Yale Vasculary Surgery Fellowship

Educational Philosophy and Goals
The goals of the Yale postgraduate residency program in General Vascular Surgery encompass the training of vascular surgeons/scientists. Our primary objective is to produce individuals with superior skills in the management of patients with vascular disease. Fundamental to this goal is our commitment to developing the teaching and administrative capabilities of our fellows. As a reflection of our academic mission and our belief that scholarship underscores clinical excellence, we will offer our fellows a broad experience in clinical (and in some cases laboratory) research concerning pertinent issues in vascular surgery, medicine, and biology.

Objectives and Curriculum
The two teaching hospitals that will form the basis for the vascular surgery fellowship are Yale-New Haven Hospital (YNHH) and the VA Connecticut Healthcare, West Haven (VA). The core surgical program which supports this fellowship is the Yale General Surgery Residency. This program provides rotations in vascular surgery to all general surgery residents at the PGY-1 through PGY-5 levels. There is great opportunity at both hospitals for clinical training and research involvement at the fellow level. This involvement will certainly enhance, rather than detract from, the overall vascular surgery educational environment available to general surgery trainees.

The vascular surgery fellowship is two years. The first year is clinical. The second year will be customized to the goals of the vascular fellow including training in endovascular techniques, research and/or noninvasive vascular testing. It is anticipated that the fellow will attend and participate in regional and national vascular meetings and will complete at least one research project, clinical or basic science.

At YNHH the 2001-02 clinical fellow was involved in 444 cases with a wide variety of routine and complex vascular reconstructions including 51 aneurysms, 76 carotids, 125 reconstructions for peripheral occlusive disease, and 25 visceral reconstructions. By the first third of the second year, the fellow participated in 10 aortic endografts and 82 other endovascular procedures.

The overall aim is to provide clinically-focused, excellent training of one fellow each year. It is also the expectation of the program that a significant portion of clinical trainees will pursue a career in academic vascular surgery, armed with the clinical, teaching, research, and leadership skills to be successful.

Fellow Clinical Responsibilities
The clinical fellow will spend the majority of his time running the YNHH vascular service with a PGY-3 resident and junior residents. The clinical fellow and residents are expected to participate in the outpatient clinics at our vascular center to learn routine nonoperative management of vascular disease, preoperative and postoperative care.

The PGY-4 (Chief Resident) will run the VA vascular service. At the VA, the PGY-4 and PGY-5 share every other night on-call from home. The second year vascular fellow will be available to assist with the unusual and more technically demanding vascular procedures at the VA (e.g., re-do carotid and aortic procedures, complex visceral artery reconstructions).

The weekly educational conferences for the students, residents and attendings are the shared responsibility of the clinical fellow, with the second-year fellow responsible for the Teaching Conference and the clinical fellow for M&M and Preoperative Conference. The clinical fellow will run daily teaching rounds at YNHH with the residents and students, as well as discussions of vascular issues with third and fourth year medical students. The clinical fellow will participate in all quality assurance and administrative meetings and will present at least one nursing inservice each month.

Research Programs
PProductive and prominent programs in both basic and clinical research are fundamental to the development of clinical excellence and our academic mission.

Our Vascular Biology Laboratory, under the direction of Dr. Sumpio, has both national and international visibility and is well-funded through NIH, AHA, and VA sources. This vigorous research program, focusing on delineating molecular events in the arterial wall in response to mechanical forces, has involvement by students, residents, visiting fellows, as well as faculty. Dr. Gahtan’s research program is centered around the regulation of smooth muscle cell migration and proliferation by the extracellular matrix. Her laboratory is currently focused on the cell-signaling mechanisms by which thrombospondin-1 induces smooth muscle cell chemotaxis. Dr. Dardik’s research program focuses on factors that contribute to the endothelial cell and whole blood vessel differentiated phenotype. He is currently examining the role of shear stress in endothelial cell signal transduction and extracellular protein secretion. Dr. Gusberg’s clinical research program is focused on predicting and assessing outcomes of neuropsychological impact of carotid endarterectomy; predicting blood pressure and functional response to renal revascularization by stent or bypass; evaluating functional and quality of life outcomes in patients undergoing elective thoracoabdominal and infrarenal aortic aneurysm repair (open or endovascular). Dr. Lynne Kelley has just joined our faculty and she has special expertise in endovascular techniques, especially related to carotid artery procedures.

