::Departments : Super Specialities : Vascular surgery
Department of Vascular Surgery
SHORT HISTORY OF THE DEPARTMENT

In the year 1928,  the department was started as Venereal disease clinic. Venereal disease, ENT and dental diseases were the only specialty that had clinics of their own at that time.
In the year 1952, the clinic was upgraded as a department with the assistance from  World Health Organization(WHO), central and state government .
In the year 1954, PG Diploma course in  Diploma in Venereology was started.
In the year 1956   the department was upgraded as Institute of Venereology. World Health Organization has recognized this institute as teaching and training center for whole of   India And South East Asia.
In the year 1961 ,Central Venereal diseases reference laboratory established for interlab evaluation of  VDRL.
In the year 1966  ,PG course in MD(Venereology) was  started.
In the year 1972 , Outreach programme for the control of Sexually Transmitted Diseases (STD ) was initiated with grant  from Indian Council Of Medical Research (ICMR)  and WHO.
In the year 2003 ,The PG course , MD(Venereology) and the PG Diploma  course ,Diploma in Venereology were reconstituted as combined course of   MD (DVL) and Diploma in Dermato Venereology and Leprosy(DDVL) respectively. A State level STD medical officer conference 4th and 5th November,2003 sponsored by TANSACS was conducted by the institute.
In the year 2006, 6th to 8th October 30th national conference of IASSTD was conducted at Chennai.
     Prof. H. T. Vira Reddi renowned surgeon from Chennai was posted as Honorary Professor in MMC his parent institution. In 1963, he travelled to United Kingdom to specialize in Vascular Surgery at St. Thomas Hospital, London after which he started the vascular surgery unit in Madras Medical College. This Vascular surgery unit, established in the late sixties was the foundation for the current department. The government of Tamilnadu realized the need for separate department and in 1978 under the leadership of Prof. T. P. Jacob, the department of vascular surgery was formed. He was the first head of the department.In the year 1985; the MCh course was started for the first time in the country with a post graduate strength of one candidate  .
     In 1993, Prof. S. A. Hussain took over from Prof. T. P. Jacob and pioneered the department for over a decade and half (1993-2006). He would be credited for increase post graduate seat from one to two per year and for establishing the need for separate speciality when Medical Council of India felt that the speciality could be merged with cardiothoracic speciality. The work carried out by the department was highlighted which convinced the MCI the need to have a separate speciality for the peripheral vascular surgery. Prof. H. A. Hussain should also be credited for the formation of Vascular Society of India in 1994, the first meeting held at Chennai in Madras Medical college.
     The department currently is headed by Prof. S.Jeyakumar, and the second unit is headed by prof.N.Sridharan
PREVIOUS HOD’S
 
 
1.PROF.T.P.JACOB
2.PROF.S.A.HUSSAIN
3.PROF.T.VIDYASAGARAN - under whose leadership the second unit of the department has come to function from September, 2007 and the number of postgraduates increased to 3 candidates per year since August 2010.
4.PROF.M.RAJKUMAR-credited with making the Department of vascular surgery into an institute .First DIRECTOR of INSTITUTE OF VASCULAR SURGERY.
5.PROF.J.AMALORPAVANATHAN-Also the HEAD  OF TRANSTAN

ACADEMIC ACTIVITIES:
Type of course: Medical
Name of the course offered: Medical / Superspeciality / Master of Churgicate (MCh)
  1. Eligibility : MS (Gen. Surg)/DNB (Gen. Surg)/ MS (Ortho)/DNB (Ortho) Degree from any Indian university  recognized by the Medical Council of India  and obtained permanent registration from any of the State Medical Councils  
  2. Course duration : 3 years
  3. Sanctioned number of seats: 3 per year
  4. Affliated University: Tamil Nadu Dr MGR Medical University
  5. Selection procedure : Selection of students for admission to M.Ch (Vascular Surgery) course is based on Common Entrance Examinations conducted by the Selection committee ,Directorate of Medical Education and Counseling./NEET
  6. University examination details: The Examination for MCh (Vascular Surgery)  is held at the end of the 3 YEARS.
       7. Length of training
 3 YEARS
4 MONTHS ROTATION AMONG UNITS
SPECIAL POSTINGS
1 ST YEAR- RADIOLOGY                                         15 DAYS
- CARDIOTHORACIC SURGERY                              15 DAYS
 2nd YEAR                                                                 2 MONTHS (OUTSTATION POSTINGS)
3rd year                                                                    parent department
CONFERENCES :
  3 ANNUAL CONFERENCE/3 MID TERM CONFERENCE-VSI
  1 INTERNATIONAL  CONFERENCE/PAPER PRESENTATION
 

