Vascular Surgery Residency and Fellowship Residency established with ACGME approval in 2009; fellowship started in 1999. Designed to produce surgeons who can provide comprehensive care to the vascular patient and be expected to fully participate in the rapid expansion of the field of vascular surgery, both clinically and academically. First Resident, July 2010 1st graduate: Brigitte Smith, MD, Univ of Wisconsin School of Medicine Assistant Professor Univ of Utah 2nd graduate: Jessica Secor, MD, Boonshoft School of Medicine at Wright State Private practice Illinois PGY-5 Elena Rinehardt, MD, University of Washington School of Medicine PGY-4 Christopher McAninch, MD, St Louis University PGY-3 Jason Le, MD Chicago Medical School at Rosalind Franklin University PGY-2 Shruthi Thiagarajasubramanian, MD, MI State College Of Medicine PGY-1 Alexander Leung, MD, Boston University School Of Medicine 5+2 Fellowship program: matching 1 fellow annually PGY-6 Peter Bartline, MD, Univ of Utah - General Surgery PGY-7 Camila Castello, MD, St Luke’s NYC - General Surgery

Jon Matsumura, MD Professor and Chief, Division of Vascular Surgery Residency, Northwestern University, 1988-1995 Vascular Fellowship, Northwestern University, 1995-1996 President, Midwestern Vascular Surgery Society, 2009-2010 PI or site PI on 18 industry sponsored Grants PI: WL Gore: "Thoracic Aneurysm Graft Corelab", (2001-2009) National PI: WL Gore: "Phase II Clinical Trial of the Bifurcated Excluder Endograft for Treatment of Infrarenal Aortic Aneurysms” International PI: Cook, Inc: “Zenith Thoracic TAA Endovascular Graft” National Co-PI for Abbott Vascular: “Asymptomatic Carotid stenosis, stenting versus endarterectomy Trial”, 2004- present PI.-Medical Director AortaCore Imaging Lab# 08-01:Evaluation of the GORE Conformable TAG® Thoracic Endoprosthesis for Treatment of Acute Complicated Type B Aortic Dissection (2009-2017) PI. NIH R01 (Terrin, Matsumura, Baxter) Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial (N-TA3CT) Author of more than 100-peer reviewed articles, 42 book chapters and editor of 10 books

John R. Hoch, MD Professor of Surgery Program Director, Vascular Residency and Vascular Fellowship Chief of Vascular Surgery, Madison VA Hospital, 1994 – 2011 Residency, Thomas Jefferson University, Philadelphia, PA, 1983-1989 Fellow, Vascular Surgery, University of Missouri-Columbia, 1989-1991 Research: PI VA Co-op trial #410 and #498 Industry sponsored clinical trials Chair, UW Anticoagulation Taskforce Clinical Interests: Complex aortic and visceral artery occlusive disease Endovascular management of arterial occlusive and aneurysmal disease Systems approach to VTE prevention Less invasive management of varicose vein disease

Girma Tefera, MD Professor of Surgery Chief of Vascular Surgery, Madison VA Hospital and Vice-Chair Division Vascular Surgery, 2011-Present Director, UW Limb Salvage Angioplasty and Carotid Stenting Residency in General Surgery, Howard University Hospital, Washington, D.C., 1994-1999 Fellowship in Vascular Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, 1999-2000 Research and Clinical Interests Carotid stenting, Limb salvage angioplasty FEVAR and complex TEVAR Ethiopian Medical Education Initiative ( MEPI) as well as Leader of multiple funded health and nutrition projects. Ethiopian Emergency Medicine Training Initiative Co-Founder University Wisconsin Global Health Initiative Medical Director of ACS Operation Giving Back (OGB). OGB is a comprehensive resource that helps surgeons find volunteer opportunities worldwide that match their expertise and interests.

