Vascular Special Interest Area (SIA)
Introduction
The advanced training module in Vascular anaesthesia is for ST6-7 trainees. It is designed to provide trainees with clinical experience in the peri-operative care of complex vascular patients. Involvement in teaching, clinical audit/ quality improvement and management is also important when completing this module. This programme is for a period of 6 months (9 months LTFT).
On completion the trainee is expected to have acquired a level of knowledge and experience suited to management of both elective and emergency vascular patients. The trainee is expected to have participated actively in QI, Research and Teaching and should have reached a level of competence suitable to take up a post of Consultant Anaesthetist with an interest in Vascular anaesthesia.
Caseload
We are a busy vascular unit with a high case load of major and complex work. Are caseload covers the whole county, as well as South Glos and the Swindon area. NVR data (from 2023) shows we did 62 elective AAA, half of which were elective. We also during that year did almost 200 lower limb revascularisation procedures, and over 50 carotid endartectomies.
We don’t do thoracic aneurysms, complex supra-renal aneurysms or FEVARs/TEVARs. However there is plenty to keep most people interested!
There is an elective vascular list every day in GRH with 2 hot lists (emergency lists) a week as well, one (usually AV fistula list) in CGH a week and sometimes some minotr vascular in the community. There are also ad hoc lists/cases in the IGIS hub depending on the case mix.
Programme
It is anticipated that the trainee will be scheduled 2 days per week in Vascular theatre and any service lists will aim to be in vascular (where possible). There may be times when there is a more junior trainee scheduled to the list as well as the advanced trainee. This is perfectly acceptable as there will be completely different training needs and requirements, and gives an opportunity to obtain the required teaching aspect of the module. Vascular Pre-assessment clinic is mostly on Thursdays and the advanced trainee will be scheduled to attend here at least once per month (if possible).
Theatre lists
Major cases
Most surgeons manage their own lists and waiting lists. They have limited clerical support and so it is best to contact the surgeons directly to ask when they have certain operations coming up. Once you know, then liaise with the rota writer to ask to be allocated to these lists.
The AAA screening coordinator is Glenda Turton (glenda.turton@nhs.net). The group contact is ghn-tr.aaa.screening@nhs.net
GRH performs the full range of upper and lower limb revascularisation procedures including CEA, Aneurysm surgery, Fem-pop bypass, Axillo-bifem bypass, as well as radiological cases either in the IGIS hub in GRH and some other work done in CGH.
MDT meetings
There is a vascular MDT meeting which happens every Tuesday morning. It is currently being run remotely, via Microsoft Teams and is very interesting. The meeting is held every Friday, from 13:30 and lasts for about 2 hours.
meg.lack@nhs.net is the Vascular MDT & Pathway Co-ordinator (0300 422 3544).
On call
The trainee will be on the third on call rota whilst undertaking their module. This is a 1:8 rota.
Departmental teaching sessions
Ideas include: ROTEM teaching, Tea-trolley teaching, Blocks, Major haemorrhage sim/ruptured AAA (Jo Cornes – Simulation lead), Endovascular emergencies sim – remote site etc.
Department anaesthetic teaching happens at 8am in person and virtually. The advanced trainee would be welcome to lead a session or two during their module.
Preoperative Assessment Clinics
High risk vascular patients are seen face-to-face in the pre-operative assessment clinic, usually on a Thursday. Email the rota coordinators to get list of patients to be seen and to get allocated on CLW.
Quality improvement and audit projects
The Advanced trainee is expected to play an active role in Vascular QI/research projects. Please consult the module leads for ideas. There will be ample opportunities to present work locally and we would encourage and support you to submit your projects to regional and national meetings.
External Clinical placements
It may be possible to arrange a few days at Southmead hospital to experience complex endovascular repair, contact Karine Zander early if interested.
Structured Learning Events (SLEs)
There is no minimum requirement for numbers of SLEs during the SIA module but it is useful to undertake these regularly in a variety of areas and to use them as evidence towards your sign off at the end. You should sim to achieve entrustment level 4 by the end of the 6 months.
Other useful contacts/info
Cardiac physiologists for switching on and off ICDs/Defibs peri-op
Vascular SpR on-call (Gen Surg SpR)
Renal SpR on-call
Blood bank
CPD:
VASGI conference attendance isn’t mandatory but would be useful. It is worth joining the VASGBI that publishes concise up to date recommendations as well as offering trainee grants for projects.
It may be possible to help organise or facilitate an event, contact Ronelle Mouton or Karine Zander at NBT.
Vascular SIA HALO sign offs
The module leads, Dr Kidd and Dr Kellie will be responsible for supervising your module and signing off your HALO at the end of the 3-6 months.
Please refer to the SIA HALO Guidance in Appendix 1 of this document to see Key Capabilities and examples of evidence needed for HALO sign off at the end of the SIA module.
Anaesthetic Consultants with a specialist interest in Vascular
All the general anaesthetists will do vascular lists. The following people do a regular list.
Dr Lawrie Kidd (Vascular Lead)
Dr Hugo Hunton
Dr Robin Cooper
Dr Ian Crabb
Dr Yvonne Marney
Dr Toby Jacobs
Dr Neil Kellie
Dr Sophie Scutt
Dr Jane Donald
Vascular Surgeons
Mr Richard Wilson
Mr David Cooper
Mr Sachin Kulkarni
Mr Vivek Vardhan
Miss Joanna Manson
Miss Emily Kirkham
There are also a group of IR radiologists who do a lot of vascular work.
Dr Guy Hickson
Dr Amy Greenwood
Dr Ray Ramnarine
Vascular ANPs
These are a great source of wisdom – ghn-tr.vascularanp@nhs.net
Module leads: