EGYPTIAN BOARD FOR VASCULAR

AND ENDOVASCULAR SURGERY

EBVES

CURRICULUM
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 PREFACE

 The Egyptian Fellowship Board, and the Egyptian Board of Vascular-Endovascular

Surgery (EBVES), worked collaboratively to make this curriculum available for
trainees’ guidance and support.
 Worldwide, postgraduate medical education is now governed by sets of
academic standards that describe the qualities and abilities of graduates. In
addition, there are standards for the training processes, trainees selection and
methods of assessment to ensure transparency and clarify expectations.
 The Egyptian Fellowship boards has already defined and published its standards
for the general and professional competencies expected from our graduates in
different specialties upon successful completion of training. These expectations
are clearly reflected in the VES curriculum.The curriculum describes what
trainees should know and be able to do upon completion of training. The
curriculum also describes in details, expectations from trainees at the end of the
training program.
 Methods of assessment and examination regulations are also available in the last
section of the curriculum.
 All topics covered during clinical and theoretical studies are outlined. This will
help trainees to guide their readings and their choice of learning activities. In
addition, all required procedures are listed together with the expected
performance.
 Mandatory courses are also mentioned and the Egyptian Fellowship Board will
work closely with EB-VES to ensure proper organization of courses at appropriate
training stages.
 We hope that all our trainees, trainers and educational supervisors will follow
the guidelines provided in the curriculum and cooperate with The Egyptian
Fellowship Board and EB-VES to implement the curriculum in the best ways.
 This curriculum will be revised and updated every 3 years.

Secretary General
The high Committee of Medical Specialties
Professor Abdelhamed Attia

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4
 Introduction
The Medical Syndicate of Egypt has recognized the specialty of Vascular Surgery as
an independent specialty in March 1997, one of the earliest worldwide. Registration
as Specialist or as Consultant Vascular Surgeon in the Medical Syndicate depended
primarily on membership in the Vascular Society of Egypt (VSE), which based the
membership requirements on experience and training in vascular departments. Until
recently, there was no structured training for vascular surgeons, and no specialty
exams. The Vascular and Endovascular Surgery (VES) curriculum has been created to
provide a roadmap for structured training in this specialty, and to prepare the
candidate to sit for the final exam of the Egyptian Board for Vascular and
Endovascular Surgery (EBVES). Vascular and endovascular surgery is defined as the
clinical and scientific discipline concerned with the diagnosis, treatment and
prevention of diseases affecting the arteries, veins, and lymphatics. This definition of
our specialty is the basis for this curriculum, which is defined as an outline and
summary of topics to be covered by Vascular Surgery. It contains an outline of what
is being covered by Vascular Surgery and all information on training, assessments,
and certification for the Egyptian Board of Vascular and Endovascular Surgery
(EBVES) examination. The Vascular Curriculumwill ensure consistency throughout
training and will ensure that all staff and trainees know what is required and what is
not. This Curriculum has been developed in line with those from the Europe, UK, USA
and Australasia; and within the rules of the Egyptian Fellowship program. It is
hopedthatit could be the basis for a harmonized national training program in
vascular and endovascular surgery implemented on a national level in all vascular
departments in Egypt.
Training in VES should be provided in Vascular Surgical Units based in centers where
a full range of medical and surgical facilities exists. These centers should provide
postgraduate training in vascular and endovascular surgery and have teaching and
research facilities, and should be headed by a trained vascular surgeon.
A Vascular and Endovascular Surgeon is a surgeon specifically trained in the care of
vascular patients, according to the rules and standards specified in this document.
Post-graduate training leading to recognition as a specialist in VES should equip the
candidate with knowledge and skills, which enable him/her to be competent in the
entire field of the specialty. This document has been prepared for and approved by
the Egyptian Board of Vascular and Endovascular Surgery (EBVES), and the Egyptian
Fellowship Board
Curriculum committee, Egyptian Board of Vascular & Endovascular Surgery
Rashad Bishara MS, FRCS, RPVI Ahmed A. morsi MD
Consultant Vascular Surgeon Consultant Vascular Surgeon
Al-Sahel Teaching Hospital Al-Matareya Hospital

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 Acknowledgement
This curriculum has been created through collaboration between the Chairmanand
the distinguished members of Egyptian Board for Vascular and Endovascular Surgery
(EBVES),and the Egyptian Fellowship Curriculum Committee. The following members
of the Board have made substantial contribution to the curriculum development:

 Rashad Bishara MS (Chicago), FRCS Ed, RPVI (USA)

Consultant & head of Vascular-Endovascular Surgery Department,
Al-Sahel Teaching Hospital

 Ahmed Abdel Sattar MorsiMD

Consultant & head of Vascular-Endovascular Surgery Department,
Al-Mataryah Teaching Hospital

On behalf of the Board for Vascular & Endovascular Surgery

Professor Hussein Kamal El-Din
Professor of Surgery
Cairo University

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REFERENCES

The committee consulted the following sources:

 European Board for Vascular and Endovascular Surgery

 UK Vascular Surgery curriculum
 American Board for Vascular Surgery
 Egyptian Board for Cardio-Thoracic Surgery
 Egyptian Board for Urology
 Egyptian Board for General Surgery
 Egyptian Board for Orthopedic Surgery
The committee was particularly inspired by the curriculum of the Egyptian Board of
Cardio-Thoracic Surgery, and the Syllabus of the European Board for Vascular and
Endovascular Surgery. Some segments of those two curricula were directly copied
into this curriculum with minor changes to adapt for the local training facilities and
the local common vascular diseases.

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10
TABLE OF CONTENTS

54 ............................................................................................................................. Goal
54 ............................................................................................................................. Aims
55 ...................................................... The Vascular and Endovascular Training Program
55 .............................................................................. RULES AND REGULATIONS
Entryrequirementsforthe Egyptian Fellowshipof Vascularand Endovascular
55 ................................................................................Surgery Training Program
55 ..................................................................Structure and duration of Training
51 ..........................................................................................Mandatory courses
51 ................................................................................. Rotation plan of trainees
51 ................................................................................... Interruption of training
51 ............................................................................................... Dismissal policy
51 ............................................... RULES FOR EVALUATION OF TRAINEE PERFORMANCE
51 ........................................................... Workplace Based Assessment (WPBA)
51 ........................................................................................ Learning agreement
51 ..................................................................................................... The logbook
02 ............................................................ Procedure Based Assessments (PBAs)
05 .................................................................... Who should do pba assessment?
05 ............................................................... What does a completed PBA mean?
00 ..................................... Tips for Using Procedure-Based Assessments (PBAs)
02 ................ PROCEDURES SELECTED FOR ASSESSMENT (INDEX PROCEDURES)
02 ......................................................................................... RESEARCH PROJECT
02 .................................................................... ANNUAL REVIEW PROCESS (ARP)
04 ....................................................................... TRAINEES DUTIES & RESPONSIBILITIES
04 ................................................... The Job description of the Vascular Trainee
04 ................................. Job description of the trainee of the 1st and 2nd years
04 ............................................. Job description of the trainee 3rdand 4th years
04 .......................................................................................................... In wards:
05 .............................................................................................................. In OPD
05 .................................................................... In Operating Theater or Cath Lab
05 .......................................................................................Educational activities
05 ............................................... Job description of the trainee of the 5TH year

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05 ......................................................................................... In Emergency room
01 ........................................................................................................... In wards
01 .............................................................................................................. In OPD
01 .................................................................... In Operating Theater or Cath lab
01 .......................................................................................Educational activities
01 ........................................................................................... Learning Activities
01 .......................................................................................Central Scientific Day
01 ................................................................................ SUPERVISORY & TRANING STAFF
01 ...................................................................................................... The Trainer
01 .......................................................................... Job description of the trainer
01 ........................................................... The Educational (Scientific) Supervisor
01 ..................................................................................................Qualifications:
01 ................................................ Job description of the educational supervisor
22 ....................................................................... Vascular Specialty Coordinator
22 ......................................................... Job description of specialty coordinator
25 ............................................................................................. CONTENTS OF TRAINING
25 ...................................................................................... Professional behavior
25 .................................................................................... Teaching and research
25 .................................................................................................. Basic sciences
20 ............................................................................................... General Surgery
20 ................................................................ Surgical Technique and Technology
20 .................................................................................... Endoscopic techniques
22 .......................................................................................Vascular Anaesthesia
22 ........................................................................... Anaesthesiology Techniques
22 ...................................... Critical Surgical illness and Intensive Care Medicine
22 ............................................................. Preoperative and postoperative care
23 .......................................................................................... Emergency Surgery
23 ................................................................ Vascular and Endovascular Surgery
23 .......................................................................... Abdominal Aortic Aneurysms
24 ........................... Peripheral Vascular Occlusive Disease (Acute and Chronic)
25 ....................................................................................... Renal Artery Disease
25 ............................................................................................. Visceral Ischemia

