The goal of the SIR-RFS Vascular Disease Service Line is to create a universal vascular disease curriculum for all IRs based on four crucial educational pillars: clinical education, practice building, procedural education, and imaging education. The need for this arises from interventional radiology’s new role in medicine as a primary specialty, with which there is an implicit recognition that the IR is able to evaluate and treat pathology from a unique perspective. Now, the IR is expected to not only diagnose radiographically, but also clinically, while delivering minimally invasive therapy and providing longitudinal patient care. Through our initiatives, the VDSL works to provide a more standardized curriculum for like-minded medical students, residents, and fellows so that they may more effectively and completely manage their patients.
“The angiographer who enters into the treatment of arterial obstructive disease can now play a key role, if he is prepared and willing to serve as a true clinician, not just as a skilled catheter mechanic. He must accept the responsibility for the direct care of patients before and after the procedure; now see them as patients, not just as blocked arteries.” -Dr. Charles Dotter, visionary and father of Interventional Radiology
Justin Guan (Co-chair)
Mithil Pandhi (Co-chair)
Jason Van Rompaey
Joseph Hyung Kang
- CTisUs: Great website with CTA/CTV protocols
- RPVI (Registered Physician in Vascular Interpretation) Examination: Credentialing which documents the highest standard in vascular ultrasound interpretation, useful for an IR-run vascular US lab.
- Preventative Care
- Best Medical Therapy RFS Survival Guide
- 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
- 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
- Peripheral Arterial Disease
- Systemic Review of Treatment of Intermittent Claudication in the Lower Extremities RFS Journal Primer
- Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
- Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II): Overview of how to stratify aortoiliac, femoropopliteal, and infrapopliteal lesions and determine which patients should receive endovascular versus surgical therapy.
- Acute and Critical Limb ischemia: When Time is Limb
- PARTNER (Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care) Study
- CAPRIE (clopidogrel versus aspirin in patients at risk of ischaemic events) Trial
- HOPE trial (Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators)
- Thoracic Aortic Aneurysms
- Abdominal Aortic Aneurysms
- VDSL Journal Club 5/4/14: EVAR/TEVAR Fenestrated/Branched Grafts and 2013 AHA/ACC Lipid Guidelines hosted by Nassir Rostambeigi and Brandon Olivieri
- Endovascular Treatment Options for Complex Abdominal Aortic Aneurysms RFS Journal Primer
- The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. (ADAM Trial)
- Summary: A randomized controlled trial at US VA hospitals comparing immediate open AAA repair with imaging surveillance. 73,451 veterans, aged 50 to 79, were enrolled with asymptomatic AAA between 4.0 and 5.4 cm. On average, 1.2-1.4% of the study participants were found to have a AAA of 4.0 cm or larger. The mortality rate did not differ between the open repair and surveillance groups. There was no increase in operative mortality if surgery was delayed until aneurysms reached a diameter of 5.5 cm. However, a higher rate of myocardial infarctions were observed in the surveillance group (3.8% vs 1.0%). Authors concluded that surgical intervention can be reasonably delayed until aneurysms grew to at least 5.5 cm. Subsequent follow-up examined risk factors in the same cohort. Age, smoking, family history of AAA, and atherosclerotic disease were the primary positive risk factors for aneurysms 4 cm or larger. Primary negative risk factors included female sex, diabetes, and black race. The greatest association was seen with smoking, which demonstrated 4- to 6-fold greater risk.
- The UK Small Aneurysm Trial (UKSAT)
- Summary: A randomized controlled trial at 93 UK hospitals to determine ideal management for infrarenal AAA between 4.0 and 5.5 cm. A total of 1090 patients were enrolled. 563 were randomized to early elective open repair and 527 were randomized to ultrasound surveillance until the AAA exceeded 5.5 cm, increased at a rate greater than 1 cm/yr, or became tender. The 30-day mortality rate was 5.5% for the surgery group and 7.2% for the surveillance group. After 12 years, the mortality rate was 63.9% for the surgery group and 67.3% for the surveillance group. Neither metric was considered statistically different. The authors concluded that surveillance remains a safe option until the aneurysm grows to 5.5 cm or becomes symptomatic.
