Albany Medical Center is the referral center for vascular surgery in the Capital Region. We are fortunate to work with surgeons who are some of the foremost pioneers in vascular surgery. The division of vascular anesthesia provides care to patients undergoing major vascular surgeries including thoracic aortic aneurysm repair, abdominal aneurysm repair and peripheral revascularizations. We also perform a large number of endovascular repairs for aneurysms. The procedures are often complex and the patient population is often the sickest, frequently requiring periopertave ICU care. A multi-disciplined team approach is frequently employed to treat the patient. The division of vascular anesthesiology comprises of six dedicated anesthesiologists who are board certified, fellowship trained, and TEE experts. TEE experience is not only helpful in monitoring the patient introperatively, but enables them to make on the spot diagnosis for life threatening conditions. The attention and training our residents receive in the vascular anesthesia rotation is frequently one-on-one.
Our residents gain experience in managing open and endovascular Aortic and Thoracic Abdominal Aneurysm repairs. These advanced cases familiarize them with invasive monitors such as A-lines, Central Venous Lines, Lumbar drains, and advanced Cardiac output monitors such as TEE's, Pulmonary Artery catheters, and the new arterial cardiac output monitor: the Flotrac monitor.
While many institutions still perform Carotid Endarterectomys under general anesthesia, our residents become experienced with managing these complex cases under Regional Anesthesia. Again, our surgeons are known as pioneers in this approach and this department was there in the early years of developing this technique.
The resident spends 1 month in the vascular rotation in the CA-2 year. This rotation provides exposure to a wide variety of vascular cases. Residents continue to gain more experience during their advanced OR rotations.
Understand coexisting pathology in vascular patients and strategies to deal with it
Understand the physiology of clamping and unclamping of aorta
Perioperative management of occlusive and aneurysmal aortic disease
Management of carotid endarterectomies
Perform superficial and deep cervical block
Management of lower extremity revascularization
Management of thoraco- abdominal aneurysms
Understand spinal cord ischemia
Perform spinal drainage
Comments typical of a resident on the Vascular Anesthesia rotation:
The vascular surgery group here has three dedicated operating rooms. Typical cases involve endovascular abdominal repairs, endovascular thoracic aortic aneurysm repairs, open AAAs, lower extremity bypass surgeries, carotid endarterectomies, lower extremity amputation and ulcer debridements to name a few. The endovascular cases take place in OR 1 where an image intensifier is always available.
While cases are scheduled the previous day, it is important each morning to verify the cases in your room as the assignments are constantly in flux. It is the exception that one will perform all the cases scheduled the previous day, let alone that morning, as cases are shuffled between operating rooms depending on which cases is completed first.
Techniques to be familiar with include radial arterial lines as these will be performed on almost every case. One learns both superficial and deep cervical plexus blocks. Central lines are placed when required, however in most cases two functioning intravenous lines are sufficient. Prior to the vascular rotation it is unlikely that one has placed a spinal drain, so this will initially be demonstrated for you. The TEE is also available for monitoring and assessment of cardiac function. Otherwise the room set-up is much the same as the rest of the general OR.