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21 .....................................................................................Carotid Artery Disease
21 ....................... Innominate, Subclavian and Vertebrobasilar Arterial Disease
21 .............................................................................. Thoracic Outlet Syndrome
21 ................................................................................................... Diabetic Foot
21 .............................. Management of Vascular Trauma and Iatrogenic Injuries
21 .............................................................................................. Venous Diseases
32 ................................................................................................... Lymphedema
35 ..................................................................................... Endovascular Therapy
35 .......................................................................................... Imaging Modalities
35 ............................................................................................. Basic Techniques
35 .................................................................................................. Miscellaneous
30 .......................................................................................... Pulmonary Disease
32 ..................................................................................... Coagulation Disorders
32 ............................................................................................... Vascular Access
33 ...............................................................................................Sympathectomy
33 ................ Diagnosis and Management of Miscellaneous Vascular Problems
34 .............................................................. List of Vascular & Endovascular Procedures:
35 ....................................................... Required Level of competence Each Year
35 ............................................................................................................... Year 3
31 ............................................................................................................... Year 4
40 ............................................................................................................... Year 5
Requirements to sit for the final exam ……………………………………………………………………50

The EBVES exam …………………………………………………………………………………………………….52

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GOAL

The goal of EFVES curriculum is to graduate a safe competent trained specialist in

Vascular and Endovascular surgery (VES) who will be able to work within Health
Services and will have the knowledge, skills and attitudes required to do this and to
develop further subspecialty expertise if appropriate.

AIMS

The educational process in the fellowship of VES aims to equip trainees with the
necessary knowledge, skills and attitude so that they will acquire competencies; at a
level consistent with practice in the specialty of VES and at the level of
professionalism, that will include the following:
 Patient care that is appropriate, effective and compassionate while dealing
with health problems and health promotion.
 Medical knowledge in the basic/clinical sciences and medical ethics with
application of such knowledge in the diagnosis and management of patients
with vascular surgery disorders.
 Acting as safe independent specialists whilst recognizing the limitation of
their ability and the obligation to seek assistance from colleagues when
appropriate.
 Interpersonal and communication skills that ensure effective information
exchange with individual patients/their families and work in a team with
other health professionals.
 Appraisal and utilization of new scientific knowledge to update and
continuously improve clinical practice.
 The ability to function as a trainer and teacher in relation to colleagues and
healthcare workers.
 Maintenance of standards appropriate in their professional field and able to
respond constructively to assessments and appraisals.

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 THE VASCULAR AND ENDOVASCULAR TRAINING PROGRAM

RULES AND REGULATIONS

ENTRY REQUIREMENTS FOR THE EGYPTIAN FELLOWSHIP OF VASCULAR

AND ENDOVASCULAR SURGERY TRAINING PROGRAM

1. The trainee carries MB BCh or equivalent from a recognized university

2. Completed a rotating house officer position for twelve months
3. The trainee must hold a valid license to practice medicineby the licensing
authority
4. For affiliates to the ministry of health, the trainee must hold the position of
vascular surgery resident or vascular surgery specialists or assistant specialist.
5. Holders of postgraduate degrees in general surgery are eligible to join the
training program
6. Acceptance into the training program is competitive, based on the number of
available training spots, priority given to higher marks. Minimum grade “Very
Good” in M.B.BCh and “Very Good” in Surgery is required for acceptance.
Minimum grade of “Very Good” in the Master Degree of Surgery or the Diploma
of Surgeryis required for holders of those degrees.

STRUCTURE AND DURATION OF TRAINING

The structure of the training program of the Egyptian Fellowship Board of Vascular –
Endovascular Surgery (VES) requires five years of supervised training that must be
conducted in an accredited hospital before sitting for the final examinations. The
first and second years of training follow the General surgery first and second year
training program.The trainee should sit and pass the first part exam in Surgery
before entering the third year. The third, fourth and fifth years of training, constitute
the VES specialty training and are mainly conducted in the Vascular Departments of
accredited centers.
The 36-month specialized VES training duration may include six-months rotation
spent in a university hospital (optional). This can be done according to a trainee’s
request and a trainer approval. The remaining 30 monthsare to be spent in VES
departments, and 1-month yearly vacation is allowed. The six-month University

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hospital rotation covers the clinical training in various vascular subspecialties with a
focus on angiology. During the entire training program, the candidate is dedicated as
a full time resident. Holidays and on call duties are arranged according to Ministry of
Health and Population regulations.
The five-year training program is based on candidates entering the program after
obtaining their medical school degree (MB Bch or equivalent).Variations in the
duration and rotations of training may be allowed (by adecision from the scientific
council) for holders of postgraduatequalifications. For holders of the Master of
Science degree in Surgery, the Diploma of Surgery, the Egyptian Board in General
Surgery, and the MD degree in General Surgery, training modifications may be
allowed as outlined in the table below:
Qualifications General Vascular

Surgery

MB BCh or equivalent 2 years 3 years

Diploma of Surgery 1 year 3 years

Master of Science (M.Sc.) in 0 3 years

General Surgery*

Egyptian Fellowship In General 0 2 years

Surgery

MD General Surgery 0 2 years

 For holders of a Medical Doctorate (MD) in vascular surgery, the candidate may
apply for a waiver of training requirements that will be evaluated by the VES
scientific council on a case-by-case basis

MANDATORY COURSES

Candidates of first & second years of training must successfully complete the
following courses:
1- Basic Surgical Skills (including intestinal & vascular anastomosis)

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2- Basic Life Support
3- Patient Safety
4- Basic skills in endoscopy
5- Advanced Trauma Life Support (ATLF)
5- Medical Ethics

ROTATION PLAN OF TRAINEES

 ST 1&2 general surgery training in centers both accredited for general surgery
and basic vascular surgery
 ST3/4/5 vascular and endovascular surgery training in accredited vascular
surgery unit based in centers where a full range of medical and surgical facilities
exists. These centers should provide postgraduate training in vascular and
endovascular surgery and have teaching and research facilities, and should be
headed by a trained vascular surgeon

INTERRUPTION OF TRAINING

It is not permissible to interrupt such a structural training program except in major

unavoidable circumstances. Such circumstances should be convincing and approved
by the Secretary General of the higher committee of Medical Specialties and the
program director. The interruption once approved should not be for more than one
year.

Interruption of training in Egyptian hospitals may be allowed and replaced by

training outside Egypt based on the Trainee request and the Trainer’s approval, as
long as it is conducted in a teaching or university hospital abroad, and for a period
no more than one year.

DISMISSAL POLICY

Dismissal from the training program occurs in the following cases:

1. Interruption of the training program for more than one year
2. Getting a Grade (Unsatisfactory) recommendation by the AnnualReview
Processes with no response to recommended remedial actions
3. Failure to abide by the general rules and regulations of the Egyptian
Fellowship Board
4. Breaking of institutional regulations e.g. by unprofessional misconduct

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 RULES FOR EVALUATION OF TRAINEE PERFORMANCE

WORKPLACE BASED ASSESSMENT (WPBA)

Performance of the trainee is evaluated on regular and continuous basis. The

evaluation process should involve all aspects of the training including clinical and
procedural/surgical skills, review of the logbook as well as review of attendance and
participation and the research study. This is performed on monthly basis and
through the annual assessment review process (ARP) for the trainees.
Workplace based assessment will be performed for procedural skills by using
procedure based assessment (PBA). It is mandatory that each trainee achieves a
satisfactory level in the selected 10 procedures in order to be legible to sit for the
final exam

LEARNING AGREEMENT
 Soon after start of each post, the trainee and trainer should arrange a formal
meeting to discuss trainee needs and career plans.
 An agreed plan should be documented in the learning agreement form detailing
objectives, procedures, and other activities to be achieved during the placement.
 This form should be filled no later than one month after the start of the post and
the form should be forward to the Egyptian fellowship offices to be retained in
the candidates file.
 Dates of future meetings to review the progress of the trainee and the training
process should be agreed on during the initial meeting and documented on the
form.
 In each of the above meetings, the trainee and the trainer should discuss the
achieved objectives and plan further actions.
 At the end of the post, the completed learning agreement should be forward to
the Egyptian board offices together with trainee and training post assessment
forms to document the progress of such objectives in respective post. These
forms together with other evidence will form the basis of the Annual Review
Process (ARP) meeting

THE LOGBOOK
 It is the responsibility of the trainee to record activities into the logbook at least
on weekly basis.
 These entries should be signed by the trainer directly supervising the trainee
during the procedure and countersigned by his assigned trainer.

