The Vascular Anesthesia Rotation gives the resident the opportunity to care for some of the most critically ill patients presenting to the operating room while honing their clinical and technical skills on a day-to-day basis. Many of these patients have diffuse atherosclerotic disease and coronary artery disease and severely compromised end organ function. These patients are considered the “sickest patients in the hospital”. Vascular surgery is associated with a high risk for morbidity and mortality due to the complex pathophysiology of vascular disease that can affect very organ system and meticulous perioperative care is required to assure good outcomes.
Surgical procedures range from the relatively minor, such as angiograms and dialysis access procedures to major surgeries such as peripheral arterial bypasses, carotid endarterectomies or repairs of abdominal or thoraco-abdominal aortic aneurysms or dissections.
The ability to perform endovascular procedures has revolutionized vascular surgery. Endovascular surgery is considered less “invasive” and may be associated with lower perioperative morbidity, however it is not without risks and requires painstaking anesthetic preparation and management. This is particularly true for complex endovascular aneurysm repairs that often require full hemodynamic monitoring including arterial, central venous and /or pulmonary artery catheters. Low thoracic or high abdominal aneurysms also frequently require the placement of spinal drains to protect the spinal cord from ischemia. At Columbia University Medical Center the anesthesiology team places the spinal drain prior to surgery and the vascular rotation provides the unique opportunity for senior residents to perform this procedure.
There are four state of the art operating rooms that allow any kind of open or endovascular surgery and these are fully equipped with the latest imaging technology.
The Vascular Anesthesia Rotation is geared to the CA-2 and CA-3 resident. Besides gaining experience caring for critically ill patients, the resident will become proficient in placing and interpreting arterial catheters and central venous and pulmonary artery catheters. There will be ample experience in performing spinal anesthetics and epidural catheters in addition to spinal drains. Arterio-venous fistulas placements are routinely done using ultrasound assisted regional anesthetics such as supraclavicular bocks. The residents will further be able to obtain an in-depth understanding of vascular physiology and the relationship of vascular disease with other organs systems.
We also provide a 1 or 2 year combined clinical and research fellowship training (Liver transplantation/major vascular) for those individuals interested in an academic career and gaining clinical experience in the anesthetic management of highly complex cases. The fellowship emphasizes comprehensive training in perioperative care of patients undergoing liver transplantation as well as major vascular surgical procedures. This fellowship can include a substantial amount of time for clinical or laboratory research.
Gebhard Wagener, MD, Division Chief
Tricia Brentjens, MD
HT Lee, MD, PhD
John S. Mercer, MD
Vivek Moitra, MD
Yejun Zhao, MD