PATTERN OF EXAMINATION
Theory Examination


 The Post Graduate students write 4 theory papers each of 100 Marks and of 3 hours duration (Total 300 marks) at the end of the 3rd  year

Paper I -Basic Sciences applied to Vascular Surgery
Paper II -Vascular Surgery
Paper III -Vascular and Endo Vascular Surgery
Paper IV - Recent Advances in Vascular Surgery

Practical Examination
(a) Clinical Patient presentation/discussion:
(i) One long case: The long case will be structured comprising – history taking, clinical examination, investigations, decision making, proposed treatment modalities, ethical justification and personal attributes.
(ii) Two short cases: The short cases will also be structured in which only one particular system may be considered and therapy decision/discussion, made.
(b) Identification of Surgical Pathology, excised specimens & discussion, reading X-rays & CT Angio/MR Angio, identification of Instruments & discussion, identification of braces & calipers & discussion thereon.
(c)  Dissertation and Log book Evaluation
TRAINING PROGRAMME
 
 The training programme shall aim to provide sound knowledge in the diagnostic and investigative aspects of Vascular Surgery for the candidate.
 
It will provide practical training in clinical and operative surgery including endovascular surgery. In addition to the exposure to Vascular Surgery at the institute, the candidate, will also received an opportunity during the training period to spend a period up to three months in other specialized centers for enriching his experience in Vascular Surgery.
 
During the training period the candidate shall work for all three years on full-time resident basis under the Head of the Department Vascular Surgery. He shall take part in all activities of the department including participation in seminars, conferences, teaching assignment, operating sessions, experimental surgery and other duties that may be assigned to him by the Head of the Department.
 
 
 INTERNAL EVALUATION
 
 LOG BOOK :
 
 The candidate must maintain a log book of all his/her activities with respect to:
 
1)     Bio-data
2)     Complete list of postings with periods and dates;
3)     Complete list of all the inpatient cases managed by him/her directly;
4)     List of important emergency cases and interdepartmental consultations attended by him;
5)     List of diagnostic and therapeutic procedures including surgeries assisted or performed;
6)     Summaries of some important emergency and elective cases managed by them;
7)     List of case presentations, postgraduate seminars, journal reviews and other important academic activities performed
8)     List of abstracts and papers presented in Scientific Society Meetings, Conferences, Clinico-pathological conferences, etc.,
9)     Research projects completed;
10) Papers published or sent for publication;
11) Teaching assignments performed and
12) Any other relevant details.
13) A soft copy of the log book as E-LOG BOOK may be submitted at the time of examination
LOG BOOK:
 
            As per MCI Reculation, ( clause 13.4 ©, the Postgraduate student of a Postgraduate Degree Course in Super specialities shall maintain Log Book of the work carried out by them and the training programme undergone during the period of training including details of surgical operations assisted or done independently by.
 
