David Rosenthal, M.D., Robert Batson, M.D., Joseph Mills, M.D.
- Aortic Trauma
- Carotid Trauma
- Brachiocephalic Trauma
- Visceral Arterial Trauma
- Extremity Trauma
- Venous Trauma
- Diagnosis of Vascular Trauma - Arteriography /Duplex
- Nonoperative Therapy
- Traumatic A-V Fistulas
- Iatrogenic Vascular Trauma
- Additional Important/Non-Core Cirriculum Topics:
- Associated Neural Injury
I. Etiology and Pathophysiology
1. To understand the mechanism of vascular injury to the upper extremity, thoracic aorta, abdominal aorta and its branches, and lower extremities.
2. To recognize the clinical importance of penetrating vascular trauma (penetrating objects), significance of different gunshot wounds (high/low velocity) and the blunt or crush injury to the vascular system.
3. To define how vascular reconstructive procedures and the failure of these procedures affect the circulatory system.
4. To understand the mechanism of iatrogenic vascular injury and its prevention.
II. Diagnostic Evaluation
1. To understand the characteristic signs and symptoms of acute vascular compromise.
2. To demonstrate an understanding of the wounding mechanism, assessment of the wound and characteristic findings of the affected extremity distal to the wound and associated injuries.
3. To understand the usefulness of alternative imaging techniques ( ie two plane x-ray, Doppler/duplex color flow ultrasonography , venography , angiography, MRI and CT scans) in the management of vascular trauma.
4. To define the characteristic diagnostic finding of imaging techniques in vascular trauma.
III. Acute Arterial Injuries
1. To understand the characteristic signs and symptoms of acute arterial injury.
2. To define the clinical features of major arterial injury.
3. To understand the indications for noninvasive (Doppler or duplex color flow ultrasonography CT, MRI) and invasive ( arteriography , venography ) diagnostic studies.
4. To define the preoperative assessment and management of the patient with a major arterial injury.
5. To understand the operative management of acute arterial injury and the management of concomitant venous or visceral injuries.
6. To define the operative approach for specific arterial injuries ( ie left and right subclavian ).
7. To understand the management of postoperative complications and the management of associated injuries.
IV. Venous Injuries
1. To understand the characteristic signs and symptoms of acute venous injury.
2. To define the clinical features of major venous injury.
3. To understand the indications for noninvasive (Doppler or duplex color flow ultrasonography CT, MRI) and invasive ( venography ) diagnostic studies.
4. To define the preoperative assessment and management of the patient with a major venous injury.
5. To understand the operative management of combined arterial and venous injuries, technical management of venous injuries ( ie ligation , lateral suture repair, end-to-end anastomosis , venous patch graft or venous replacement graft).
6. To define operative approach and appropriate management of specific major venous injuries ( ie management of retro hepatic IVC, subclavian vein).
7. To understand the management of postoperative complications, and associated injuries.
V. Arteriovenous Fistulas (AVF)
1. To understand the characteristic signs and symptoms of AVFs .
2. To understand the mechanism of injury associated with traumatic AVFs .
3. To define the pathophysiology of AVFs ( ie peripheral vascular resistance, heart rate, stroke volume, cardiac output and blood pressures).
4. To understand the indications for noninvasive and invasive diagnostic studies.
5. To define and understand treatment options ( ie invasive radiologic procedures, endovascular procedures, and operative techniques).
VI. Latrogenic Injuries
1. To define the mechanism of the iatrogenic injury.
2. To understand the clinical features associated with the iatrogenic injury.
3. To understand the indications for noninvasive and invasive diagnostic studies suspected iatrogenic injury.
4. To define the indications for nonoperative vs. operative treatment of iatrogenic injury.
5. To understand the management and potential complications associated with an iatrogenic injury.
VII. Concomitant Fracture and Neurologic Injuries
1. To understand the characteristic signs and symptoms of associated fractures and neurologic injuries with vascular trauma.
2. To understand the anatomic relations with fractures, neurologic injury and the vascular system.
3. To define the mechanism of injury from fracture, dislocation, or subluxation .
4. To understand the influence of penetrating, blunt and crush injuries on the vascular system.
5. To define the noninvasive and invasive diagnostic tests associated with fracture and neurologic injuries.
6. To define associated reconstructive procedures associated with fracture, neurologic injury and the vascular system.
7. To understand the postoperative management of the patient with combined vascular, fracture, or neurologic injury.
VIII. Nonoperative Management of Vascular Injuries
1. To define the clinical criteria and indications for nonoperative versus operative management of patients with vascular injuries.
2. To define the clinical pathology and mechanism of injury (penetrating, crush, blunt) associated with combined vascular and visceral injuries.
3. To define and understand the surgical anatomy in relationships of the abdominal aorta and its major branches to the abdominal organs.
4. To define the role of the surgical technique ( ie x-rays, peritoneal lavage , laparoscopic assessment, systoscopy , proctosigmoidoscopy , IVP, arteriography , etc) with suspected vascular and visceral injury.
5. To define the operative management of the patient with combined vascular and visceral injury.
6. To demonstrate an understanding of postoperative care for critically ill patients with combined vascular and visceral injuries, potential complications and their appropriate management.
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Posted June 2010