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 Educational activities should also be recorded and signed by person in charge of
the activity and countersigned by the assigned trainer.
 Logbooks should be ready for inspection by the education supervisor at all times.
 It is the responsibility of each trainee to fill the logbook statistics in the trainee
assessment form (attached). This form should be counter signed by his assigned
trainer.
 Logbooks and trainee assessment forms constitute part of the evidence
submitted for the annual assessment meeting by review committee.

PROCEDURE BASED ASSESSMENTS (PBAS)

The PBA is a formative method (without marks allocated in the exit exam) for
assessing a range of competencies involved in performing certain surgical
procedures during routine training. It enables trainees to build on assessor feedback
and follow their own progress. Although PBA is formative, the summary evidence
will be used to inform the ARP and will contribute to the decision made as to how
well the trainee is progressing and his eligibility to sit for exam. The tool has two
principal components:
1- A series of competencies within six core domains (consent, preoperative
planning, preoperative preparation, exposure and closure, operative technique and
post-operative management) that are scored as follows:
N = Not observed U = Unsatisfactory S = Satisfactory
2- An overall global assessment divided into four levels rated as follows:
 Level 0: Insufficient evidence observed to support a judgment
 Level 1: Unable to perform the procedure under supervision
 Level 2: Able to perform the procedure under supervision
 Level 3: Able to perform the procedure with minimal supervision (occasional
help)
 Level 4: Competent to perform procedure unsupervised (and deal with
complications). It is the ability to perform the procedure to a standard
expected of a specialist in practice.
The PBA forms are attached as separate annex to this curriculum and are available as
soft copy at the Egyptian Board administration office.

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WHO SHOULD DO PBA ASSESSMENT?
In general this is likely to be on most occasions the trainee’s assigned trainer, but it is
anticipated that in any one training period, particularly for certain procedures, other
surgical consultants may be involved depending on the trainee’s work pattern. The
surgical assessor must be trained in the use of the PBA.
Trainees will also find that reflecting on the assessment criteria (as contained in the
assessment form and validation worksheet) can help them define any gaps in their
understanding or ability, which they can bring to the discussion with their assigned
trainer and other senior colleagues.

THE NUMBER OF ASSESSMENTS REQUIRED:

During a period of training, trainees will be observed multiple times carrying out
different domains of the procedure until reaching the satisfactory standard and their
overall rating is (4). Trainees are encouraged to perform as many as possible.

HOW SHOULD IT WORK?

The trainee’s learning agreement should indicate which PBAs (or sections of PBAs)
were selected. The procedures should be representative of those the trainee would
normally carry out at that level and should be one of the indicative list detailed in the
training book.
The process is trainee led. It is the trainee’s responsibility to ensure the required
number of PBAs is performed to a satisfactory standard by the specified timescale.
The trainee will need to be familiar with the PBA form, internal validation table and
portfolio consolidation sheet. The trainee generally chooses the timing and arranges
with the assessor.
Assessors do not need to have prior knowledge of the trainee. The assessor should
observe the trainee undertaking the agreed sections of the PBA in the normal course
of workplace activity (usually scrubbed). Given the priority of patient care, the
assessor should choose the appropriate level of supervision depending on the
trainee’s stage of training. Trainees should carry out the procedure, explaining what
they intend to do throughout. If the trainee is in danger of harming the patient at
any point, s/he must be warned or stopped by the trainer or attending consultant
immediately.

WHAT DOES A COMPLETED PBA MEAN?

A completed set of PBAs provides evidence that a trainee has learned to perform
competently a number of procedures in supervised settings.

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FEEDBACK
When a PBA is completed, the assessor should provide immediate feedback to the
trainee in a debriefing session. The assessor should identify areas of achievement
and opportunities for development. This should be done constructively and in a
suitable environment. The PBA will take as long as the procedure itself but the
completion of the form should take about 20 minutes including feedback to the
trainee.

AFTER THE ASSESSMENT AND FEEDBACK

The original form should be signed by both the assessor (assigned trainer or other
consultant) and the trainee. The PBA then forms a completed record of a particular
incident. The assessors’ responsibility ends at this point although it is possible an
assessor will be asked to verify a rating at a later point if a query arises.

TIPS FOR USING PROCEDURE-BASED ASSESSMENTS (PBAS)

• Perform an assessment every time an index procedure is carried out (or at least
once per list), rather than the bare minimum. This helps to make assessment and
feedback ‘routine’ and aids learning.
• Focusing on one particular phase of a procedure can reduce stress on the Assessor
and the Trainee.
• Day-case lists are ideal for assessing consent and pre-operative planning
• Review of the PBA form before the start of the procedure can help with the theatre
team briefing.
Keep a stock of PBA forms for commonly performed index procedures in theatre.
• The Trainee can write up the procedure note whilst the Assessor completes the
assessment form (not forgetting to assess the procedure note as well).
• The theatre coffee room can be an ideal place for the Assessor and Trainee to
review the completed PBA form, and for the Assessor to provide constructive
feedback.
• Completion of the form without providing feedback is much less useful for the
trainee, as it becomes a ‘tick box’ exercise.
• Items rated as ‘Development required’ should be expected the first time that a
Trainee perform a procedure. This simply means that they need more practice and
more assessments.

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PROCEDURES SELECTED FOR ASSESSMENT (INDEX PROCEDURES)

1. High ligation and stripping

2. Radio-cephalic shunt or brachio-cephalic shunt
3. Femoral embolectomy
4. Repair of arterial trauma of the upper or lower extremities
5. Peripheral bypass surgery
6. Percutaneous insertion of permanent dialysis catheter
7. Iliac angioplasty with or without stenting for stenosis
8. Femoral angioplasty with or without stenting for occlusion
9. Tibial angioplasty for stenosis
10. IVC filter deployment

RESEARCH PROJECT

The trainee will participatein a research project during the training program under
the guidance and supervision of his/her trainer.Alternatively, the trainee will write
an in-depth essay about a topic approved by his trainer. Either participation in
research or writing an essay is required for admission to the final exam.

ANNUAL REVIEW PROCESS (ARP)

The chairperson of the scientific council sets the date for the ARP, selects the
members of the review board and sends the invitations.
1. Minimum four out of the following review board members (Chairman of
scientific council + program director + council member + educational
supervisor + specialty coordinator + representative of trainers) should attend
this meeting.
2. Trainees will be notified one month ahead of the meeting date.
3. Learning agreements, logbooks (including PBAs), trainer monthly reports,
educational supervisor reports, trainee assessment forms and training post
assessment forms should be submitted by the specialty coordinator at least 3
weeks before the date of the meeting (all these forms are attached)
4. The specialty coordinator will forward the above documents to the review
board members at least 2 weeks before meeting date.
5. The following items will be assessed in the meeting:
o Verification of signatures
o Attendance of activities

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 o Trainees' performance during previous placement
o The level of competence achieved by the trainee
6. Based on the above evidence and following discussion with trainees one of
the following outcomes will be decided:
o ARP 1: Satisfactory to progress to the following stage
o ARP 2: Can proceed but with targeted training (closer than usual
monitoring and supervision, to address particular needs & provide
feedback). The recommended improvements will be reassessed in the
following ARP meeting.
o ARP 3: An official warning of discontinuation of the training program
will be issued if the previous recommendations have not been
rectified, subject to review in a follow up meeting.
o ARP 4: Unsatisfactory and should be dismissed from the training
program.
o ARP 5: Satisfactory completion for training programand satisfied all
the requirements to sit for the exam, legible to sit for a final exam.

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 TRAINEE’S DUTIES & RESPONSIBILITIES

THE JOB DESCRIPTION OF THE VASCULAR TRAINEE

JOB DESCRIPTION OF THE TRAINEE OF THE 1ST AND 2ND YEARS

Duties and responsibilities of trainees during the general surgery training (1st and
2nd years) follow the requirements described in the EgyptianFellowship Board stated
in the General Surgery curriculum

JOB DESCRIPTION OF THE TRAINEE 3RDAND 4TH YEARS

IN EMERGENCY ROOM
1. Conducts primary assessment and suggests management of patients in the ER
2. Admits patients when indicated
3. Assists in various emergency procedures performed in the ER
4. Provides ER cover and on-call duties shifts according to the hospital policy

IN WARDS:
1. Clerks all admissions (history, general and local clinicalexamination) and suggests
basic investigations and plan ofmanagement
2. Performs daily rounds on patients
3. Writes detailed daily progress notes
4. Performs preoperative assessment and preparations.
5. Prepares operative lists.
6. Provides postoperative care
7. Arranges discharge, home medication, counseling and follow upappointments of
inpatients
8. Assists in and/or performs various bedside procedures andemergency
procedures
9. Follows and obtains various results of investigations and reportsabnormal results
to seniors
10. Follows up referral of patients to other specialties
11. Observes seniors explaining to patients the methods ofmanagement and their
illness and discusses this process withseniors
12. Observes the approaches taken by the seniors when talking topatients about the
prognosis of their illness
13. Checks completeness of medical reports of patients
14. Participates in the interdepartmental consultations.
15. Maintains good relationship with patients, their relatives, themedical and
administrative staff

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16. Maintains the confidentiality and ethics of the profession.