- Dutch Randomized Endovascular Aneurysm Repair (DREAM) trial
- Summary: A randomized controlled trial at 26 centers in the Netherlands and 4 in Belgium to compare the rates of mortality and morbidity between elective open AAA repair and endovascular AAA repair. 351 patients were enrolled with an AAA of at least 5 cm in diameter. Results indicated an 89.6% survival rate for open repair and 89.7% for endovascular repair. Aneurysm-related deaths accounted for 5.7% of open repair patients, but 2.1% of endovascular repair patients. All related deaths occurred secondary to perioperative complications and complication-free rates at two-year follow-up were 65.9% for open repair and 65.6% for endovascular repair. Authors ultimately concluded that although early survival benefits were seen with the endovascular repair group, any benefits were lost within the first year of follow-up. The authors further explain that follow-up in excess of two years may find that the endovascular group ultimately has worse outcomes but that those data were not obtained in the trial. Recommendations were made that patients be optimized with medical management (beta-blockers, anti-platelet therapy, and statins) regardless of the method for AAA repair.
- Endovascular versus Open Repair of Abdominal Aortic Aneurysm (EVAR 1) Trial
- Summary: A randomized controlled trial at 34 centers in the UK to compare endovascular repair and open repair for AAA measuring at least 5.5 cm in diameter by CT. 1082 patients were enrolled in the study. The study revealed that 30-day mortality was 2/3 lower in the endovascular repair group (9 deaths in the endovascular group vs. 25 in the open repair group). All-cause mortality at four-year follow-up was similar in the two groups at 28%. Aneurysm-related mortality, however, was 4% in the endovascular group and 7% for the open repair group. With regard to complications, the rate for the endovascular group was 41% at four-year follow-up compared to 9% in the open repair group. The need for re-intervention was also greater for the endovascular group at 20% compared to 6% in the open repair group. At the time of treatment, the cost difference between endovascular repair and open repair amounted to $1,613 ($10,818 vs $9204). After four years, the difference in cost between the two groups was $3311 ($13257 vs $9946).
- The ACE trial: a randomized comparison of open versus endovascular repair in good risk patients with abdominal aortic aneurysm.
- Summary: A randomized controlled trial in 25 centers in France attempted to clarify the role of endovascular repair in low-risk patients following the mixed-results of EVAR 1 with higher risk participants. 299 participants were enrolled with AAA greater than 5 cm by CT. Three deaths occurred perioperatively (2 in the endovascular group, 1 in the open repair group) but did not yield a statistically significant difference between groups. An additional 26 patients died during 3 year follow-up without differences in survival rates between the two groups (96.5% for open repair vs 95.2% for endovascular repair). Aneurysm-related deaths were greater for the endovascular group (4%) compared to the open repair group (0.6%). Neither all-cause mortality nor deaths attributed to aneurysms were statistically different between the two groups. Of the major adverse events at 3 year follow-up, the endovascular group demonstrated a statistically significant re-intervention rate (16% vs 2.7% for open repair). AAA rupture was considered the greatest post-operative cause of morbidity/mortality in the endovascular group.
- Outcomes following endovascular vs open repair of abdominal aortic aneurysm (OVER): a randomized trial.
- Summary: An ongoing randomized controlled trial at 42 VA Medical Centers to compare outcomes after endovascular or open repair of AAA. 881 veterans are enrolled in the study with an AAA of at least 5.0 cm. Perioperative mortality was significantly higher for the open repair group (2.3% vs 0.2%). At two year follow-up, there was insignificant difference in all-cause mortality. No significant differences were seen when examining re-interventions or aneurysm-related hospitalizations. Incisional hernias were common for the open repair group with a re-intervention rate of 4.9%. The endovascular group most frequently experienced endoleaks leading to a re-intervention rate of 4.1%. Follow-up is continuing to obtain longer-term data.
- Endovascular Repair of Aortic Aneurysm in Patients Physically Ineligible for Open Repair (EVAR 2) Trial
- Summary: A randomized controlled trial at 31 centers in the UK to compare endovascular repair with medical therapy to medical therapy alone in patients unable to undergo open repair. 338 patients were enrolled in the trial with 166 in the endovascular group and 172 with medical management alone. The 30-day mortality rate for the endovascular group was 9%. Four years after randomization, 64% of patients had died (142 deaths with 42 attributed to the aneurysm). No difference was seen between the two groups with either all-cause mortality or for aneurysm-related mortality. The difference in cost between the two groups was $8649 ($13632 for the endovascular group vs $4983 in the medical management group). The authors have concluded that there was no difference in outcome for patients for whom open repair was considered unsafe, regardless of the intervention. In light of these data, the authors placed an emphasis on improving patient cardiac, respiratory, and renal function before attempting endovascular repair.
- Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial.
