Vascular Division

Vascular division members

The Division of Vascular Anesthesia provides high quality anesthesia care for some of the sickest patients in the operating rooms. Our faculty enjoy and demonstrate expertise in the management of complex and challenging clinical cases, specializing in high acuity anesthesia care in geriatric patients. The Division provides anesthesia for nearly 150 carotid endarterectomies, 25 to 50 open aortic cases, and over 150 lower extremity bypass operations each year. The Strong Hospital Operating Rooms have a dedicated endosuite and nursing team, allowing the vascular surgeons to perform about 50 endovascular carotid stent operations and over 100 endovascular thoracic and abdominal aortic stent procedures annually. Our faculty are proficient in both the endovascular as well as open procedures, aware of the benefits and potential pitfalls of every type of procedure. Managing approximately 1,400 cases per year, the Vascular Anesthesia Division provides a wealth of clinical experience for our residents to perfect their skill in caring for patients with cardiac disease who are undergoing noncardiac surgery. Residents learn to manage significant blood loss and its complications in these highly complex patients, using invasive monitoring and potent vasoactive and cardiac drugs. In addition to general anesthesia, regional anesthesia is routinely used, including cervical plexus blocks for awake carotid surgery, upper extremity blocks for AV access, lower extremity blocks (femoral and sciatic) for peripheral surgery, and thoracic epidural catheters for postoperative pain management in abdominal aortic surgery patients.

Our educational programs are aimed at both residents and faculty. Our residents spend a focused and concentrated two-week introduction to vascular anesthesia as a junior resident and then an additional two-week advanced rotation as a senior resident. First, residents begin to learn the pathophysiologic changes that occur with vascular surgical procedures and the appropriate anesthetic management of vascular patients. Appropriate preoperative evaluation of vascular patients is emphasized, and there is an introduction to intraoperative and postoperative care for various vascular surgical procedures. More independence and detailed intraoperative and postoperative care are the emphasis of the advanced rotation. Teamwork with surgeons and nurses is emphasized during both rotations. All cases for the week are reviewed with the entire team – surgery, anesthesia, and nursing – each Monday morning during a case conference to allow for open communication of plans and concerns.

The Division has produced numerous references for residents and faculty regarding the care of vascular patients. Readily available via the internet on an electronic course organizational system, the “Vascular Anesthesia Manual” reviews aortic, carotid, and peripheral vascular surgical procedures and anesthetic management including pertinent pathophysiology. Additionally, care plans for endovascular procedures are presented as well as reviews on pacemakers, hemostasis and arrhythmias. Best Practice Perioperative Care Plans have been developed by the Division using evidence-based approach for anesthetic management for:

• Radio-Frequency Ablation of GSV Procedures
• Bicarbonate Infusions to Prevent Contrast Induced Nephropathy
• Spinal Drains for Thoracic Aortic Procedures

The Vascular Division annually provides highly-regarded educational offerings on cross-clamp physiology, acid-base balance, preoperative cardiac evaluation, and carotid procedures. This year the Division is excited to offer two new educational sessions:

• Stents and More Stents - a 1.5 hour session reviewing all the implications of endovascular procedures from the intricacies of the procedures to potential complications
• Vascular Education Day – a full day vascular interactive mini-conference with invited vascular surgery residents and fellows utilizing case discussions, team-based learning and simulation to teach preoperative evaluation, issues with carotid surgeries including complications and the intricacies of open aortic procedures. Teamwork and communication skills among surgery, anesthesia and nursing will also be emphasized during the learning sessions. Pre and post-testing will be provided to evaluate students and provide feedback on learning.