Integrated Vascular Surgery Residency Program

Overview

The Integrated Vascular Surgery Residency Program at Massachusetts General Hospital enrolls trainees who desire to achieve a five-year general surgery residency program combined with an additional two-year specialty training in vascular surgery. The program is closely integrated with the Mass General Surgical Residency Program.

The program currently graduates two residents per year. By the end of the intensive training, the graduate is expected to have the skills necessary to:

• Diagnose and define abnormalities of the vascular system
• Formulate a treatment plan based on available medical and surgical therapeutic options
• Perform the full spectrum of surgical and endovascular reconstructive procedures

The resident is expected to become well-versed in the pre- and post-operative management of patients with vascular disease, as well as the principles of both open and endovascular treatment. The resident should become competent in the use of diagnostic angiography, interventional procedures and the interpretation of all vascular imaging studies. The resident should become facile with open procedures, their proper indications and prove competence in the performance of vascular reconstructions with minimal assistance.

The resident will gain an in-depth understanding of the pathophysiology of vascular disease, particularly in areas of hemodynamics, predisposing factors for atherosclerotic disease and knowledge of the pharmacokinetics of drugs used in the treatment of vascular pathology.

Curriculum

By the end of training, the successful graduate should possess all the necessary skills required to be proficient in the diagnosis and treatment of diseases of the peripheral arterial, venous and lymphatic systems. The aim of the program is to prepare the residents to become very proficient in the diagnosis, management and proper planning of the appropriate interventions, as well as the performance of such interventions with minimal assistance, for the following categories of vascular conditions:

• Aneurysmal disease (infrarenal, thoracoabdominal, visceral and peripheral)
• Congenital malformations
• Extracranial cerebrovascular disease (carotid bifurcation and aortic arch)
• Hemodialysis access (arteriovenous fistulas and permanent intravenous lines)
• Inflammatory vascular diseases
• Peripheral obstructive disease (aorto-iliac, infrainguinal and upper extremities)
• Thoracic outlet obstruction
• Traumatic injuries
• Venous disease (reflux, varicose veins and deep venous thrombosis)
• Wound healing strategies

Clinical Experience

The trainee will be expected to be able to efficiently conduct the whole spectrum of common vascular procedures outlined below.

Open Surgical Procedures and Techniques

• Aortic aneurysm repair
• Aorto-bifemoral bypass
• Carotid endarterectomy
• Central line placement
• Extra-anatomic bypass
• Magnifying and lighting instruments
• Patch angioplasty
• Peripheral aneurysm repair
• Peripheral arterial bypass
• Peripheral endarterectomy
• Prosthetic and autogenous conduits
• Removal of infected grafts
• Thoracic outlet decompression
• Thromboembolectomy
• Varicose vein excision
• Vascular access construction
• Vascular clamps and instruments
• Vascular exposure and control
• Vascular surgical retractors
• Venous ablation procedures
• Visceral artery bypass

Endovascular Reconstructive Procedures and Techniques

• Atherectomy

• Balloon angioplasty

• Balloon expandable stents

• Carotid artery stenting

• Diagnostic angiography

• Embolization techniques

• Endovascular aneurysm repair

• Endovenous techniques

• Mesenteric and renal stenting

• Percutaneous recanalization

• Percutaneous thrombectomy

• Platform sizes (0.014 to 0.035 cm)

• Stent placement (self-expanding)

• Thoracic endovascular grafting

• Thrombolysis

Medical Management

• Acute cardiac disorders
• Coagulation
• Diabetes mellitus
• Evaluation of cardiac risk
• Hyperlipidemia
• Hyperperfusion disorders
• Hypertension
• Renal insufficiency
• Stroke
• Wound care

In addition, the resident will be expected to have acquired the necessary knowledge and skills in the proper use of noninvasive vascular lab testing. Thorough understanding of the physics of flow and ultrasound measurements is essential. The resident is expected to demonstrate a complete understanding of the accuracy and limitations of noninvasive ultrasound and hemodynamic testing, as well as alternative diagnostic modalities appropriate for the clinical situation. Familiarity with actual hands-on testing is expected for most common procedures such as carotid ultrasound and venous testing. The successful graduate is expected to have a thorough knowledge of diagnostic criteria and the proper interpretation of tests for the following:

• Hemodynamic testing (upper and lower extremities)
• Duplex scans (carotids, abdominal aortic and visceral, graft surveillance)

Vascular lab training is integrated throughout the patient care process from outpatient to inpatient care.

The diagnostic skills and use of specialized radiographic imaging by the resident are expected to be sharpened significantly during the senior years. The resident is expected to demonstrate advanced expertise in the proper use and interpretation of vascular structures on CT and MR angiography. They resident is expected to perform and interpret diagnostic angiography of all vascular beds in the scope of diseases mentioned before. A clear understanding of radiation physics and safety is also expected before completion of the training program.

How to Apply

Please submit the following documents electronically via ERAS:

• Four letters of reference (one must be the medical school dean’s letter)
• Curriculum vitae
• Photo (preferred, but not required, for identification during interview process)
• Personal statement
• Medical student performance evaluation (MSPE) letter
• USMLE transcript (step 1, 2 and 3 results or equivalent)

Shortly after all applications are received, selected individuals will be invited for formal interviews to be held in December and January. At that time, current residents and staff will meet with the applicants. Tours will be given by the residents and any questions you have about the program will be answered.

Apply now via ERAS >