Charles W. Acher, MD Professor of Surgery Director, Thoracoabdominal Aneurysm Program Residency, University of Wisconsin, Madison, WI, 1973-1978 Fellowship, GI and Peripheral Vascular Surgery, Gloucestershire Royal Hospital, Gloucester, England, 1978-1980 Peripheral Vascular Fellow, Baylor College of Medicine, 1982-1983 Clinical and Research interests Prevention of ischemic spinal cord injury in repair of TAAs Management of Complex Aortic and Visceral artery disease Repair of Aortic Arch and Thoracoabdominal Aneurysms by open and endovascular techniques

Gretchen Schwarze, MD, MPH Associate Professor of Surgery Harvard Medical School, Boston, MA, 1995 JFK School of Government, Boston, MA, MPH 1995 General Surgery Residency at Mass General 2002 Vascular Residency, University of Chicago, 2004 Research and Clinical Interests KL2 “Prevention of postoperative conflict about life supporting therapy by improving preoperative communication with older patients” 12-’15 Greenwald Faculty Scholars Award 08-’14 Advance Directives for High Risk Surgical Patients NIA 1R03AG047920 GEMSSTAR:A Communication Tool to Assist Older Adults Making Difficult Surgical Decisions” “14-’16 Developer of the UW Medical School Ethics Curriculum Evaluating tools and processes to help close the gap between what surgeons know and patients understand Navigating Major Surgery: supported through a Patient-Centered Outcomes Research Institute (PCORI) Program Award (CDR-1502-27462) Best Case / Worse Case Patient Experience Physician Champion UWHC 2012 Recipient Dean’s Teaching Award 2011

Dai Yamanouchi MD, PhD Associate Professor of Surgery Surgical Residency, Saiseikai Maebashi Hospital, Japan, 2001-2002 Research Fellowship, Nagoya University Graduate School of Medicine, Japan, 2003-2004 Clinical Fellowship in Vascular Surgery, Nagoya University Hospital, Japan, 2004-2007 Research Fellowship, Weill Cornell Medical College, New York, NY, 2007-2008 Fellowship in Advanced Endovascular Surgery, University of Wisconsin-Madison, Madison, WI, 2009-2010 Research interests: AHA Scientist Development Grant ‘12-15 Role Osteoclast-like Cells in AAA Industry sponsored EVAR clinical trials National PI Branched TEVAR Trial Industry Sponsored Research Grant to study the effect of Nano-Bubble Biomedical Engineering Project to develop Endovascular Devices

Kyla Bennett, MD Assistant Professor (2015 – present) Duke University: medical school, general surgery residency and vascular surgery fellowship at Duke University Medical Center. Clinical focus on aortic, carotid and limb salvage surgery. Vascular thoracic outlet syndrome interventions and management of venous obstruction. Research interests include: outcomes and access-to-care disparities, methodology for large database analysis to improve model integrity and pre-hospital management of ruptured AAA and dissections.

Paul DiMusto, MD Assistant Professor (2015-present) Associate Program Director, residency & fellowship University of Michigan: undergraduate, medical school, general surgery residency, and vascular surgery fellowship. Clinical interests focus on aortic disease: including aneurysms, dissections, and occlusive disease. He performs both open and complex endovascular repair of the aorta. He spent two years during residency studying the molecular biology underlying the gender difference in abdominal aortic aneurysm formation.   Interest in education of medical students, residents and fellows.   Working with Dr. Hoch to develop a simulation curriculum for the vascular trainees.

Bo Liu, PhD PhD, Biochemistry, SUNY Downstate, New York, NY, 1993 Postdoctoral fellow, Transcription regulation; signal transduction, Memorial Sloan-Kettering Cancer Center, New York, NY, 1996-1999 Research: RO1: understand regulatory mechanisms underlying l functions of vascular smooth muscle cells and how these mechanisms malfunction in vascular diseases AAA and Restenosis T32 NIH-sponsored Vascular Biology Training Grant Available after PGY5 year

Vascular Surgery Residency Provide incremental, progressive training in core surgery (CS) and vascular surgery (VS) during the five year program Four integrated sites: UW Hospital, Wm. S. Middleton VA Hospital (connected by corridor), Meriter Hospital (5 minute drive) and Transformations (aesthetic center; 10 min drive) Affiliated Rotations: St Mary’s Hospital, Madison and Theda Clark Hospital, Neenah, WI. Future site Swedish American Hospital Rockford, Il Optional research year(s) after 5 years training or after PGY-2 T-32 funding mechanism