            (13.4(d) The Log Book shall be checked and assessed by the faculty members imparting the training.
      Reviewed each week by the guide and chief
RESEARCH WORK
As per MCI RESEARCH PAPER WHICH SHOULD BE CASE SERIES SHOULD BE SUBMITTED APART FROM THE E-JOURNAL OF TNMGRMU
Separate research wing with a committee in each institute
 PRACTICAL SCHEME
Particulars Time for candidate to examine the cases Time for Examiners to question the candidate Maximum Marks
Long case 1 Case * 60 minutes 60 Minutes 100
Short case 2 Case * 15 Minutes 30 Minutes 100
Ward Rounds 3 Patients * 10 Minutes 30 Minutes 100
OSCE 5 Stations * 3 Minutes 15 Minutes 50
Viva voice   15 Minutes 100
Log Book     50
Internal assessment     50
 
 
 
 
THEORY
 M.Ch. Branch VIII- Vascular surgery
 
 
            Paper I             Basic Sciences as applied to Vascular Surgery
            Paper II            Vascular Surgery
            Paper III           Vascular & Endo Vascular Surgery
            Paper IV          Recent Advances in Vascular Surgery
 
12.OSCE
 
1.      Path slide
2.      Clinical situation – interpretation
3.      Instrument
4.      Imaging
5.      Drug – Usage/indications
 

 
Periodic academic activities held in the department:
·         Seminars is conducted once a month.
·         Guest Lectures , Update programs Journal Club Meeting is conducted once a fortnight.
·         Clinical discussions is conducted on all working days.
·         Inter-departmental meetings are being arranged periodically.
 
          Chennai vascular society meets-monthly with best paper awards.
 
 
LIST OF POST GRADUATES;
1.DR.JAYAKRISHNAN
2.DR.S.K.BALAJI
3.DR.SASIKUMAR
4.DR.VADIVELU
5.DR.SASIKUMAR
6.DR.MOHANRAJA
7.DR.SRIDHAR
8.DR.RAMYA
9.DR.RAJA
 
EACH ASSISTANT PROFESSOR MONITORS 2 POSTGRADUATES
BASED ON
1.CLINICAL EVALUATION INDEX
2.CASE BASED DISCUSSION
3.PERFORMANCE BASED ASSESSMENT
4.MULTI SOURCE FEEDBACK
5.DOPS- Direct observation of procedural skills
Internal assessment marks are based on these 5 parameters and presentation in
conferences
Ward rounds
Clinical society
Journal clubs
Seminars

Annual Day 
     The Department of Vascular Surgery will be celebrating its annual day in the month of February. It proposes to inaugurate the MMC Vascular Alumni Association. The month of February is also the birth month of Prof. H. T. Vira Reddi, the pioneer vascular surgeon who was responsible for the development of Vascular surgery as a speciality . The annual day will be celebrated with a release of souvenir highlighting the work done by the department, rare case reports and publications. It will also carry statistics to enable the department to establish the need for improving the facilities and man power to keep abreast of the scientific advances.
 
Research and Publications:
Research on the genotype variability in Warfarin metabolism in patients with DVT - completed
Research on effect of  allogenic stem cells in patients with critical limb ischemia – ongoing.
Giant Axillary artery Aneurysm mimicking Angiosarcoma. Internet Journal of Surgery, October 2008.
International publication 
Management of a challenging AVM of the scalp and orbit in a patient with polycystic kidney disease. Nupur Bit, T. Vidyasagaran, J. Amalorpavanathan, et al. Annals of Vascular Surgery: 26 (8);1129
Accepted for publication -
Peadiatric isolated bilateral iliac aneurysm. R. Chithra, T. Vidyasagaran, J. Amalorpavanathan, et al. Journal of Vascular Surgery
An extremely rare case of renal vein thrombosis and review of literature. D. Prabhakar, T. vidyasagaran, T. Amalorpavanathan, et al. Veins and Lymphatics 

Prizes and Awards constituted by the Department
Prof CMK Reddy Gold Medal Examination for the MS postgraduate students
University Gold Medal Examination for the M Ch postgraduates