IN OPD
1. Attends the vascular clinic
2. Participates in patients management under appropriate supervision
3. Completes various hospital forms

IN OPERATING THEATER OR CATH LAB

1- Arranges patient's admission to theater or cath lab
2- Revises patient's notes
3- Reviews type and side of operation or intervention, reserves blood, obtains
informedconsent before operation
4- Arranges endoscopes / endovascular equipment for operation
5- Follows the surgical skills and procedures competence level describedin the
syllabus
6- Registers the operations / interventions done in the log book, and signs it by the
operating surgeons
7- Writes operative notes and postoperative treatment

EDUCATIONAL ACTIVITIES
1. Attends and presents cases in daily and grand rounds
2. Participates in journal clubs, morbidity and mortality, and other hospital
educationalmeetings
3. Attempts to attend local educational courses and national /international
conferences. The trainee is expected to earn 30 CME credit hours per year of
specialized vascular training through attendance of national / international
conferences and regular teaching activities held on weekly or monthly basis.

JOB DESCRIPTION OF THE TRAINEE OF THE 5TH YEAR

IN EMERGENCY ROOM
1- Conducts assessment and management of patients in ER
2- Prescribes treatment.
3- Admits patients
4- Performs various emergency procedures performed in ER under thesupervision
as appropriate
5- Provides ER cover and on-call Rota according to hospital policy

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IN WARDS
5. Revises and supervises clerking of all admissions, requests advanced
Investigations with consultation of seniors and draws plan ofmanagement
6. Performs daily rounds
7. Comments on daily progress notes
8. Arranges discharge, home medications, counseling and follow up appointments
of inpatients
9. Assists and teaches to perform various bedside procedures andemergency
procedures
10. Follows and obtains various results of investigations and reportsabnormal results
to seniors
11. Plans treatment.
12. Revises preoperative assessment and preparations.
13. Reviews operative lists.
14. Revises operative records.
15. Follows up referral of patients to other specialties
16. Observes and participate with seniors explaining to patients the methods of
managementand their illness and discusses this process with seniors
17. Observes and participate with the seniors when talking to patientabout
prognosis of their illness
18. Checks completeness of medical reports of patients
19. Participates in the interdepartmental consultation.

IN OPD
1. Attends the vascular clinic
2. Manages patients with the availability of appropriate supervision.
3. Completes various hospital forms

IN OPERATING THEATER OR CATH LAB

1- Revises type of operation / intervention, anesthesia, and surgeon allocated tothe
operation.
2- Observes and assists in different operations / interventions.
3- Follows the surgical procedure schedule described for the ST5.
4- Writes postoperative notes and treatment as advised by thesenior staff.
5- Registers the operative / interventional procedure in the logbook.

EDUCATIONAL ACTIVITIES

27
1- Attends and presents cases in daily and grand rounds
2- Participates in journal clubs, morbidity and mortality, and other hospital
educational meetings

3- Attempts to attend local educational courses. The trainee is expected to earn 30

CME credit hours per year of specialized vascular training through attendance of
national / international conferences

LEARNING ACTIVITIES

It is expected that the trainees be attached to their training hospitals for 6

days/week & are freed from any hospital duties 2 days per month to participate in
the Central Scientific Days. The weekly timetable of clinical &scientific activities held
in the training hospitals should be drafted at the beginning of each rotation &
documented in the Learning Agreement Form.
This form is sent to the Egyptian Fellowship Board and copies are kept by the
trainee/s. This form is made available to the educational supervisors. It represents
the basis of their visits to the hospitals. It is the duty of the trainers to ensure that
trainees are freed from hospital duties at least for an additional half day per week,
which is dedicated for self-directed learning. Activities held in the training hospital
cover the following items:
· Daily ward round
· Weekly grand round
· Regular case presentation / morbidity and mortality
meetings
· Journal club
· Clinical Audit

CENTRAL SCIENTIFIC DAY

All Trainees are expected to have protected learning time at a specific day twice per
month. The teaching program of these days is drafted centrally at the Egyptian
Fellowship Board.The Specialty Coordinator notifiestraining centers by the agenda of
these two days. The central scientificday follows a general format that includes three
sections:
 Clinical Section: consisting of clinical rounds, casepresentationsandcase based
discussion
 Lecture / didactic presentation section: the lectures cover the core topics of the
vascular syllabus
 Trainee-led section: various learning activities are exercisedincluding
presentation of reviewed topics by trainees, journal club, and research project
presentations.

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SUPERVISORY AND TRAINING STAFF

THE TRAINER

QUALIFICATIONS OF THE TRAINER

1. High vascular qualification such as Egyptian Fellowship, MD, American Board,
FRCS or any other equivalent qualification.
2. An experience of at least 3 years after the high qualification.
3. Employed on a full time basis, if possible.

JOB DESCRIPTION OF THE TRAINER

1- Provides training & teaching for the trainees according to the provided
curriculum & intended learning outcomes
2- Reviews and agrees upon the learning agreement forms and activitieswith the
trainee.
3- Supervises various activities of the trainees.
4- Arranges the rotation plan to subspecialties and other trainers, if applicable.
5- Ensures the documentation of the different activities in the logbook by the trainee
and counter signs these activities.
6- Conducts periodic educational evaluation of the trainee, including monthly
reports and workplace-based assessment (WPBA), with feedback to the trainee and
forwarding assessment documents to the Egyptian Fellowship of Vascular Scientific
Council.
7- Attends a meeting with the educational supervisor every three months to discuss
the learning progress of the trainee and solve any arising problems.
THE EDUCATIONAL (SCIENTIFIC) SUPERVISOR

QUALIFICATIONS:
1- High vascular qualification such as MD, American Board, FRCS orequivalent.
2- A consultant vascular status, 10 years after the high qualification.
3- A member of the vascular scientific council.
JOB DESCRIPTION OF THE EDUCATIONAL SUPERVISOR
1- Checks and evaluates the progress of the training program.
2- Evaluates trainers’ monthly reports and proposes remedial actions for any
deficiencies.
3- Ensures that all training activities are running according to the stated
curriculum.

29
4- Meets with the trainer every three months to discuss the learning progress of the
trainee and solves any arising problems.
5- Checks the availability of requirements and facilities for training and advises the
scientific council when appropriate.
6- Checks that each trainee is involved in an audit process.
7- Assesses the logbook activities of each trainee & provide needed remarks for
both trainer & trainees on individual basis.
8- Ensures the adherence to the rotation plan for each trainee.
9- Reports to the scientific board and discusses with them the performance of
trainees and their eligibility to sit for the exam
10- Ensures the applicability and regularity of WPBA.
11- Discusses with hospital authorities the administrative affairs of th2trainees and
proposes solutions.
12- Participates in the annual review process and in exit exams as nominated or
required by the EBVES.
VASCULAR SPECIALTY COORDINATOR

JOB DESCRIPTION OF SPECIALTY COORDINATOR

1- Manages training across hospitals and hospital networks
2- Keeps records of trainees' progression in trainees’ files
3- Collects and follows up all forms related to the training process. These forms
should be organized and summarized in a suitable spreadsheet reflecting each
activity corresponding to trainees, trainers, supervisor and training post.
4- Organizes the training sequence to meet the needs of the trainee
5- Recruits trainers under scientific council supervision
6- Recruits trainees in collaboration with the Egyptian Board administration and
according to the approved scientific board requirements.
7- Follows up and facilitates trainers and supervisors activities
8- Links with training hospitals’ management teams to coordinate the training
program in each training center
9- Coordinates the Annual Review Process (HARP) meetings
10- Prepares for and participates in visits for accreditation of training hospitals
11- Follows up on regular audit of training centers performance which is based on:
a. Reports from trainers
b. Reports from educational supervisors
c. Trainee post assessment forms

12- The specialty coordinator should identify any issues arising frompreviously
mentioned monitoring approaches or as a direct complaintfrom trainees and
coordinate appropriately with relevant personnel to resolve it.