Our clinical research programs are enhanced by the interdisciplinary collaboration that has developed in our Vascular Center. Ongoing clinical research projects include: the impact of diabetes (and its control) on vascular disease (and its treatment); multidisciplinary approach to complex diabetic foot wounds including microvascular reconstruction; use of duplex scanning for intraoperative assessment; diabetic ulcer study (Regranex); thrombin inhibitor H376/95 vs. standard therapy for DVT (THRIVE V); ORG31540/SR90107A vs. unfractionated heparin for PE; abdominal aortic aneurysms open vs. endovascular graft repair (OVER VA Cooperative Trial); and Iron and Atherosclerosis Symptom Trial (FeAST VA Cooperative Trial).

Institutional Support
The hospital support services at YNHH and the VA include ward secretaries on every floor, who are responsible for organization and maintenance of the patients' charts including laboratory data, scheduling laboratory tests, etc. There is a blood drawing and an IV team at both hospitals. There is a patient support team which includes transport and orderly services. All hospitals are computerized such that all orders, laboratory data and so forth are carried out through the computer system. There are surgical ICU and step down units with a critical care service to assist in patient management.

Facilities and equipment
TThe entire Vascular Surgical Service, aside from the academic and ambulatory care facilities, is housed within YNHH, thereby integrating the various services and facilitating the care of patients by the resident staff. The university outpatient facility is located in the Yale Physicians Building and the attending and resident clinics are staffed on the third floor. There is a non-invasive vascular laboratory on site on the third floor with capabilities of Duplex studies, PVRs, and transcutaneous oximetry and staffed by registered vascular technologists. The vascular fellow will get “hands-on” training with intraoperative and outpatient Duplex scanning.

At YNHH, a dedicated OR suite is equipped with modern up-to-date instruments, including angioscopy, duplex ultrasound, and C-armimaging appropriate for endovascular procedures. There are 25 beds on the surgical floor, 7-5, that is utilized by both the Vascular and Transplant services with overflows to the neighboring General Surgical Units. There are 12 beds in the Surgical ICU for use by the vascular service with overflow to the adjoining Neuro, CT or Medical ICU.

Faculty

Professors
Richard Gusberg, MD
Bauer E. Sumpio, MD, PhD, Chief

Associate Professor
Vivian Gahtan, MD, Chief VA Vascular Svc

Assistant Professor
Alan Dardik, MD, PhD
E. Lynn Henderson Kelley, MD

Clinical Assistant Professors
Ralph DeNatale, MD
Walter Kwass, MD
Thomas Sweeney, MD

Vascular Fellows
1997-99 Georg Steinthorssen, MD (Dartmouth)
1998-00 Kathryn Collins, MD, PhD (Ohio State)
1999-01 Leila Mureebe, MD (MCP-Hahnemann)
2000-02 Jose R. Borromeo, MD (St. Luke’s-Roosevelt)
2001-03 Siamak Barkhordarian, MD (Temple)
2002-04 Kwame Amankwah, MD (SUNY, Downstate)
2003-05 Bolaji Nafiu, MD (King Drew Medical Center)

Applications
Bauer Sumpio, M.D., Ph.D.
Chief, Vascular Surgery
Yale University School of Medicine
333 Cedar Street, FMB 137
PO Box 208062
New Haven, Connecticut 06520-8062

(203) 785-6217
bauer.sumpio@yale.edu