Prizes and Awards won
Dr.  Elancheralathan won the prize for the best video presentation in VSICON 2010, Chennai.
Dr  Nupur Bit won the best paper award in VAICON 2012, Cochin
Dr. Aruna Giri won the second prize in the VSI Rolling trophy competition held for postgraduate students and trainees at the midterm meet of VSI, 2012  held at Mahabalipuram, Chennai.
Dr. R. Chithra won the best poster award at VSICON 2012, Jaipur
DR.M.Balaji-Best PG award VSTCON-2013
                      2nd prize-VSI midterm meet-2014,GOA
DR.Jayanth-2 nd prize VSI midterm meet -2015,GOA
DR.M.Krishna- Best extempore presentation VSI midterm meet -2015,GOA
Dr.S.prathap kumar- ALL INDIA VASCULAR SOCIETY OF INDIA-ROLLING
TROPHY 2016
BEST POST GRADUATE AWARD- VSI 2016
VASCULAR SOCIETY OF TAMILNADU-
2015-ROLLING TROPHY
BEST POST GRADUATE AWARD -2015 (chennai
vascular society)
best paper award-VSICON 2014
BEST PAPER AWARD-VSICON 2015
DR.MURALI-2nd prize-VSI MIDTERM,KOCHI
DR.I DEVARAJAN-paper selected for DR.SEKHAR  BEST AWARD PAPER

CMEs’, Workshops/ conferences conducted by the department
1.2009: CME – Vascular alumini day in February
2.2010 :Vascular alumini CME In February, VSICON 2010, Endo vascular Simulator Workshop
3.2011 : Vascular alumini annual Day in June
4.2012 :  Vascular Alumini CME in February, Mid term Meet, Vascular Society of India in June

SERVICES OFFERED
No of units in the department : 2
O.P Days & Timings : 10am To 12noon
I Unit                          Mondays & Fridays
II Unit                         Tuesdays & Thursdays
O.P.D Number           29

Specialties Block  Ward No : 49
I.P Unit & Admission Day
 I Unit                         Mondays, Wednesdays & Fridays
II Unit                         Tuesdays, Thursdays & Saturdays
I & II Units                 Alternate Sundays

Bed Strength of Department : Total 40 Beds
UNIT I – 20 Beds
Unit II – 20 Beds
1 Intensive care unit
Average O.P : New Cases Male – 160, Female – 55, Children – 5
                        Old Cases Male – 400, Female – 120, Children - 3
Average I. P: 60 patients
 
Type of Surgeries performed:
 A. Occlusive arterial disease
1.      Aorto uni/bi-iliac synthetic graft bypass
2.      Aorto uni/bi-femoral synthetic bypass
3.      Ileo-femoral bypass
4.      Infrainguinal Bypass
5.      Infragenicular Bypass
6.      Multilevel – Combination of above
7.      Caritid endarterectomy
8.      Carotid – subclavian bypass
9.      Extra anatomical Axillo Bi / Uni Femoral Synthetic Graft Bypass
B.Aneurysmal disease
We have done open aneurysmal surgeries in patients with thoroco abdominal, abdominal, carotid, subclavian, axillary, iliac, femoral, popliteal and rare aneurysms involving the persistent sciatic artery with good outcome.

Treatment Options
Endoanuerysmorrhaphy with synthetic Graft to bifemoral / biiliac Arteries.
Renal artery revascularization with graft and/or reimplantation – If renal vessels involved.
Carrel’s Patch and/or Reimplantation of  mesenteric vessels – If mesenteric vessels involved.C.Thoracic Outlet

Syndrome

Patients with both vasculogenic and neurogenic TAO’s have been treated well with our standardized protocols.

D.Vascular Tumors
Especially carotid body tumors and nerve sheath tumors in the carotid region are in other regions in close proximity to major blood vessels are dealt with methodically with good results.

E. AVM - Tumor like malformations both venous and arterio – venous malformations have been appropriately managed with surgical excision or selective embolisation with the help of our experienced radiology colleagues.

F. Venous Disorders - Patients with Varicose Vein problem can get the state of the art management in our department.

Treatment Options
Varicose vein Ligation and Stripping
Perforator vein Ligation and Stab Avulsion
Foam Sclerotherpy for Perforator Incompetence Newer Modalities such as RFA(Radio Frequency Ablation) are used to the patient satisfaction in having minimally invasive surgery.