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 CONTENTS OF TRAINING

PROFESSIONAL BEHAVIOR

1. Clinical contact with the patient

Ability to take a history and carry out a clinical examination of a vascular patient.
2. Acquire counseling and communication skills
Ability to counsel patients, patients’ relatives and health professionals in the many
varied situations including stressful circumstances such as critically ill and dying
patients.
3. Understand the role of staff management and of referral in particularly
complex vascular surgical disorders
Knowledge of the role of other medical and surgical specialties in the management
of complex vascular surgical disorders; recognition of the complex conditions
occurring beyond the limits of the experience and expertise gained by the trainee at
the end of the training. Recognize Indications for appropriate referrals to Colleagues
with specific expertise or to national designated centers for specified rare conditions.

TEACHING AND RESEARCH

4. Acquire teaching experience

Demonstrate the ability to teach medical and paramedical staff by experience and
attending specific courses.
5. Develop research experience
Training in the analysis of data and an understanding of the principles and practice of
clinical research, literature research and review.

BASIC SCIENCES

Vascular and Endovascular Surgeons are expected to have a knowledge and

understanding of:
6. Embryology, with particular emphasis to the causes and embryologic
mechanisms leading to common problems in vascular and endovascular
practice;
7. Anatomy, to understand the basic anatomy and competently recognize the
applied anatomy in both clinical and operative settings relevant to individual
surgeons practice;
8. Physiology and biochemistry, to understand the effects of common surgical
disease and injuries upon the normal structure and function of the various

31
 systems of the body, and including the physiological principles of fluid
balance and nutrition of vascular surgical patients;
9. Pathology including the principles of immunology and microbiology relevant
to vascular surgical practice;
10. Pharmacology including actions and toxic effects of drugs commonly used in
perioperative and intraoperative care and in the management of critically ill
vascular surgical patients;
11. Epidemiology and statistics, to allow for critical appraisal of publications,
reviews and audit programs.

GENERAL SURGERY

12. Surgical Infections and their Prevention including Surgically important

micro-organisms; pathophysiology of the body’s response to infection; septic
shock; sources of surgical infection-prevention and control; principles of
asepsis and antisepsis; aseptic techniques; sterilization; antibiotic prophylaxis
and therapy of infections.
13. Hepatitis and HIV carriers-special precautions; avoidance of infections
transmitted by blood and body fluids.

SURGICAL TECHNIQUE AND TECHNOLOGY

14. Skin preparation; incisions and their closure; suture and ligature materials;
15. Patients' positioning; dressings; disorders of coagulation and hemostasis;
16. Diathermy-principles and precautions, alternative energy sources; lasers-
principles and precautions;
17. Pathophysiology of wound healing; classification of surgical wounds;
principles of wound management; scars and contracture; wound dehiscence;
18. Excision of cysts and benign tumors of skin and subcutaneous tissues;
19. Principles and techniques of biopsy;
20. Sampling of body fluids and/ or body excretions for laboratory investigation,
interpretation of results; drainage of superficial abscesses;
21. Basic principles of bowel, urinary tract and blood vessel anastomosis.

ENDOSCOPIC TECHNIQUES

22. Knowledge of the indications and technical skills required for employing
various endoscopic techniques such as gastrointestinal, for diagnostic and
therapeutic purposes.
23. Handling of endoscopes and hygiene measures. Exposure to the opportunity
of gaining knowledge and experience of evolving technological methods.

32
VASCULAR ANAESTHESIA

ANAESTHESIOLOGY TECHNIQUES
24. Basic understanding of the different techniques of general anesthesia; their
indications and contra-indications; local and regional anesthesia; explosive
hazards relating to general anesthesia and endoscopic surgery;
25. Central venous catheterization; fluid replacement, infusion therapy and
parenteral alimentation; blood transfusion and serology; blood coagulation
disorders and substitution measures; blood gas analysis and acid base
balance.

CRITICAL SURGICAL ILLNESS AND INTENSIVE CARE MEDICINE

26. The applied basic science relevant to the clinical assessment of critically ill
vascular patients and to the understanding of disorders of function caused
by:
a. Hemorrhage, shock and sepsis
b. Posttraumatic, preoperative, perioperative and postoperative
intensive care medicine
c. Cardiopulmonary and pharmacological resuscitation
d. Single organ failure (heart, liver, kidney)
e. Multiple system organ failure (pathophysiology and treatment)
f. Respiratory failure, pulmonary edema “shock lung”, acute respiratory
distress syndrome; septic inflammatory response syndrome;
malignant hyperthermia

PREOPERATIVE AND POSTOPERATIVE CARE

Vascular and Endovascular Surgical core activity covers elective and emergency
procedures and their pre-, peri- and postoperative aspects.

27. Laboratory tests Knowledge of the hematological, immunological,

biochemical and histopathological changes that accompany vascular surgical
diseases. Ability to interpret and relate such knowledge and results to clinical
scenarios.

33
 28. Non-invasive laboratoryKnowledge of the indications for, and interpretation
of vascular ultrasound (Duplex) tests as applied on various acute and chronic
diseases of the arterial and venous systems.
a. Knowledge of the techniques used to perform outpatient Doppler
assessment for peripheral ischemia and basic knowledge of the
technique used to perform the common Duplex tests.
29. Imaging Knowledge of the indications for, and basic interpretation of,
imaging techniques such as conventional X-rays, CT / MRI / PET scans and
radioisotope techniques in the investigation of the vascular surgical diseases.
a. Understanding of security measures in Radiology, and knowledge of
radiation-sparing techniques.

EMERGENCY SURGERY

30. Care of critically ill vascular patient with underlying conditions including
coordinated multidisciplinary management; clinical assessment of more or
less severely injured vascular patient and an understanding of disorders of
function caused by trauma, thermal injuries, hemorrhage and shock.
31. Principles of pre-hospital care; clinical assessment of critically ill and severely
injured vascular patient - scoring systems; management of the unconscious
vascular patient; monitoring of vital functions in critically ill or severely
injured vascular patient
32. Initial management of surgical patients with multiple trauma; resuscitation
and hemodynamic support; hemorrhage and shock; maintenance of airway in
severely injured and unconscious patients; management of cranial, thoracic,
abdominal and pelvic trauma; management of soft tissue trauma.

VASCULAR AND ENDOVASCULAR SURGERY

Vascular and endovascular surgery curriculum includes surgical pathologies of the

arterial, venous and lymphatic systems.

ABDOMINAL AORTIC ANEURYSMS

33. Basic Science: To describe the anatomy, physiology, pathology and natural
history of diseases which affect the abdominal aorta and their subsequent
effects.
34. Diagnostic Evaluation, Screening and Imaging:
a. To understand the incidence and prevalence of aneurysmal disease
according to age, co-morbidity and familial history.

34
 b. To understand the natural history of abdominal aortic aneurysms.
c. To understand the genetic distribution of the disease.
d. To understand the roles of ultrasound, angiography, CT and MRI/MRA
in screening and in planning surgery.
35. Treatment
a. To discuss the indications for treatment and the various options
including medical management, open surgery (including approaches)
and endovascular techniques and the outcomes in terms of
subsequent cardiovascular events and patient survival
b. To describe the surgical management of aortic aneurysms
c. To have knowledge of both the immediate and long-term outcomes of
surgery for aortic aneurysmal disease
d. To describe the management and prevention of surgical complications
including spinal cord ischemia, distal embolization, myocardial
infarction, acute renal failure, and graft infection

PERIPHERAL VASCULAR OCCLUSIVE DISEASE (ACUTE AND CHRONIC)

36. Basic Sciences (Acute and Chronic). To describe the anatomy, physiology,
pathology and natural history of diseases which affect the lower limb and
upper limb arterial system and their subsequent effects.
37. To describe the mechanism of early and late graft failure, fibro-intimal
hyperplasia and progression of disease.

