Vascular access: Arterial, Venous, US guided
Access site heamostasis
Sheathes , Guides, Catheters
Embolic protection devices
Principals of diagnostic angiography
Prevention of contrast induced nephropathy
Anticoagulation, thrombolysis and mechanical thrombectomy for acute limb ischaemia
Antiplatelet therapy in the management of peripheral arterial disease
Risk factor management of atherosclerotic peripheral vascular disease
Intracerebral interventions for acute iscaemic strokes
Carotid artery stenosis
Subclavian artery stenosis
Renal artery stenosis
The superior mesenteric and coeliac arteries
Femoropopliteal percutaneous intervention
Below the ankle interventions
Venous interventions for thrombo-occlusive disease
Endovascular therapy for venous insufficiency
Dialysis access interventions
EVAR – advanced course in measurement using a workstation Training in simulators, using 3 available stent graft,
Participation in live case procedures.
For fenestrated endovascular procedures a basic course with indications and result of current devices is planned.
The principles on how to measure fenestrated stent grafts will be delivered, as well as a comparison of the various fenestrated systems available on the market.
BEVAR – branched endovascular procedures for thoraco- abdominal aortic aneurysms, program outline like for FEVAR.
BEVAR for iliac aneurysms with comparison of the various systems on the market. How to measure and how to perform the procedures.
TEVAR – indication for TEVAR in thoracic aortic aneurysms and dissections.
De-branching visceral procedures as preparation for hybrid operation for thoraco- abdominal aortic aneurysms.
Vascular candidates should be certified to fulfill experience prior to sitting the exam of the first part regarding all above endovascular procedures and the following key topics
Practical Key Topics
Have knowledge of both open and endovenous treatment of varicose veins
2.Assessment, resuscitation and management of patients with acutely ischaemic leg.
Recognition of critical ischaemia and claudication in patients with peripheral vascular disease and knowledge of treatment options including angioplasty, stent and bypass techniques.
Diagnosis and treatment of patients with acute upper limb ischaemia.
Ability to diagnose and manage patients with femoral false aneurysms.
Recognition and management of severe vascular infections, involving native vessels and synthetic grafts
Recognize and know the principles of treatment of patients with ruptured abdominal aortic aneurysms.
Safely assess the multiple injured patient (includes ATLS )
Identify and manage traumatic and iatrogenic vascular injuries
Diagnosis and management, including operative management of abdominal and peripheral aortic aneurysms. Have knowledge of both open and endovascular repair of aortic aneurysms.
Diagnosis and management of carotid artery disease including endovascular techniques.
A basic knowledge of vascular access techniques and the treatment of arterio-venous malformations.
Recognition and management of patients with vasospastic and arteritic conditions of upper and lower limbs.
Diagnosis and treatment of patients with lymphoedema.
Have knowledge of the diagnosis and management of thoracic outlet syndrome.
Know how to manage patients with hyperhidrosis
Have knowledge of the techniques involved in renovascular surgical intervention.
Ability to assess published evidence in relational to clinical practice and ability to teach others
Inclusions criteria of candidates
Candidate should be a member of university hospital or teaching hospital or a hospital with a dedicated vascular unit
Candidate should hold a MD degree of vascular surgery or an MD degree of general surgery with a vascular thesis from an university hospital
Candidate should have had a recognized certificate of attendance to an organized training and passed examination by a recognized evaluation system from an accredited center of peripheral endovascular intervention
A completed log book containing efficient endovascular interventions approved by the board of the certificate
Candidate should be registered as vascular consultant and member at the medical syndicate
The certificate entails 3 parts (First part/entry exam + Thesis+ Second /final part)
The first part held at Cairo University Kasr Al Ainy Faculty of Medicine and entails
A series of dedicated lectures of different fields of Peripheral endovascular intervention for peripheral vascular diseases
Hands on workshops daily for 2 hours for seven days on advanced simulators
Attendance of diagnostic and interventional cathlab performed procedures as well as recorded cases with discussions
INTENDED LEARNING OBJECTIVES (ILOs)
At the end of this course, the interventionist will be able to/will
have knowledge in:
Identify types and specifications of cath-lab components, rules to protect the patient and himself from hazards of radiation exposure, and correct sterilization.
Proper general pre-intervention patient evaluation & patient selection, pre-intervention medication and common pitfalls and complications.
Recognize all common tools needed for peripheral endovascular intervention in general.
Recognize types of each tool, specific features of each one and its proposed benefit and possible hazard.
Rules to use each tool, indication, contraindication, limitation and known trick for each.
Identify specific tools to use in different locations and from different access sites and why.
Identify the specific group of tools for specific situations as CTO, IPAD, intended catheter directed thrombolytic therapy, retrieval system tools and emergency kits.
Recognize the pitfalls associated with various endovascular procedures and how to avoid them.
Principles of how to plan endovascular approach and to select access site in management of different lesions on different sites.
Endovascular surgery basics:
Concept & Strategy of Peripheral Endovascular intervention
Pre and Post endovascular intervention preparation and follow up
Imaging for endovascular procedure
Tools in Peripheral Endovascular intervention
Endovascular access sites, Fundamental techniques and complications.
Angioplasty; indication, types and results
Endovascular stents; Types, indications, limitations and complications
Endovascular Management of indicated reconstruction of significant arterial stenosis
Endovascular management of Arterial CTO
Indications, Roles and limitations of thrombolytic therapy.
Endovascular aneurysm repair
Roles in endovascular management of venous diseases.