G. Venous Access Surgeries
Arterio – Venous Fistulas
  • Radio Cephalic fistula
  • Brachio Cephalic fistula
  • Ulnar Basilic / Brachio Basilic    Transposition
  • Ulnar Basilic / Brachio Basilic RSV interposition graft
  • Synthetic AV Graft
H. Acute Limb ischemia
In trauma cases, our emergency supportive surgical management is instrumental in  salvaging the limb. In the medical ward, when patients presenting with  acute limb ischemia secondary to Cardiac / medical ailments, our service is mandatory to save the viability of the affected limb.

Apart from routine departmental work, our services are available for
Arterio – venous access surgeries for patients with chronic kidney disease for haemodialysis.
Limb preservation surgeries which require isolation of neurovascular bundles to enable the orthopedic and onco surgeons to excise the malignant tumors and position the custom made prosthesis
Our services are also utilized in organ transplantation.
SYLLABUS
The Specialty of Vascular Surgery  is an upcoming surgical specialty in INDIA and has evolved out of the specialty of general surgery.
 The vascular syllabus and the ability at the completion of training to manage a vascular emergency 'take', provide a common purpose across the specialty of Vascular Surgery. The major areas of special interest associated with the specialty of Vascular Surgery are listed below, each involving the acquisition of both open and endovascular/endovenous competencies to include relevant imaging skills:
 Aortic
Carotid
 Limb salvage
 Venous Vascular Access
 Renovascular
 In addition to these clearly defined disease-based areas of special interest there are others that are less well developed within the syllabus but represent substantial areas of practice:
 Vascular Surgery related to trauma
The Vascular Surgery of Childhood
 Vascular medicine
The variations in the scope of practices within the specialty are highly variable and largely shaped by local circumstances, the needs of the service and the personal development of the surgeons delivering those services. All vascular surgeons will be given the opportunity to develop an area of special expertise by the time they gain their MCH DEGREE and some will then go on to include that area as a major part of their consultant practice as their individual careers develop. There is also significant shared ('Interface') practice with other specialties and subspecialties such as interventional radiology, cardiology, cardiothoracic surgery, diabetic medicine, care of the elderly medicine, renal medicine, transplant surgery and stroke medicine
Areas of Special Interest
Superficial venous disease
 Deep venous disease
 Lower limb ischaemia (acute and chronic)
Upper limb ischemia (acute and chronic)
Aortic aneurysmal disease
 Peripheral artery aneurysms
 Vascular access
 Renovascular disease
 Carotid artery disease
 Mesenteric vascular disease
 Vascular trauma
Hyperhidrosis
 Lymphoedema
 Endovascular surgery
Thoracic outlet syndrome
 Diabetic foot
Vascular anomalies
Vasospastic disorders and vasculitis
Index Procedures
 In Vascular Surgery these are generally groups of procedures which are common and/or are seen as representing important areas of technical expertise. In the trainee surgical logbook peer comparison graphs are produced for these procedures to give information about the amount of experience gained. The more common procedures are also used during assessment by Surgical Directly Observed Procedural Skills (Surgical DOPS) and Procedure Based Assessments (PBAs).
 • Aortic aneurysm
o Elective open repair tube graft
 o Elective open repair bifurcated graft o Endovascular repair
o Ruptured aneurysm repair
AORTOILIAC OCCLUSION
AORTO BIFEMORAL/EXTRA ANATOMIC BYPASSES
• Carotid endarterectomy
• Infra-inguinal bypass
o Above knee run-off
 o Below knee popliteal run off
o Calf vessel run off
o Popliteal artery exclusion bypass
• Emergency Lower Limb
 o Femoral Embolectomy
o 4 compartment fasciotomy
o Repair of false femoral artery aneurysm
 • Upper Limb
o Brachial artery embolectomy
 • Re-do Vascular Surgery
 o Removal of infected graft
 • Varicose vein surgery
o Sapheno-femoral and sapheno-popliteal ligation.
 o Endovenous LSV and SSV ablation
 o Foam injection sclerotherapy
• Vascular access
 • AV fistula at wrist, upper arm
• Revision of failed AV fistula
ENDOVENOUS STENTING/PLASTY
IVC FILTERS
 
 

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