The first year of the fellowship involves a clinical experience in the total preoperative, intraoperative, and postoperative management of complex vascular patients characteristic of a county experience, a VA vascular practice, and an academic medical center. Approximately 4 months will be spent each at Santa Clara County, the VA, and Stanford University Medical Center. Call responsibilities are shared between the 1st and 2nd year fellow and the senior integrated residents.

Vascular Surgery Service: The VA vascular surgery service is comprised of the Fellow, a clinical PGY-2 general surgery resident, and one surgery intern. The county vascular surgery service is comprised of the Fellow, a physician’s assistant, and one surgery intern. The Stanford vascular service is comprised of the fellow, a clinical PGY-3 vascular or cardiac surgery resident, an intern, and a 3^rd or 4^th year medical student. On-call evening and weekend coverage is shared between the fellows and senior level integrated residents. The Fellow does not participate in any other general surgery call. Dedicated Clinical Nurse Coordinators, Nurse Practitioners, or Physician’s Assistants provide preoperative teaching, scheduling of routine studies, and aids in the discharge planning, as well as supports other daily clinical activities of the service.

Conferences: The Fellows and senior residents are responsible for organizing the weekly vascular conference, which is held every Monday morning. The conference alternates every other week between Interesting Case presentations and vascular M&M. There is a weekly didactic Rutherford basic science review conference organized by the faculty. Journal club is held on a monthly basis reviewing current controversial topics.

Outpatient Experience: The Fellows and senior residents are to be in clinic at least one half day per week, often up to one full day weekly, and participates in the preoperative evaluation and postoperative follow-up of patients with the attending surgeons.

Benefits: Time is allowed for presentations at national meetings, board examinations, and up to three weeks of paid vacation. The cost of California licensure and a $2,000 annual educational stipend is provided through the Residency Office. In addition, a $3,000 stipend is given to cover moving expenses to Northern California.

• Stanford Vascular Service:  An intense operative experience consistently involves over 400 open and endovascular cases during a 12-month period, over 350 of which are RRC Category I major vascular reconstructions. This is well above the 90% percentile of all the vascular fellowships in the country. The case mix is relatively evenly distributed among aortic, cerebrovascular, and distal arterial revascularizations. Within each of the major categories, approximately 25% are "redo" reconstructions. The 2nd year fellow also is involved with a large proportion of endovascular cases, including aortic stent-grafting with branched/fenestrated devices, diagnostic arteriograms, and peripheral angioplasty/stenting. The team consists of the fellow, a PGY-3 resident, 1 surgical intern, one vascular sub-intern, and one 3rd year medical student. The vascular surgery service shares a 28-bed Cardiovascular Intensive Care Unit with the Cardiothoracic service. It has an open-service structure and all the vascular patients are managed by the vascular service in conjunction with a Cardiac or Surgical Intensive Care Unit service. There is no in-house call. There is particular emphasis during the second year of fellowship on complex EVAR and TEVAR, of which over 150 cases annually are performed. Access and experience with multiple new devices in clinical trials is expected.    
• Research: The Division has an active clinical trials program as well as well-funded research laboratories in biomechanical engineering and vascular biology. Stanford's location near the heart of Silicon Valley provides a unique opportunity for collaboration with biotechnology industries for medical device research and development. In addition, the vast case volume offers a tremendous amount of material for conducting prospective and retrospective clinical studies, either within the Division or with our vascular imaging divisions (Interventional, MR, and CT). The Fellow is expected to participate in research projects leading to presentations at national meetings and write peer-reviewed publications.
• Conferences: In addition to the weekly vascular conference, the senior Fellow is expected to actively participate in the weekly Vascular Surgery conferences. Other educational activities include the weekly Basic Science Conference, quarterly Vascular Surgery Journal Club, and weekly teaching sessions with residents and medical students.

General Surgery residents receive their vascular training as junior residents on the University Vascular Surgery service during their PGY-I and PGY-III years, when they are actively involved in the daily management of the vascular patients. The PGY-II in General Surgery obtains additional vascular experience at the Palo Alto VA hospital and affiliated institutions. At the completion of their training, the General Surgery Chief Residents typically will have performed 70 to 120 major vascular cases, which is well above the RRC guidelines.

Radiation exposure in vascular surgery – understanding and mitigating risks to patients, physicians and the pregnant vascular surgeon 

The January 2011 supplemental issue of the Journal of Vascular Surgery provides a timely, in-depth exploration of radiation exposure in vascular surgery – its history, its potential to harm, preventative measures to forestall injuries to patients and physicians, and current federal regulations on its use. A dedicated effort from the Society for Vascular Surgery’s Women’s Leadership Committee, the supplemental issue also provides content that speaks to the unique concerns of current and future women in the field. In particular, women planning to have children may be particularly interested in whether pregnancy is a safe and feasible endeavor as a vascular surgeon. As Shaw and colleagues point out in their review of pregnancy and radiation exposure, much is known about the effects of radiation dosages and fetal outcomes. This knowledge equips female surgeons and vascular programs with evidence-based methods of minimizing radiation dose during pregnancy such that building a family and being a vascular surgeon do not have to be mutually exclusive endeavors.