- Summary: A randomized controlled trial at 20 European and Western Asian hospitals to determine the survival advantages of early endovascular repair vs surveillance in patients in small AAAs (4.1 to 5.4 cm by CT). 360 participants were consented with 96.4% ultimately participating. At 54 months, the mortality risk in the endovascular group was 14.5% vs. 10.1% in the surveillance group. 10 re-interventions were necessary in the endovascular group, compared to zero in the surveillance group. In this study, the most common complication requiring re-intervention were endoleaks. The perioperative mortality rate was equal between groups, as was the aneurysm-related mortality rate. The authors concluded that annual CT surveillance of small aneurysms remains a safe alternative to early intervention.
- The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial.
- Summary: A randomized controlled trial at 4 UK centers to determine the mortality benefit from screening men for AAA using ultrasound. 67,770 men participated in the study, with 33,883 randomized to screening. A 4.9% prevalence of AAA was detected. At 10 year follow-up, the mortality rate in each group was about 30%. Of those who died, 58.2% did not experience a ruptured aneurysm or undergo AAA repair. In total, the rate of aneurysm-related mortality was 0.66% in the screening group vs 1.12% in the control group. This yielded a relative risk reduction of 42%. The benefits of screening continued to increase during the 13-year follow-up when examining the rate of aneurysm-related mortality and AAA rupture rate. The number needed to screen to prevent a single aneurysm-related death over 13 years was 216. The authors concluded that the net benefit of screening outweighed any perceived harm, since this ratio is favorable when compared to other screening tests. The authors also evaluated the cost-effectiveness of screening in the UK. The greatest costs incurred were from elective and emergency AAA repairs–both of which are reduced with screening.
- Deep Venous Thrombosis (DVT) RFS Survival Guide
- Fibrinolysis for Patients with Intermediate Risk Pulmonary Embolism. The PEITHO Trial. RFS Journal Primer
- Acute Pulmonary Embolism—Part 1, Epidemiology and Diagnosis
- Acute Pulmonary Embolism—Part 2, Treatment and Prophylaxis
- Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of VTE, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
- Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial.
- Chronic Venous Insufficiency
- Transjugular Intrahepatic Portosystemic Shunts (TIPS)
- Dialysis Management, Central Venous Access, and Central Venous Occlusions
- A Single-Incision Technique for Placement of Implantable Venous Access Ports via the Axillary Vein. RFS Journal Primer
- Extremities Retrospective Study in 23 Patients of the Self- Expanding Sinus-XL Stent for Treatment of Malignant Superior Vena Cava Obstruction Caused by Non-Small Cell Lung Cancer. RFS Journal Primer
- The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) ™ has provided evidence-based clinical practice guidelines for all stages of chronic kidney disease (CKD) and related complications. Read here about anything you may want to know about managing patients with chronic kidney disease.
- NKF KDOQI Guidelines for Vascular Access
- Adrenal Vein Sampling
- International Society for the Study of Vascular Anomalies 2014 (newest) Classification
- Vascular Malformations: Classification and Terminology the Radiologist Needs to Know
- Thoracic Aorta Trauma RFS Survival Guide
- Splenic Trauma RFS Survival Guide
- Pelvic Trauma RFS Survival Guide
- Extremity Trauma RFS Survival Guide
- Effectiveness of Prophylactic IVC Filters in Trauma Patients RFS Journal Primer
- Interventional Radiology VDSL Practice Building: Strategic Planning by Raj P. Shah MD, MBA
Please select from the available survival guides below. Those without a link are coming soon.
Pulmonary Embolism (CDT/Embolectomy)
Multiple Choice Question Banks: This is a standard way of simply building our knowledge-base over the course of residency. Doing at least 10-20 questions a week is a feasible way to augment and maintain your clinical knowledge through radiology residency.
- MKSAP: This 1200 Qbank is what medicine residents finish in about 2 years to prepare for IM boards. It also gives current guidelines and reference articles for each question.
- USMLEWorld QBank for IM Boards: This Qbank with over 950 questions used by medicine residents to prepare for IM boards.
Internal Medicine Intensive Review Courses: Typically about 5 days in length, these courses would be a great way (after the core exam is taken) to provide a knowledge boost to get ready for a career of patient care. Imagine going to one of these after having done a question bank or MKSAP!
- Mayo Clinic: $1200 for residents
- Harvard: $1100 for residents
- Cleveland Clinic: $1100 for residents
- UCSF: $800 for residents
- Colombia University in NY: $350 for residents
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