ACUTE PERIPHERAL ISCHEMIA

38. Diagnostic Evaluation. To describe the signs and symptoms characteristic of
acute arterial ischemia and the differential diagnosis.
39. To discuss the role of IA DSA, MRA, CT and duplex imaging in the assessment
of acute peripheral ischemia.
40. To develop a management plan based upon the clinical history, blood
investigation and imaging.
41. Treatment To discuss the indications for treatment and the various options
including medical management, open surgery (including approaches) and
endovascular techniques and the outcomes in terms of the management of
acute peripheral vascular ischemia including graft patency, limb salvage rates
and overall patient survival

35
CHRONIC PERIPHERAL VASCULAR ISCHEMIA
42. Diagnostic Evaluation. To describe the characteristic signs and symptoms of
chronic peripheral vascular ischemia relative to the patient's history and
physical examination.
a. To discuss the various roles of imaging studies.
b. To describe the basis of the ankle brachial index, ankle peak systolic
velocity and their use in the assessment of patients chronic peripheral
vascular ischemia
c. To develop a management plan based upon the clinical history, blood
investigation and imaging.
43. Treatment. To discuss the indications for treatment and the various options
including medical management, open surgery (including approaches) and
endovascular techniques and the outcomes in terms of the management of
chronic peripheral vascular ischemia including graft patency, limb salvage
rates and overall patient survival

RENAL ARTERY DISEASE

44. Basic Sciences. To describe the anatomy, physiology, pathology and natural
history of diseases which affect the renal arteries and their subsequent
effects on renal function.
45. Diagnostic Evaluation, Screening and Imaging.
a. To describe the indications and limitations of imaging studies for renal
disease
b. To describe the role of renal protective agents in preventing contrast
induced nephropathy.
46. Treatment. To discuss the indications for treatment and the various options
including medical management, open surgery (including approaches) and
endovascular techniques and the outcomes in terms of the blood pressure
control, renal function, subsequent cardiovascular events and patient survival

VISCERAL ISCHEMIA
47. Basic Sciences .To describe the anatomy of the mesenteric blood supply and
the various pathological processes that result in acute and chronic disease.
48. Diagnostic Evaluation Acute Mesenteric Ischemia
a. To describe the signs and symptoms of acute mesenteric ischemia.
b. To develop a management plan based upon the clinical history, blood
investigation and imaging.

36
 49. Treatment Acute Mesenteric Ischemia. To discuss the indications for
treatment and the various options including medical management, open
surgery (including approaches) and endovascular techniques and the
outcomes in terms of the management of intestinal necrosis, long term
nutritional support and overall patient survival
50. Diagnostic Evaluation of Chronic Mesenteric ischemia
a. To describe the signs and symptoms of chronic mesenteric ischemia
b. To develop a management plan based upon the clinical history, blood
investigation and imaging.
51. Treatment of Chronic Mesenteric Ischemia. To discuss the indications for
treatment and the various options including medical management, open
surgery (including approaches), endovascular techniques, and the outcomes
(patient survival, vessel patency, freedom from restenosis).

CAROTID ARTERY DISEASE

52. Basic Sciences. To describe the anatomy, embryology and pathology of the
arch, great vessels, and intracranial arteries.
53. Diagnostic Evaluation, Screening and Imaging
a. To describe the signs and symptoms of (i) transient ischemic attack
(TIA), (ii) reversible ischemic neurologic deficit (RIND), (iii) stroke in
evolution and (iv) completed stroke.
b. To describe the role of non-invasive tests in the identification of
carotid artery lesions.
c. To discuss the value and shortcomings of DSA, CTA and MRA/MRI
imaging techniques in the diagnosis of carotid artery disease.
d. Define the most appropriate diagnostic steps for the evaluation and
for the choice of treatment.
54. Treatment
a. To develop a management plan based upon the clinical history, blood
investigation and imaging.
b. To discuss the indications for treatment and the various options
including medical management, open surgery (including approaches),
endovascular techniques, and the outcomes (complications, stroke
rate, and restenosis and patient survival).

37
INNOMINATE, SUBCLAVIAN AND VERTEBROBASILAR ARTERIAL DISEASE
55. Basic Sciences. To describe the anatomy of the innominate, subclavian and
vertebral arteries. To describe the embryology of the above and relate the
common anomalies to the embryology. To describe the pathophysiology of
atherosclerosis, trauma, dissection, arteritis and radiation as it applies to the
innominate, subclavian and Vertebrobasilar arteries.
56. Diagnostic Evaluation, Screening and Imaging
a. To describe the symptoms and signs of brain ischemia and that of the
upper extremity
b. To describe the role of non-invasive tests in the identification of these
lesions of the innominate, subclavian and Vertebrobasilar arteries.
c. To discuss the value and shortcomings of DSA, CTA and MRA/MRI
imaging techniques in the diagnosis of these entities.
d. Define the most appropriate diagnostic steps for the evaluation and
for the choice of treatment of these conditions.
57. Treatment. To discuss the options for (a) medical treatment, (b) surgical
repair or (c) endovascular and the outcomes (complications, and patient
survival).

THORACIC OUTLET SYNDROME

58. Basic Sciences .To describe the anatomy of the thoracic outlet, including the
anatomic variations in bones, muscles, and cervical ribs.
59. Diagnostic Evaluation, Screening and Imaging,
a. To describe the symptoms associated with thoracic outlet syndrome
(arterial, venous, neurogenic).
b. To discuss the role of imaging in TOS
c. To develop a management plan based upon the clinical history, blood
investigation and imaging.
60. Treatment .To discuss the indications for treatment and the various options
including medical management, open surgery (including approaches) and
endovascular techniques and the outcomes (complications, stroke rate,
restenosis and patient survival).
DIABETIC FOOT
61. Basic Sciences. To define the normal arterial and venous anatomy of the
circulation of the foot. To demonstrate an understanding of the etiology of
the underlying problems of the diabetic foot. To outline factors that can
affect blood glucose levels in the peri- and postoperative period

38
 62. Diagnosis, Screening and Imaging
a. To demonstrate an understanding of the presenting signs and
symptoms of the diabetic foot
b. To discuss the role of non-invasive and invasive imaging in the
diabetic foot
c. To develop a management plan based upon the clinical history, blood
investigation and imaging
63. Treatment. To discuss the indications for treatment and the various options
including medical management, open surgery (including approaches),
endovascular techniques, and the outcomes (complications, graft patency,
limb salvage and patient survival).

MANAGEMENT OF VASCULAR TRAUMA AND IATROGENIC INJURIES

64. Basic Sciences .To describe the mechanism of vascular injury and Sequelae
thereof to the upper extremity, thoracic aorta, abdominal aorta and its
branches, and lower extremities.
65. Diagnostic Evaluation and Imaging .To describe the characteristic signs and
symptoms of acute vascular (arterial and venous) compromise secondary to
trauma.
a. To describe the role of imaging in the management of vascular
trauma, and associated fractures and neurological injuries.
b. To develop a management plan based upon the clinical history, blood
investigation and imaging.
66. Treatment. To discuss the indications for treatment of acute arterial and
venous injuries and complications thereof including nerve and bony injuries,
AVF and the various options including medical management, open surgery
(including approaches) and endovascular techniques and the outcomes
(complications, graft patency, limb salvage and patient survival).

VENOUS DISEASES
67. Basic Sciences .To describe the normal venous anatomy of the lower and
upper limbs. To describe the embryology of venous development and the
important variants. To describe the physiology and common pathological
conditions which affect the venous systems.
68. Diagnostic Evaluation, Screening and Imaging

39
 a. To discuss the role of noninvasive and invasive evaluation of the
venous system including and duplex scanning, venography, CTV, and
MRV.
b. To describe the "CEAP" classification system of chronic venous
insufficiency.
c. To discuss the etiologic categories of venous dysfunction
69. Treatment.
a. To discuss the indications for treatment of acute and chronic venous
disease including the various options including medical management,
open surgery (including approaches), endovascular techniques, and
the outcomes.
b. To describe the types of available therapy for superficial venous
insufficiency (varicose veins) including elastic stockings, liquid and
foam sclerotherapy, endovenous ablation, stab avulsions, and
stripping.
c. To discuss the indications for treatment of acute pulmonary embolism
including the various options such as medical management, and
endovascular techniques and the outcomes.

LYMPHEDEMA
70. Basic Sciences. To describe the anatomy of the adult lymphatic system from
the level of the terminal lymphatics to the cisterna chyli. To describe
physiological determinants of lymph flow, including intrinsic contractility of
lymph vessels, increased interstitial pressure, muscular activity, arterial
pressure, respiratory pressure, and gravity.
a. To discuss the consequences of the loss of chyle into body cavities or
through a chylocutaneous fistula.
71. Diagnostic Evaluation, Screening and Imaging
a. Describe clinical classifications of lymphedema
b. Discuss the role of imaging in patients with lymphedema
c. Develop a management plan based upon the clinical history, blood
investigation and imaging.
72. Management of Chronic Lymphedema. Discuss the indications for treatment
of chronic lymphedema including the various options including medical
management, and physical therapy and the outcomes.

40
ENDOVASCULAR THERAPY
73. Understand the basic principles of interventional radiological techniques.
74. Demonstrate a working knowledge of the equipment, techniques, technical
problems, troubleshooting and recovery techniques.
75. Demonstrate a working knowledge of the physical properties of devices
including wires, catheters, balloons, coils, stents, stent-grafts, filters and
delivery systems.