Integrated Residency (0-5) Year 1 10m Core and 2m Vascular Year 2 and Year 3 7m Core and 5m Vascular both years Year 4 and Year 5 12m Vascular each year

Integrated Residency (0-5) Core General Surgery: Surgical Intensive Care 2 months Emergency General Surgery 2 months Surgical Trauma 2 months Night Float (vascular) 2 months Anesthesia 0.5 months Off-site general/vascular 1 month General Surgery 8.5 months Core Surgical subspecialties: Transplantation 2 months Plastic Surgery 1 month Thoracic Surgery 2 months Cardiac Surgery 1 month 24 months

Integrated Residency (0-5) PGY 1-3 Years Vascular Rotations Vascular Surgery : UW Vascular 5 months Vascular Lab 1 month Vein Care 1 month VA Vascular 2 months Vascular - related: Cardiology 1 month Vascular Access 1 month Elective/Research 1 month 12 months

Integrated Residency (0-5) PGY 4 & 5 Years Vascular Surgery 24 months Alternating 3 month rotations with PGY-4, PGY-5 and PGY-7 Fellow UW Vascular 12 months (6m/yr) VA Vascular 6 months (3m/yr) OnService 6 months (3m/yr) Acute care Endovascular Veins V-lab Research ______________ 24 months No conflict between Residents and Fellow; pair fellows &

Core Surgery Training PGY 1-3 Provide complete “foundation of the principles and practices of surgery” ACS course SCORE Curriculum Similar training experiences as categorical general surgery residents Core Surgery Technical Skills Lab Instrument identification, knot-tying and suturing Management and repair of central lines and enteric feeding tubes Wisconsin Elements of Laparoscopic Surgery (WELS) Advanced Trauma Life Support (ATLS) and ACLS Laparatomy and bowel anastomosis Principles of Ultrasound – FAST and line placement Principles of vascular anastomosis

Core Surgery Training PGY 1-3 Specialized conferences e.g. Trauma Call during PGY1-3 no greater than 1:3 Excellent working relationship with general surgery SCORE curriculum VSITE PGY 1-5 Resident Evaluation by core faculty

Core Surgery Rotations Outside UWHC Theda Clark Hospital - Neenah, WI (PGY-3; 1 month) Community general surgery; no residents Nice mix of open and laparoscopic operations 4 weeks; weekends off St Mary’s Hospital - Madison, WI (PGY-3; 2 months) Community general surgery; no other residents Mix of general, cardiac surgery and vascular patients Meriter Hospital (PGY-1 & 3; 2 months) Community general surgery VA Hospital General Surgery Service (PGY-1; 1 month)

Integrated Vascular Surgery Rotations Curriculum APDVS curriculum on-line with references, both Basic Science and Clinical Curricula Vascular SCORE Written Curriculum Goals and Educational Objectives UCLA/SVS Vascular Review Course in September of PGY4 RPVI Exam in PGY3 year (Division covers cost) Web-based universal curricula being developed by APDVS Milestone Driven Monthly Global (Web-ex online) and Local Journal Clubs

Vascular Conferences Monday morning 6:30 to 9:30 am (excused from OR) 6:30 to 7:15 Indications 7:15 to 7:30 Web-Ex morning sign out 7:30 to 8:30 Basic Science 1/mo; Noninvasive Lab conference 1/mo; Global Journal Club 1/mo; Clinical Research conference 1/mo 8:30 to 9:30 Teaching conference Faculty sponsored Monthly Journal Club

Integrated Vascular Surgery Residents Attendance at Monday conferences required on all rotations; excused from OR and general surgery rotations Divisional support for meetings at which you present Prepare the resident for the design, implementation and conduct of clinical trials Assigned research mentor: Expected to present at least once at National or Regional vascular meeting during residency Expected to take at least one research project from concept, through the IRB, data collection, statistical and conceptual analysis and publication

