Introduction to Vascular Science

Module details

Title

Introduction to Vascular Science

Type

Rotation

Module code

SPS103

Credits

10

Requirement

Compulsory

Aim of this module

This rotation will provide trainees with the knowledge and understanding of how vascular science contributes in the diagnosis and monitoring of patients with a variety of vascular diseases.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Document local patient diagnostic and treatment pathways for TIA, DVT and PVD.	Action View
# 2	Learning outcome 2,3	Competency Control infection risks in accordance with departmental protocols.	Action View
# 3	Learning outcome 2,3	Competency Minimise risks and hazards in compliance with health and safety policies.	Action View
# 4	Learning outcome 2	Competency Obtain a suitably completed request form, greet the patient, and check patient ID and recent clinical history.	Action View
# 5	Learning outcome 2	Competency Prepare the environment, equipment and patient for ABPI measurements.	Action View
# 6	Learning outcome 2,3	Competency Explain the procedure for each type of investigation to the patient, address any procedure-related questions they may have and provide information on how the patient will be informed of the results.	Action View
# 7	Learning outcome 2	Competency Treat patients in a way that respects their dignity, rights, privacy and confidentiality.	Action View
# 8	Learning outcome 2	Competency Take appropriate action to respond to the specific needs of the patient, as defined by department protocol.	Action View
# 9	Learning outcome 2	Competency Gain informed consent for ABPI.	Action View
# 10	Learning outcome 2	Competency Obtain and record accurate systolic pressure measurements from each arm and from each ankle vessel and calculate the ABPI.	Action View
# 11	Learning outcome 3	Competency Interpret and critically evaluate the differences between normal and abnormal results.	Action View
# 12	Learning outcome 2	Competency Conclude investigations	Action View
# 13	Learning outcome 4	Competency Manipulate an ultrasound probe to acquire a vascular ultrasound image in both longitudinal and transverse cross-sections describing the main features of the image.	Action View
# 14	Learning outcome 4	Competency Adjust the gain, depth and focus point of the ultrasound image.	Action View

Assessments

You must complete:

• 1 case-based discussion(s)
• 1 of the following DOPS/ OCEs:

Perform ABPI	DOPS
Perform Ultrasound	DOPS
Greet patient, explain the procedure, consent and explain the results	OCE

Learning outcomes

1. Document local patient diagnostic and treatment pathways.
2. Plan, prepare and acquire an ankle brachial pressure index (ABPI) from a range of adult patients.
3. Interpret the results of ABPI measurement, differentiating between normal and abnormal results.
4. Plan, prepare and acquire a vascular ultrasound image in both transverse and longitudinal views.

Learning outcomes

1. Recall the structure and function of blood vessels, capillary exchange, factors affecting blood flow, control of blood pressure and flow and circulatory routes.
2. Explain the diversity of vascular disease, patients and presenting symptoms, and recognise the expected co-morbidity associated with vascular disease and the health and safety risks during the investigation. 
3. Describe and evaluate the range of vascular science diagnostic techniques used to diagnose and monitor vascular diseases across a range of healthcare settings.
4. Describe the use of angiography, computerised tomography (CT) and magnetic resonance angiography (MRA) in the diagnosis of vascular disease.
5. Explain the basic practical and scientific principles and recognise when the use of an ankle brachial pressure index (ABPI) measurement is clinically indicated.
6. Explain and justify the range of surgical, endovascular and medical options used to treat vascular disease.
7. Explain the basic practical principles of obtaining a vascular ultrasound image.
8. Explain the infection risks associated with vascular ultrasound and cerebrovascular patients and how they are managed.

Indicative content

Structure and function of blood vessels, capillary exchange, factors affecting blood flow, control of blood pressure and flow and circulatory routes

Overview of peripheral vascular diseases and symptoms

• Nature of peripheral vascular disease
  • Atherosclerosis
  • Arteritis
  • Aneurysmal disease
  • Dissection
  • Microvascular disease
  • Arterial thrombosis
  • Trauma, punctures and false aneurysms
  • AV malformations/fistulas
  • Venous thrombosis
  • Venous incompetence
  • Extrinsic compression
• Anatomy of peripheral arterial disease
  • Extracranial and intracranial arterial disease
  • Lower extremity arterial disease (aorta-ankle)
  • Mesenteric and portal arterial disease
  • Aortic disease and aneurysms
  • Renal artery disease
  • Raynaud’s disease
• Peripheral arterial disease symptoms
  • Stroke
  • Transient ischaemic attack
  • Vertebrobasilar insufficiency
  • Thoracic outlet syndrome
  • Acute mesenteric ischaemia
  • Chronic mesenteric angina
  • Portal hypertension and liver disease
  • Swelling and tenderness (abdominal/groin/popliteal fossa)
  • Intermittent claudication
  • Chronic limb ischaemia, ulcers and gangrene
  • Renovascular hypertension
  • Raynaud’s disease
• Peripheral venous disease
  • Deep venous thrombosis
  • Superficial thrombophlebitis
  • Venous incompetence
  • Post-thrombotic syndrome
• Peripheral venous disease symptoms
  • Limb swelling
  • Hyperpigmentation
  • Ulceration
  • Varicose veins
    • Primary
    • Recurrent
• Risk factors for peripheral vascular diseases
  • Age, smoking, hypertension, diabetes, heart disease