Complications of endovascular procedures
Future ambitions in endovascular management of PAD
Endovascular therapeutic embolization
Lectures given by national faculty of Cairo University Vascular Surgery department and German faculty of Cologne Vascular surgery department encompass the following topics
TOPICS OF THE LECTURES :
1.Minimally invasive surgery & Peripheral Endovascular intervention, strategy
This is to give an overall view on future and needs for minimally invasive procedures, the intended learning objectives and the basic structure of endovascular strategy
Endovascular imaging & Basic radiology safety concepts
It is intended to cover the basics of radiological safety to go with the
international guidelines and regulation in that field.
Endo-Vascular access & How to get there from here
This fundamental lecture will cover the most common endovascular access sites, and why, and also their advantages and disadvantages, and special elaborations on certain tools in certain access sites.
Endovascular tools; needle, sheath,
Will elaborate and discuss different types of needles and sheaths in different procedures of endovascular interventions, with advantage and disadvantage of each type.
Endovascular tools; wires,
As Wire technology is an essential part of successful intervention and with the
development in the field of wire technology, this presentation will cover nearly all types of wires used in peripheral interventions for PAD.
Endovascular tools; catheters,
This presentation will cover the common shapes and characteristics of catheters used in endovascular interventions, with more elaboration on the use and advantage and disadvantage of each type of catheter.
Mechanism of balloon action on different types of arterial diseases. Different types and shapes of balloons. Special balloons for special lesions and for specific sites. Indication, complication and contraindication in use of different balloons in different diseases and different sites.
This presentation will cover all types of stents used for peripheral interventions and their different classification. Indications, contraindication and special characteristics for certain types of stents in specific peripheral lesions at different regions.
Endovascular complications; puncture site, remote lesion site and journey rout site.
This presentation will cover complications of endovascular interventions. What are the precautions to avoid complications, early detection and proper management.
IVC filter; Indication, techniques, types , pitfalls , and complications and how to manage them.
How to build endovascular strategy
This lecture’s aim is to help participants how to build an effective and safe endovascular strategy, how to take a decision to change strategy of treatment and when to stop endovascular trial for revascularization.
Tools for complications (Emergency Tools)
Tools and materials for arterial embolization
Basics in patient and device selection for EVAR
Identification of specific tools in different types of emergency kits that have to be available in the endovascular suite. Early detection of endovascular emergency during the intervention as; acute thrombosis, arterial perforation or rupture and retrieval of foreign body from endovascular tools. How complication can happen, how to avoid, how to treat, and which emergency kit you need to deal with each complications.
Hands on in cathlab training that encompass
Identification of all components of endovascular angiography suite, characteristics and specifications of all its equipment.
2- Identification of all types of wires, sheaths, catheters, stents, balloon angioplasty, atherectomy, and thrombolytic tools to develop basic independent skills, or enhance existing skills in all non-coronary vascular beds.
Time and Duration of each session Three to Four hour for five days and in each Hands-on session specific tools will be seen handled and maneuvered with multiple tutors to answer candidates’ questions as follows :
Types of needles , sheaths, diagnostic catheter, and how to do puncture
Types of wires and balloons, and how to use wire-balloon combinations
Guiding catheter, stents and stent deployment systems
IVC filters types, techniques and possible complications.
Thrombolytic tools and tools of complications (emergency kits)
Also various procedures including
(a) Diagnostic angiography to lower limb
(b) Diagnostic angiography to renal, carotid and mesenteric arteries
(c) Cross over technique for contra-lateral approach from one femoral to the other
(d) When and how to use brachial or radial approach
(e) How to manage different TASC lesions by endovascular intervention.
(f) Early diagnosis and Management of complications during peripheral endovascular Intervention.
EXAM of the First Part
The examination of the 1st part (CAIRO) will be held on the last day of the course
This will include:
90 MCQ questions to be answered in 90 minutes.
It will be held through the internet by user name and password for each candidate. This password can allow him to react to the questions only through 90 minutes from being logged in.
The exam will be corrected and a consequent curve of result is put to select the Candidates who pass the 1st part examination (success is >60% of the attended questions ) Four candidates who achieve the highest score will be allowed to attend the 2nd part with their thesis at the vascular surgery department in Cologne university, a title of thesis from course faculty members will be delivered through email in 24 hours.
This thesis needs to include at least 10 cases, that will be done or assisted by him, supervised by one of the senior invited faculty members in Egypt.
This thesis will be presented by the candidate to Cologne vascular surgery board members (candidate will answer ten questions) during presentation the thesis at Cologne University
Failed candidates will receive only certificate of attendance of the first part training program
Training at Cologne University encompass
Basic and complex issues of peripheral endovascular interventions will be presented to the attending physicians, and will be addressed comprehensively by a rational mixture of theoretical lectures, case demonstrations, attendance of live cases at the table in the cath-lab, discussion of the cases of the day
Workshops concerning various EVAR prosthesis and working on 3D virtual
Reconstructed aorta and advanced simulators
Workshops for measurement of the EVAR Prosthesis with different software
Workshops on performing duplex ultrasound contrast enhanced diagnosis for Aortic segment to detect endoleaks
Lectures concerning endovascular procedures by the department staff
Access and assistance in operating theater for open aortic operations aorto-bi-femoral bypass
Daily lectures covering the above mentioned endovascular curriculum in an advanced level rather than the basic approach of part one addressing the candidates that met the inclusion criteria and passed part one exam after part one training
Exam of the second part
Written exams conducted by the German and Egyptian Faculty encompassing all endovascular and open vascular curriculum
MCQ problem solving cases clinically oriented
Oral exam and case solving and decision making and including x rays , CT angiograms , MRA, Duplex assessment and clinical scenario discussion and decision taking and preoperative and intraoperative and postoperative decision making
Candidates who pass the final examinations will receive a certificate of acceptance of their presented thesis, attendance of the second part training program and success of the final evaluation exam
Failed candidates will receive certificate of attendance of training course only