Medical and Surgical Management of Vascular Disease

Details

Title

Medical and Surgical Management of Vascular Disease

Type

Stage One

Module code

HPS126

Requirement

Compulsory

Module objective

By the end of this module, the Clinical Scientist in HSST will be able to apply their knowledge, skills and experience in the clinical setting to undertake or participate in medical or surgical therapy as considered appropriate within their clinical environment. This will include the appropriate steps required to comply with legislation and clinical governance to ensure the service is both safe and effective. They will also be able to apply a detailed knowledge of management options available to the supervising clinician based on the investigative findings. Whilst working in practice the Clinical Scientist in HSST will be expected to critically evaluate their own response to both normal and complex situations consistently demonstrating the professional attributes and insights required of a Consultant Clinical Vascular Scientist.

Knowledge and understanding

By the end of this module, Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge to the treatment options for a range of patients, including those with complex problems with respect to vascular disease including:

 Management and Treatment options for Peripheral Arterial Disease:

• Medical treatment – pain control, antibiotics, best medical therapy, supervised exercise programme, risk modification (weight, diet, smoking, hypertension, diabetes).
• Angioplasty, stenting, artherectomy, embolectomy, hybrid procedures.
• Endarterectomy, bypass surgery (synthetic and vein grafts).
• Amputation with or without limb prosthetics.

Treatment of Pseudo aneurysm 

• Type and cause (e.g. iatrogenic, IV drug abuse)
• Ultrasound guided Thrombin injection
• Ultrasound guided Compression
• Surgical repair

Management and treatment of Abdominal aortic aneurysm

• Surveillance options and intervals.
• Best Medical therapy, if patient considered unfit for intervention.
• Open Surgery (infra-, supra-renal and thoracic involvement).
• Endovascular repair, including a detailed knowledge of stent options and types available.
• Hybrid procedures.

Management and Treatment of peripheral aneurysms

• Surveillance options and intervals.
• Best medial management (blood pressure, anticoagulation for large thrombus load).
• Open repair.
• Endovascular options including stents.

Management and Treatment options for Venous incompetence with or without Venous Ulceration

• Conservative management
• Surgery including ligation stripping and avulsions
• EVLT
• Radio frequency ablation
• Foam sclerotherapy
• Four layer compression dressings
• Role of compression stockings
• Treatment of venous stenosis or compression (e.g. May-Thurner Syndrome, post Deep Vein Thrombosis)

Management and Treatment of Deep venous thrombosis

• Medical therapy including anticoagulants
• National Guidelines (NICE)
• Venous thrombectomy
• Role of vena cava filters
• Surveillance for post thrombotic syndrome
• Role of compression stockings
• Treatment of residual venous stenosis

Management and Treatment of Carotid artery disease

• Best medical therapy
• Carotid endarterectomy (conventional and eversion techniques)
• Carotid Angioplasty and stenting.
• Carotid bypass and reconstruction surgery
• Hybrid procedures

Management and Treatments of Compression syndromes including Thoracic outlet syndrome (TOS) and popliteal entrapment

• False positive incidence in general population
• Conservative management and physiotherapy
• Surgical options including 1st rib resection (TOS)
• Surgical exploration and decompression of popliteal fossa

Renal Failure

• Management options for dialysis (peritoneal or access fistula)
• Types of access procedures

Vascular Malformations

• Conservative treatment or surveillance.
• Endovascular options including, stents, coils, sclerosing agents and onxy.
• Surgical options, including (ligation or excision).
• Post treatment surveillance.

Inflammatory Vascular Disease

• Types of vasculitic inflammatory disease including autoimmune disorders with vasculitic involvement.
• Range of specialties dealing with inflammatory vascular disorders including Vascular Medicine and Rheumatology.
• Treatment options and pathways including best medical therapy.

Technical and clinical skills

By the end of this module, the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current evidence and its application to the performance and mastery of the technical skills required to perform or assist with appropriate medical or surgical management of vascular disease and will:

• provide guidance on the applicability of imaging tests related to the patient’s clinical presentation and condition.
• provide guidance on the applicability of imaging or other appropriate monitoring (e.g. TCD) to be carried out during a surgical procedure.
• assist in the guidance of therapeutic procedures (Endovenous ablation, sclerotherapy).
• operate, optimise and maintain (including safety checks) equipment required to perform the procedure (e.g. EVTL laser system).
• undertake training in laser safety.
• apply infection control and sterile techniques for interventional and therapeutic procedures.
• order and maintain consumables required to perform a procedure (e.g. stents, catheters and guide wires).
• prepare the environment in which the procedure is to be performed.order and maintain consumables required to perform a procedure (e.g. stents,catheters and guide wires).
• perform tasks to decontaminate equipment and environment following procedure.

By the end of this module, the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills with respect to the medical and surgical management of patients with vascular disease. They will communicate effectively with patients, relevant clinicians and other healthcare professionals and will:

• advise patients and colleagues as appropriate.
• explain, when appropriate, the procedure to the patient, take a clinical history and obtain informed patient consent.
• interpret the results from the range of diagnostic tests that have been performed.
• extend or adjust the scope of the test based on the patient’s condition and management options.
• choose and provide expert opinion on the most appropriate treatment for the clinical presentation.
• perform or assist with the therapeutic procedure / treatment in a safe and orderly environment.
• obtain urgent support from supervising clinician when required.
• report on the outcome of the procedure to the patient and supervising clinician
• arrange patient follow up as required.

Attitudes and behaviours

By the end of this module, the Clinical Scientist in HSST will be expected to evaluate their own responses to both normal and increasingly complex situations. They will also be expected to consistently demonstrate the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior medical staff including specialist consultants and will:

• lead and promote a culture of interaction with service users and patients.
• recognise the importance of the multidisciplinary clinical team and take responsibility for ensuring appropriate and effective decision-making processes are in place.
• support and contribute to the development of multidisciplinary clinical team working and work with the team to determine scientific service priorities.
• balance data confidentiality, security and protection, and the sharing of data with relevant stakeholders, including patients, to ensure high quality patient-centred care.
• apply rigorous scientific critiques to the evaluation of data related to clinical practice in the support of clinical decision making and patient management.
• critically reflect on your practice to identify personal development needs to transform and maintain up-to-date practice and knowledge of advances in the medical and surgical management of vascular disease.