Cardiology Rotation PGY1 A focused exposure to consultative cardiovascular medicine, echocardiography and nuclear myocardial perfusion imaging stress testing. 2 weeks with the UW Hospital Cardiology Consult Service, and spending 1 week each reading studies in the UW Hospital Echocardiography Laboratory and Nuclear Cardiology Laboratory. Will function on each service in a role equivalent to a first year cardiovascular medicine fellow

Non-invasive Vascular Lab Rotation PGY-2 Daily reading at the University Hospital and West Clinic; no night call Daily hands-on participation in UW vascular lab with time spent in UW West clinic and VA vascular labs Didactic lectures on CD from SVS/APDVS Gain a complete understanding of the indications, interpretation and limitations of each test. Prepared to pass ARDMS RPVI examination during third year of residency Vascular lab interpretation responsibilities continue in PGY3- and 4 years at VA

Venous Disease Rotation PGY-3 1 month rotation at Meriter Hospital Venous clinic at Meriter, UW West Clinic and Transformations Office-based and hospital operating room-based interventions Minimally invasive techniques, and the postoperative care of patients with venous disorders Hands on venous imaging in the vascular labs at West and UWHC Also participate in vein care during Meriter Hospital core surgery rotations years 1-3 and when rotating on Onservice rotation PGY 4&5.

Vascular Surgery Elective PGY3 To allow the resident one month of elective time in the third year to conduct vascular research or pursue additional training in open vascular procedures or endovascular techniques The PGY-3 resident will work with the Program Director and Chair of the Division of Vascular Surgery to identify programs of interest either within the University of Wisconsin system, or elsewhere in the United States. Option for AV Access rotation at Swedish American Hospital, Rockford, IL

University and VA Vascular Rotations PGY2 and PGY3 Junior resident on the UW and VA Vascular teams working with Gen Surg PGY1 & 3 and Vascular PGY4 & 5 and fellow. Experience in endovascular and open interventions With the input of faculty, develop therapeutic plans, perform endovascular and open interventions and follow up the patients Responsible for majority of endovascular procedures in the UW Cath lab and VA Hybrid OR under the guidance of vascular surgery faculty when on rotation. Perform CEA, femoral to popliteal bypass, CFA endarterectomy, EVAR, amputations, extra-anatomic bypass, assist with complex open aortic reconstructions Participate in weekly VA and UW clinics

Vascular Rotations PGY4 and PGY5 UW Vascular Service (6 months/yr) 2 three month blocks each of the PGY4 & 5 years GenSurg PGY-3 (at times vascular PGY2 or 3) PGY 1 (shared with VA Vascular Service) 3 nurse practitioners on the floor (They are awesome!) Seven 7:30 OR starts Zeego Angio Operating Suite (also at VA) Complex open and Hybrid procedures Endovascular diagnostic and therapeutic interventions in OR and cath lab, staffed by vascular surgery faculty Vascular Clinic at UW West clinic average of ½ day/wk

Vascular Rotations PGY4 and PGY5 VA Vascular Service (3 months/yr) 1 three month block as chief each of the PGY-4 & -5 years Open and endovascular general vascular cases PGY-1 (shared with UW Service) Inpatient VA NP and case managers Clinic on Wednesdays at VA, morning and afternoon Junior residents on UW service also attend VA clinic Active faculty teaching in clinic OR 4 7:30am starts Endovascular experience in new Zeego Hybrid Angio Suite/Operating Room.

