes. The study will assess patency rates of the vein grafts postoperatively in patients treated with either study medication or placebo.
- Vascular surgery is also participating in a Veterans Administration Cooperative Studies Program, which is a randomized trail of open versus endovascular repair of abdominal aortic aneurysms. Another future trial is an NIH study for carotid angioplasty and stenting. The goal of this study is to demonstrate the effectiveness of percutaneous carotid angioplasty and stenting compared to a contemporary group of patients treated with standard carotid endarterectomy.
- A study will be starting soon for patients who have ischemic ulcers on their lower extremities secondary to peripheral arterial disease. The study will look at the benefits of taking an antiplatelet medication versus placebo as additional treatment of ulcers.
Two full-time clinical research nurses staff the clinical research program. These individuals are essential in obtaining IRB approval and coordinating the proper conduct of the trials.
Teaching activities include seminars for medical students, rounds with medical staff members and residents, participation in the annual Division of Vascular Surgery postgraduate symposium, and service on the faculty of the Northwestern University Prosthetic-Orthotic Center.
Fellows run a monthly journal club as well as participate in weekly conferences that may be attended by division and other Northwestern medical staff members, housestaff members, and vascular surgeons from Chicago-area medical centers. Fellows are involved in vascular surgery, round table case, and morbidity and mortality conferences as well as grand rounds.
Fellows are encouraged to attend meetings of the American Association for Vascular Surgery (AAVS), Society for Vascular Surgery (SVS), and Midwestern Vascular Surgery Society and to participate in these as well as in local and regional surgical society events. Vascular fellows regularly present papers at the AAVS/SVS joint annual meeting and meetings of the Chicago Surgical Society.
An endovascular experience is gained by rotations in the Division of Interventional Radiology and on the vascular surgery service. An endovascular suite has been installed in the operating room for vascular surgeons. All residents are expected to meet the criteria of AAVS and SVS for competence in endovascular surgery, including arteriography, placement of endovascular stent grafts for the treatment of abdominal aortic aneurysms and thoracic aneurysms, and angiography and stenting for peripheral occlusive disease. One full day per week is spent with interventional radiology. Additional experience is gained through a training center.
Candidates for the general vascular surgery fellowship must have completed a general surgery residency program as required by the American Board of Surgery and must be board eligible or board certified.
The program participates in the National Resident Matching Program (NRMP) for selection of candidates; all candidates must participate in the Match. Applicant agreements are available from the NRMP, 2501 M Street NW, Suite 1, Washington, D.C. 20037-1307, phone 202/828-0676.
The program must receive completed applications by February 1 of the year before the residency begins (for example, by February 1, 2008, for the program starting July 1, 2009).
The vascular surgery service contacts strong candidates and arranges personal interviews. Final selection for the fellowship is based on a recommendation by the chief of surgery of the center where the candidate completed a general surgery residency and the personal interview with vascular surgery service members at Northwestern.
William H. Pearce, MD
Violet R. and Charles A. Baldwin Professor of Vascular Surgery
Mark K. Eskandari, MD
Associate Professor of Surgery and Radiology
Melina R. Kibbe, MD
Assistant Professor of Surgery
Jon S. Matsumura, MD
Associate Professor of Surgery
Mark D. Morasch, MD
Assistant Professor of Surgery
Vera P. Shively, MS
Senior Research Associate
James S.T. Yao, MD, PhD
Emeritus Professor of Surgery
For more information, contact the Division of Vascular Surgery, Northwestern University, Feinberg School of Medicine, 201 East Huron Street, Suite 10-105, Chicago, Illinois 60611-3039, 312/695-4857; fax 312/695-4955 or visit the Department of Surgery Web site.
E-mail: sminton@nmh.org
