The Vascular Diagnostic and Intervention Fellowship Program is a one-year, non-ACGME training program. Trainees will obtain broad exposure to the comprehensive diagnostic and therapeutic strategies for all non-coronary vascular diseases. These include peripheral arterial, carotid, renal, aortic, mesenteric, and aneurysmal disorders; acute and chronic venous thromboembolic disease; hypercoagulability; uncommon causes of vascular diseases; and limb edema.
Trainees will obtain in-depth exposure to all catheter-based interventions for vascular disease, as well as experience in decision making regarding optimal treatment, including medical and surgical alternatives. Fellows will have hands-on exposure to non-invasive vascular testing, including a basic understanding of the performance and interpretation of these tests, with the goal of preparing the fellow, upon completion of the fellowship, to sit for the Registered Physician in Vascular Interpretation (RPVI) certification examination.
Finally, it will be expected that fellows will pursue clinical research resulting in presentation of data at a regional or national symposium, and ultimately, publication in a peer-reviewed journal.
Requirements of the Vascular Diagnostic and Intervention Fellowship Program include:
- Completion and passing of all three USMLE steps
- ABIM board certified or board eligible
- The accepted applicant must obtain a full Massachusetts license (limited license if on visa)
- A valid ECFMG certificate for all foreign medical graduates
- Only J1 visas accepted
- Completion of a previous interventional cardiology fellowship is required
The Interventional Vascular Medicine Fellowship is a one year program concentrating both on diagnosis and management of patients with peripheral vascular disease and the performance of percutaneous peripheral vascular procedures. The program is in addition to the ACGME-accredited Clinical Cardiology and Interventional Cardiology Fellowship Programs.
The central goal of this fellowship program is to provide integrated training in the diagnosis, care, and percutaneous treatment of patients with vascular disease and to allow fellows to assume positions of academic leadership in the field of cardiovascular medicine. Candidates will have had training in clinical cardiology and percutaneous coronary procedures. This fellowship program provides the opportunity to gain knowledge and procedural expertise in the evaluation and management of patients with a wide variety of vascular diseases including:
- Acute or chronic arterial occlusion of the lower extremities
- Atherosclerotic renal artery disease
- Atherosclerotic disease of the brachiocephalic vessels including the carotid artery
- Coronary artery disease
- Venous disease
- Inflammatory vasculitis
- Procoagulant states
The fellow will come to appreciate that atherosclerosis is a systemic disease that often involves several vascular beds resulting in the frequent association of coronary and peripheral vascular disease. He or she will acquire knowledge of the indications, contraindications, limitations and appropriate techniques for the percutaneous evaluation and treatment of patients with peripheral vascular disorders. He or she will gain insight into the anatomy of the different peripheral circulations, the pathophysiology and natural history of peripheral vascular disease and its impact on various organ systems. The program will focus on the diagnosis and treatment of the major clinical syndromes including:
- Acute or chronic leg ischemia
- Malignant hypertension due to renal artery stenosis
- Cerebrovascular event/stroke due to atherosclerosis of the carotid artery
The fellow will develop a broad-based knowledge of diagnostic and interventional techniques for peripheral vascular disease and will acquire the technical skills of invasive diagnostic imaging and intervention. These skills encompass the full range of techniques including vascular access, diagnostic angiography, angioplasty and stenting, administration of adjunctive pharmacotherapy and recognition and management of complications and will involve various vascular beds. In addition, the fellow will continue to perform a limited number of coronary interventions to maintain and reinforce his or her expertise in these procedures.
The fellow will be actively involved in both outpatient and inpatient management of vascular disease patients, including patients in the intensive care unit and emergency department.
Inpatient Clinical Consultation
The fellow will participate in the inpatient consultation service. Responding to vascular medicine consultations, the fellow will see and evaluate inpatients with a variety of vascular diseases. The fellow will obtain a history of the patient's presentation, perform a physical examination and actively participate in the interpretation of the non invasive test data including ankle brachial index and duplex ultrasound studies. The case will be discussed and pertinent physical examination, laboratory and non-invasive study data reviewed by the attending and fellow. The fellow will be trained to integrate the patient's entire medical/clinical presentation and non-invasive study data to make accurate diagnoses and appropriate clinical decisions with respect to further invasive evaluation of the patient and therapeutic interventions. The strengths of percutaneous versus surgical versus medical therapy will be discussed for each case by the attending and fellow. Written consultation will be provided addressing the pertinent issues relevant to the patient.
The fellow will see patients with the vascular medicine attending staff at least one day per week in the outpatient setting. As described in the inpatient consultation section above, the fellow will be involved in the evaluation and management of patients in the clinic setting as well. Outpatient follow-up will be performed for patients with peripheral vascular and cardiovascular disease treated with drugs, percutaneous interventions or surgery as dictated by their condition.
Percutaneous Vascular Procedures/Intervention
The development of excellent vascular angiographic and interventional skills will be paramount for the fellow. Under guidance of the attending responsible for the procedure, the fellow will acquire the skills of angiography and catheter based interventions in the peripheral vasculature. The fellow will at all times be expected to participate in the procedural care of patients that he or she has cared for clinically either in outpatient or inpatient setting. The fellow will be trained to use appropriate percutaneous invasive techniques to improve symptoms, reverse critical ischemia and avert or limit the extent of vascular bypass surgery necessary in patients with peripheral vascular disease.
The fellow will be trained in different techniques of gaining safe and secure vascular access including the:
- Contralateral femoral artery approach
- Antegrade common femoral approach
- Retrograde common femoral artery approach
- Popliteal artery access
- Radial and brachial access
The fellow will learn which approach is appropriate for the percutaneous treatment of target lesions in various peripheral arteries including the external iliac, common femoral artery, superficial femoral artery, tibial vessels, renal artery, subclavian artery and carotid artery.
The fellow will be exposed to appropriate vascular imaging techniques applied for visualization of various vascular beds. He or she will learn the radiographic views to evaluate the:
- Arch of the aorta and the great vessels including the brachiocephalic arteries
- Abdominal aorta and branches including the mesenteric and renal arteries
- Iliac arteries and arteries of the lower extremities
The fellow will learn the techniques to best visualize the carotid bifurcation, origin of the renal and mesenteric arteries, the common iliac bifurcation and common femoral bifurcation which are predilection sites for atherosclerotic disease. They will learn to use the appropriate diagnostic catheters and angiographic views to identify the sites of atherosclerotic obstruction, delineate the severity of the stenoses and determine if the patient is suitable for surgery and/or percutaneous intervention.
The fellow will be trained in the selection and use of guiding catheters, guidewires, balloon catheters and stents designed for the peripheral vasculature. He will be trained to perform the critical manipulations applied in peripheral vascular interventions including:
- Aortoiliac intervention
- Femoral-popliteal intervention
- Infrapopliteal intervention
- Renal artery intervention
- Subclavian and innominate intervention
- Extracranial carotid artery intervention
The fellow will develop an understanding of the impact of patient characteristics, target vessel location and lesion morphology on the success rate of percutaneous interventions. The strengths and limitations of differing percutaneous interventional approaches including balloon angioplasty, balloon expandable stents, self expanding stents and other commonly used interventional devices will be discussed by the attending and fellow.
The fellow will be trained in the management of mechanical complications of peripheral vascular interventions including dissection, thrombosis, spasm, perforation and peripheral vessel occlusion.
To apply for a position starting July 1, 2018, please submit your CV, personal statement, copy of USMLE transcripts and three letters of reference by either mail, e-mail or fax.
Mass General Hospital
55 Fruit Street GRB8-813
Boston, MA 02114
Call for more information: 617-643-3238