Vascular Rotations PGY4 and PGY5 OnService Rotation (3 months/yr) 1 three month block as chief each of the PGY-4 & -5 years Responsible for covering vascular cases at Meriter and new East side Hospital, as well as acute cases UW vascular service Endovascular and open arterial cases Vein care Spine exposures Endovascular experience in UWHC Zeego Angio Operating Room, UW cath lab, Meriter Cath Lab and VA Zeego Room. Time for research, vascular lab work and additional vein care opportunities

Vascular Call PGY2 & 3 On core rotations Every third night call from home Except 2 months SICU in-house every third night On vascular rotations Share back-up call from home for in-house night-float intern with PGY3 general surgery resident, PGY4 & 5 and the fellow PGY4 & 5 Call is from home Backup night-float intern every 3-4 nights during week Backup junior residents every fourth weekend in rotation with fellows The vascular PGY4, PGY5 and fellows are on call and have rounding duties every fourth weekend Weekend Midlevel NP support

Vascular Resident Cases 2011-2016 UW Resident National Ave. Breast 33 12 Transplant 7 6 Thoracic 21 18 Hernia 45 31 Biliary 28 20 Abd Gen 9 Lg Intest 15 Sm Intest Skin 27 24 Total Major Core Operations 293 205 Total Primary Vascular Operations 869 861 Total Major Vascular 541 472

Vascular Resident 2011-2016 * Primary and secondary cases UW Fellow 2014-2016 National Average Fellows UW Resident 2011-2016 National Average Residents Abdominal Obstructive 23 16 15 Open AAA 10 11 EVAR 73 59 65 60 All Aneurysm 119 89 130 123 Cerebrovascular 48 70 99 82 Peripheral 218 182 392 255 PTA AortoIliac 52 44 67 46 PTA/Stent Fem-Pop 128 121 93 Mesenteric 9 4 3 TEVAR 14 20 17 Open TAA 21 63 45 56 49 Total Major Vascular Operations 557 398 541/716* 472/664* * Primary and secondary cases

Programs and Clinical Trials Limb Salvage Angioplasty Program Carotid Stent Program (1 post-marketing trials allowing treatment of asymptomatic and symptomatic patients) Thoracic Endograft Program Fenestrated EVAR program (>30 cases / year) Cook: P-branch Endovascular Graft Pivotal Study BEST CLI Trial SCAFFOLD CAS Trial; GORE® TAG® Thoracic Branch Endoprosthesis (TBE Device) GORE IBE bifurcated iliac trial Roadster flow reversal cerebral protection carotid stent trial CREST 2 Trial; CEA vs CAS vs Medical Management

Clinical Research and Critical Thinking Faculty research mentor assigned PGY1 year (PD acts as Resident advocate) PGY1: Present twice in Vascular conference Case report PGY2 Initiate clinical study involving imaging or other topic Quality Project PGY3 Retrospective Review 1 month research/elective rotation Quality Improvement paper Introduction to Clinical Trials Course Initiate Prospective study PGY4 Retrospective paper Prospective study continues Should be presenting at regional or national meeting PGY5 Complete projects initiated in prior years Should be presenting at national meeting After PGY-5 year: T32 Grant: opportunity to spend 1-2 years in postgraduate clinical or basic research

New Initiatives Global Health: Ethiopia Beginning in January 2017 The first vascular residency in Africa (outside South Africa) Faculty from the Univ. of Wisconsin and other invited institutions will rotate every other month to Addis Ababa Opportunity for PGY-4 Vascular resident to rotate for 1 month when UW faculty present at end of 4th year. Simulation Curriculum: #1 goal for Division this year Simulation Center UWHC Open skills training: low cost and high-end Active faculty mentoring Mentice Endovascular simulator

80-Hour Work Week

Questions?

Vascular Imaging Rotation PGY2 The PGY-2 vascular resident will rotate for 1 month on the Vascular Imaging Service which includes CT and MR vascular imaging. Demonstrate an understanding of the principles and practice of modern vascular cross sectional imaging using computed tomography and magnetic resonance imaging. Understand principles of radiation safety The resident will attend educational conferences in radiology on CT and MR imaging and radiation safety.

Resident Evaluation Resident performance evaluation Faculty at end of each Rotation Semi-annual Review 360 evaluation by nursing (floor and OR), cath lab personnel, NP’s and support staff March In-service Exam (VSITE) Quality Improvement Project Anonymous evaluation of program and faculty via MedHub

2016 Vascular Resident Graduate “Defined Categories”