IMAGING MODALITIES
76. Understand radiation physics, safety, risks, cellular effects, somatic effects,
dose responses, monitoring, shielding and variations in x-ray equipment as
they relate to both patients and personnel including preventative measures
for safety.
77. Understand the basic principles and equipment used for fluoroscopy and
arteriography.
78. Demonstrate a working knowledge of contrast media, road mapping, dsa,
imaging techniques, measurement techniques, parallax, hand and power
injection techniques.
79. Demonstrate a working knowledge of magnetic resonance imaging,
computerized axial tomography including helical techniques with 3
dimensional reconstructions and CT angiography.

BASIC TECHNIQUES
80. Obtain a working knowledge of basic endovascular techniques including the
use of needles, catheters, guide wires, dilators and introducer techniques,
balloons, stents and intrarterial drugs.
81. Have a working knowledge of adjunctive interventional procedures required
as retrieval, recovery or "bail out" procedures in endovascular surgery
including endovascular and open techniques.

MISCELLANEOUS

CARDIAC DISEASE
82. Discuss association of coronary artery and peripheral vascular disease.
83. Understand the risk factors predictive of perioperative myocardial infarction
or cardiac death.
84. Describe the frequency of severe cad in patients with symptomatic peripheral
vascular disease.

41
 85. Describe the early and late cardiac mortality figures following major vascular
surgery.
86. Anatomy and Pathophysiology. Describe normal coronary artery anatomy
and the pathophysiology of angina, heart failure and Valvular pathologies.
87. Diagnosis.Understand the signs and symptoms of chronic stable angina,
unstable angina, myocardial infarction and congestive heart failure.
a. Describe the risks of operation in a patient with a recent myocardial
infarction, unstable angina, or poorly compensated congestive heart
failure.
b. Describe the current methods for screening for coronary artery
disease, and their limitations.
c. Identify which patients should undergo a preoperative test for
coronary artery disease
d. Discuss the need for coronary angiography prior to vascular surgery.
e. Discuss the operative approach in relation to the patients known
cardiac risk.
f. Understand when patients are most at risk of a perioperative MI.
88. Treatment
a. Recognize the need for close peri-operative monitoring, the
management of Non ST elevation myocardial infarction and the need
for risk factor modification in the long term.
b. Discuss the indications for CABG prior to peripheral vascular surgery

PULMONARY DISEASE
89. Describe the relationship between poor lung function and prolonged vascular
procedures, intra-abdominal and thoracic incisions, and poor left ventricular
function.
90. Understand that cardiac and other co-morbid conditions are more important
in determining postoperative pulmonary complications than pre-existing
pulmonary disease
91. Diagnosis
a. Describe the risk factors for pulmonary disease,
b. Describe and demonstrate the signs and symptoms of COPD.
c. Understand the limited role of clinical assessment in predicting which
patients will have a postoperative pulmonary complication.

42
 d. Understand the role of preoperative pulmonary function studies in
identifying the etiology and treatment alternatives.
92. Treatment
a. Describe how to reduce the pulmonary risk of a vascular operation by
the choice of operation and anesthesia.
b. Describe which pulmonary conditions may benefit from the
perioperative use of steroids, bronchodilators, antibiotics and
inhalers.
c. Describe the causes and treatment of the adult respiratory distress
syndrome (ARDS)

COAGULATION DISORDERS
93. Be familiar with the commonly used drugs (heparin, LMWH, warfarin and
antiplatelet drugs) in vascular surgery including their complications (Heparin-
induced Thrombocytopenia (HIT), excessive bleeding and the need for blood
products.
94. Be familiar with the common hypercoagulability syndromes, the investigation
and treatment thereafter.

VASCULAR ACCESS
95. Anatomy and Pathophysiology
a. Describe the arterial and venous anatomy of the common
arteriovenous fistula of the upper and lower extremities.
b. Describe the hemodynamic and physiologic effects of creating an
arteriovenous fistula. To discuss the anatomic and physiologic
etiologies for arterial steal,
96. Diagnostic Evaluation, Screening and Imaging
a. Develop a management plan based upon the clinical history, blood
investigation and imaging.
97. Treatment. Discuss the indications for vascular access and the various
options includingtypes of access and endovascular techniques and the
outcomes (complications, patency, and infection).

43
SYMPATHECTOMY
98. Basic Science. Describe the anatomy of the autonomic nervous system and
the relationship between the sympathetic fibers and the abdominal aorta
and iliac vessels.
a. Describe the functions of the sympathetic nervous system and the
pathologic conditions resulting from abnormal sympathetic activity.
b. Describe the potential beneficial effects of sympathetic ablation and
possible adverse side effects.
99. Diagnostic Evaluation and Imaging. Develop a management plan based upon
the clinical history, blood investigation and imaging.
100. Surgical Technique.Discuss the indications for upper and lower limb
sympathectomy and complications and the various options including open
and closed techniques of sympathectomy.

DIAGNOSIS AND MANAGEMENT OF MISCELLANEOUS VASCULAR PROBLEMS

101. These include Raynaud’s, Causalgia/Reflex Sympathetic dystrophy,
arteritis, popliteal entrapment, cystic adventitial disease, fibro muscular
disease, Mycotic disease, vasospastic disorders, arteriovenous
malformations, intravenous drug abuse.

44
3. TECHNICAL SKILLS

Levels of technical skills:

T1: Observe

T2: Assist

T3: Perform under supervision

T4: Perform unsupervised

T5: Teach

Years of training:

Y1: Year 1

Y2: Year 2

Y3: Year 3

Y4: Year 4

Y5: Year 5

The following table describes the number of procedures and the level of competence
required from the trainee each year. The numbers indicated in the table can be
considered as recommendations, and should be weighted against the actual vascular
workload of the specific vascular unit and the learning curve of the trainee.

LIST OF VASCULAR & ENDOVASCULAR PROCEDURES:

45
 REQUIRED LEVEL OF COMPETENCE EACH YEAR

YEAR 3
Code Category Procedure Required Number of
Level of Procedures
Skill
A Arterial Embolectomy T3 10
Emergency
Primary repair of artery T2 5
Primary repair of vein T2 5
Interposition vein graft T2 5
Ruptured aneurysm T1 5
Fasciotomy T2 2
Arterial Vessel exposure: Femoral T3 10
Elective
Vessel exposure: Popliteal T2 5
Vessel exposure: Tibial T2 5
Vessel exposure: Brachial T3 10
Vessel exposure: Aorta /iliac T2 2
Vein Harvest T2 5
Graft tunneling T3 5
Arterial anastomosis: large vessel T3 10
Arterial anastomosis: small vessel T2 10
Fem-Pop Bypass T2 5
Fem-Fem bypass T2 2
Fem-Tib bypass T2 5
Aorto-iliac/ Aorto-femoral bypass T1 2
Aortic aneurysm T1 2
Popliteal aneurysm T2 2
Femoral aneurysm / T2 2
pseudoaneurysm

46
Code Category Procedure Required Number of
Level of Procedures
Skill
V Venous Ligation & stripping of GSV T3 10
Superficial
Miniphlebectomy T3 10
Endovenous ablation RFA / Laser T2 2
Foam sclerotherapy T2 10
Venous Deep Catheter directed thrombolytic T2 2
Venous stent T2 2
E Endovascular Access retrograde femoral T2 20
Access Ante grade femoral T1 15
Access Brachial T2 5
Access Femoral cross-over T2 10
Access Popliteal / tibial T2 2
Access sublaclavian / jugular vein T2 5
Access US guided T2 10
Diagnostic arteriography T3 20
Lesion crossing: stenosis T3 15
Lesion crossing: short occlusion T2 5
Lesion crossing: long occlusion T1 5
Balloon angioplasty T3 15
Stenting T2 10
Treatment of procedure T2 5
complications
Iliac interventions T2 5
SFA interventions T2 5
Popliteal interventions T2 5
Tibial interventions T2 5
Aortic Aneurysm T2 1
Popliteal aneurysm T2 1
Renal / mesenteric interventions T1 1

47
Code Category Procedure Required Number of
Level of Procedures
Skill
Carotid interventions T1 1
Portocath T2 5
Permanent dialysis catheter T2 5
H Hemodialysis Radio-cephalic Shunt T3 10
Brachio-cephalic Shunt T3 5
Brachio-basilic shunt T2 5
Prosthesis T2 2
DF Diabetic Foot Toe amputation / Drainage / T3 10
& other Debridement
surgical
procedures
Trans-met / Mid tarsal amp T2 5
Below knee amp T2 5
Above knee amp T2 5
Infected groin / infected graft T2 2
Thoracic outlet decompression T2 1
D Non-invasive ABI/ TBI / TcO2/ APSV T5 20
vascular lab &
Duplex
Lower extremity arterial T3 20
Lower extremity venous T3 20
Carotid T3 10
Aorta / iliacs T3 10
Renal / mesenteric / Testicular T3 5
NS Non-Surgical Compression therapy T3 5
Procedures
Diabetic foot offloading T3 5
Advanced wound care T3 20