Range of vascular science diagnostic techniques to diagnose and monitor vascular diseases in different settings

• Primary care
• Vascular surgical clinics
• One-stop transient ischaemic attack (TIA) clinics
• One-stop deep vein thrombosis (DVT) clinics
• Hospital wards
• Theatre and recovery

Overview of vascular scientific modalities

• Ultrasound
• Imaging
• Non-imaging Doppler
  • Continuous wave
  • Pulsed wave
• Plethysmography
  • Infrared photoplethysmography
• Transcutaneous oximetry (TCPO2)
• Laser Doppler
• Thermography
• Capillaroscopy

Overview of vascular science diagnostics tests

• Carotid and vertebral duplex
  • Diagnostic duplex
  • Preoperative assessment
  • Intraoperative assessment
  • Postoperative monitoring
  • Stent surveillance
• Transcranial Doppler (imaging and non-imaging)
  • Pre-carotid endarterectomy assessment
  • Intraoperative assessment
  • Sickle cell disease stroke risk
• Lower extremity arterial evaluation
  • ABPI and exercise testing
  • Segmental pressures
  • Toes pressures
  • Duplex ultrasound
• Upper extremity arterial evaluation
  • Brachial pressures
  • Exercise testing
  • Thoracic outlet assessment
  • Duplex ultrasound
• Detection of false aneurysms
  • Iatrogenic injury
  • IVDUs
  • Trauma
• Evaluation of arteriovenous fistulas
  • Vein graft surveillance
  • In-situ saphenous vein bypass
  • Reversed saphenous vein bypass graft
  • Prosthetic veins grafts
• Renal artery duplex
• Renal transplant duplex
• Portal and mesenteric duplex
• Evaluation of dialysis access grafts
  • Pre-fistula assessment
  • Post-fistula monitoring
• Aneurysmal disease
  • Peripheral artery aneurysms
  • Aortic aneurysms and screening programme
• Preoperative vein mapping
• Evaluation of lower extremity acute venous thrombosis
  • Deep venous thrombosis (DVT) duplex
  • Superficial thrombophlebitis duplex
• Evaluation of upper extremity acute venous thrombosis
  • Deep venous thrombosis (DVT) duplex
  • Superficial thrombophlebitis duplex
  • PICC line assessment
• Evaluation of chronic venous disease (post thrombotic incompetence)
  • Venous duplex
  • Infrared photoplethysmography (PPG)
    • Venous refilling times
    • Venous outflow
• Evaluation of varicose veins
  • Site of incompetence
  • Preoperative marking
  • Intraoperative guidance for endovascular procedures
• Evaluation of microvascular system

Other diagnostic techniques

• Angiography, MRA, CT

Treatment including risks and benefits

• Surgery
  • Carotid endarterectomy
  • Thoracic outlet
  • Open Abdominal Aortic Aneursyms (AAA)
  • Aorto-bifem, fem-pop
  • Open Varicose Vein (VV) – high ties, etc.
  • AV fistulas
• Endovascular
  • Endovascular AAA repair
  • Endovascular VV
  • Percutaneous transluminal angioplasty
  • Stents
• Ultrasound compression
• Duplex guided thrombin injection
• Medical therapies
• Risk factor modification

The basic practicalities of non-imaging Doppler

• Evaluation of peripheral vascular disease with an ABPI
  • Risk assessment and infection control
  • Patient preparation
  • Explanation of test
  • History taking
  • Patient positioning
  • Procedure and protocol
  • Recognition of normal and abnormal signals
  • Systolic blood pressure measurement using manual cuff and CW Doppler

The basic practicalities of vascular ultrasound imaging

• Obtaining an ultrasound image
• Relationship between ultrasound transducer and ultrasound image
• Very basic controls – gain, depth, focus

Activities

• Observe a range of routine investigations undertaken in Vascular Science and critically evaluate from a patient and service perspective how these investigations contribute to the diagnosis, management and care of patients with a range of *vascular diseases.
• Attend outpatient clinics and/or inpatient ward rounds and/or scientist-led clinics and prepare a portfolio of clinical cases. Discuss with your supervisor the diagnostic pathways linked to Vascular Science for a patient presenting with claudication, a suspected deep vein thrombosis and a suspected transient ischaemic attack.
• Attend outpatient clinics and/or inpatient ward rounds and/or scientist-led clinics and discuss with your supervisor the medical, endovascular and surgical treatment pathways, and critically evaluate the range of treatment options for patients with vascular disease (to include TIA, DVT and PVD).
• Attend outpatient clinics and/or inpatient ward rounds and/or scientist-led clinics to identify the range of needs of people with disabilities and gain experience of the links between Vascular Science, radiology, vascular surgery and other clinical specialisms in the investigation of vascular diseases, and reflect on the importance of a multidisciplinary approach to patient care.

 It is also recommended that trainees undertake the following clinical experiential learning:

• Attend a dietetic clinic where patients with vascular disease are treated and discuss the role of nutrition and exercise in the management of vascular disease.
• Attend a multidisciplinary meeting and reflect on the way the multidisciplinary team contributes to the care of patients with disorders of the cardiovascular system.
• Attend a hypertension clinic or diabetes clinic in primary or secondary care and discuss the links between cardiovascular risk factors and vascular disease.
• Observe endovascular and surgical procedures to treat vascular disease and reflect on the benefits and risk of treatment.