Vascular Anesthesia Rotation

The vascular anesthesia rotation gives residents 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, 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 every 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 they 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 arterial catheters and central venous and pulmonary artery catheters and interpreting waveforms. There will be ample experience in performing spinal anesthetics and epidural catheters in addition to spinal drains. We routinely perform the majority of arteriovenous fistulas placements using ultrasound-guided regional anesthetics such as supraclavicular blocks. 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.