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 YEAR 4

Code Category Procedure Required Number of

Level of Procedures
Skill
A Arterial Embolectomy T4 10
Emergency
Primary repair of artery T3 5
Primary repair of vein T3 5
Interposition vein graft T3 5
Ruptured aneurysm T2 5
Fasciotomy T3 2
Arterial Vessel exposure: Femoral T4 10
Elective
Vessel exposure: Popliteal T3 5
Vessel exposure: Tibial T3 5
Vessel exposure: Brachial T4 10
Vessel exposure: Aorta /iliacs T3 2
Vein Harvest T3 5
Graft tunneling T4 5
Arterial anastomosis: large vessel T4 10
Arterial anastomosis: small vessel T3 10
Fem-Pop Bypass T3 5
Fem-Fem bypass T3 2
Fem-Tib bypass T3 5
Aorto-iliac/ Aorto-femoral bypass T3 2
Aortic aneurysm T2 2
Popliteal aneurysm T3 2
Femoral aneurysm / pseudoaneurysm T3 2

49
Code Category Procedure Required Number of
Level of Procedures
Skill
V Venous Ligation & stripping of GSV T4 10
Superficial
Miniphlebectomy T4 10
Endovenous ablation RFA / Laser T3 2
Foam sclerotherapy T3 10
Venous Deep Catheter directed thrombolytic T3 2
Venous stent T3 2
E Endovascular Access retrograde femoral T3 20
Access Ante grade femoral T2/T3 15
Access Brachial T3 5
Access Femoral cross-over T3 10
Access Popliteal / Tibial T3 2
Access subclavian / jugular vein T3 5
Access US guided T3 10
Diagnostic arteriography T4 20
Lesion crossing: stenosis T4 15
Lesion crossing: short occlusion T3 5
Lesion crossing: long occlusion T2 5
Balloon angioplasty T4 15
Stenting T3 10
Treatment of procedure T2 5
complications
Iliac interventions T3 5
SFA interventions T3 5
Popliteal interventions T3 5
Tibial interventions T3 5
Aortic Aneurysm T2 1
Popliteal aneurysm T3 1
Renal / mesenteric interventions T2 1

50
Code Category Procedure Required Number of
Level of Procedures
Skill
Carotid interventions T2 1
Portocath T3 5
Permanent dialysis catheter T3 5
H Hemodialysis Radio-cephalic Shunt T4 10
Brachio-cephalic Shunt T4 5
Brachio-basilic shunt T3 5
Prosthesis T3 2
DF Diabetic Foot Toe amputation / Drainage / T4 10
& other Debridement
surgical
procedures
Trans-met / Mid tarsal amp T3 5
Below knee amp T3 5
Above knee amp T3 5
Infected groin / infected graft T3 2
Thoracic outlet decompression T3 1
D Non-invasive ABI/ TBI / TcO2/ APSV T4 20
vascular lab
& Duplex
Lower extremity arterial T4 20
Lower extremity venous T4 20
Carotid T4 10
Aorta / iliac T4 10
Renal / mesenteric / Testicular T4 5
NS Non-Surgical Compression therapy T4 5
Procedures
Diabetic foot offloading T4 5
Advanced wound care T4 20

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YEAR 5

Code Category Procedure Required Number of

Level of Procedures
Skill
A Arterial Embolectomy T4/T5 10
Emergency
Primary repair of artery T4/T5 5
Primary repair of vein T4/T5 5
Interposition vein graft T4/T5 5
Ruptured aneurysm T3 5
Fasciotomy T4/T5 2
Arterial Vessel exposure: Femoral T5 10
Elective
Vessel exposure: Popliteal T4 5
Vessel exposure: Tibial T4 5
Vessel exposure: Brachial T4 10
Vessel exposure: Aorta /iliac T4 2
Vein Harvest T4/T5 5
Graft tunneling T5 5
Arterial anastomosis: large vessel T5 10
Arterial anastomosis: small T4/T5 10
vessel
Fem-Pop Bypass T4/T5 5
Fem-Fem bypass T4 2
Fem-Tib bypass T4 5
Aorto-iliac/ Aorto-femoral T4 2
bypass
Aortic aneurysm T3 2
Popliteal aneurysm T3/T4 2
Femoral aneurysm / pseudo T4/T5 2
aneurysm

52
Code Category Procedure Required Number of
Level of Procedures
Skill

V Venous Ligation & stripping of GSV T5 10

Superficial
Miniphlebectomy T4 10
Endovenous ablation RFA / Laser T4/T5 2
Foam sclerotherapy T4 10
Venous Deep Catheter directed thrombolytic T4/T5 2
Venous stent T4 2
E Endovascular Access retrograde femoral T4/T5 20
Access Ante grade femoral T4 15
Access Brachial T4 5
Access Femoral cross-over T4/T5 10
Access Popliteal / tibial T4 2
Access sublaclavian / jugular vein T4 5
Access US guided T4/T5 10
Diagnostic arteriography T5 20
Lesion crossing: stenosis T5 15
Lesion crossing: short occlusion T4 5
Lesion crossing: long occlusion T3/T4 5
Balloon angioplasty T5 15
Stenting T4/T5 10
Treatment of procedure 5
complications
Iliac interventions T4 5
SFA interventions T4 5
Popliteal interventions T4 5
Tibial interventions T4 5
Aortic Aneurysm T3 1
Popliteal aneurysm T3 1

53
Code Category Procedure Required Number of
Level of Procedures
Skill
Renal / mesenteric interventions T3 1
Carotid interventions T2/T3 1
Portocath T4/T5 5
Permanent dialysis catheter T4/T5 5
H Hemodialysis Radio-cephalic Shunt T5 10
Brachio-cephalic Shunt T5 5
Brachio-basilic shunt T4/T5 5
Prosthesis T4/T5 2
DF Diabetic Foot Toe amputation / Drainage / T5 10
& other Debridement
surgical
procedures
Trans-met / Mid tarsal amp T4 5
Below knee amp T4 5
Above knee amp T4 5
Infected groin / infected graft T4 2
Thoracic outlet decompression T3/T4 1
D Non-invasive ABI/ TBI / TcO2/ APSV T5 20
vascular lab &
Duplex
Lower extremity arterial T4/T5 20
Lower extremity venous T4/T5 20
Carotid T4/T5 10
Aorta / iliac T4/T5 10
Renal / mesenteric / Testicular T4 5
NS Non Surgical Compression therapy T5 5
Procedures
Diabetic foot offloading T5 5
Advanced wound care T5 20

54
 REQUIREMENTS TO SIT FOR THE FINAL EXAM

1. Completion of five years of surgical training, with a minimum of 2 years of

specialized vascular and endovascular training
2. Achievement of satisfactory score in the ten index procedures
3. Completion of a logbook judged satisfactory by the trainer, guided by the
tables of required Technical Skills
4. Participation in a research project or completion of an essay judged
satisfactory by the scientific EBVES
5. Obtaining 30 CME hours during each year of specialized vascular training

Upon completion of the five requirements, the trainee obtains a

recommendation from the trainer, approved by the Educational Supervisor
(Head of Vascular Unit), to obtain a “Certificate of Completion of Training for
Vascular and Endovascular Surgery”. The trainer’s recommendation is
submitted to the EBVES for approval. Upon approval of the EBVES the
trainee is eligible to sit for the exam.

55
 The Egyptian Board of Vascular and Endovascular Surgery Exam

The exam consists of two parts: written and oral.

The written exam:

It consists of two papers:

 Multiple choice questions (MCQ): 100 questions in 2 hours onapplied

basic sciences related to vascular surgery
 Extended matching multiple choice questions (EMQ): 100 questions in
2 hours on vascular and endovascular surgery

The pass score for the written exam is 60% in the two papers combined.

The Oral & Clinical Exam:

It consists of 5 Oral OSCE stations and 5 Clinical OSCE stations

Each station will contain 10 short questions on one topic, or one clinical case
to be replied by the candidate in 10 minutes. There will be two examiners in
each station.

The pass mark of each station is 6/10

The candidate should pass 3 out of 5 stations in the oral and 3 out of 5
stations in the clinical exams

The final mark for the exam will be Pass or Fail.

56
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