Samuel Z. Goldhaber, MD

Disclosures

December 30, 2015

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Defining Vascular Medicine

Samuel Z. Goldhaber, MD: Hello. This is Dr Sam Goldhaber for the Clot Blog at theheart.org on Medscape. I'm speaking to you from the American Heart Association (AHA) 2015 Scientific Sessions in Orlando.

Today, I'm going to talk about where vascular medicine fits into cardiovascular medicine. I think this is a very appropriate topic to bring up at this AHA meeting because the president of the American Heart Association this year, Dr Mark Creager, is a cardiologist and a vascular medicine specialist. In his opening address, he called for much more attention to vascular medicine within the realm of cardiology.

I think the first question is: How do we define vascular medicine? What is it? I think it goes far beyond peripheral arterial disease (PAD)—that's an old definition. Perhaps 10 or 20 years ago, PAD was considered by some to be the bulk of vascular medicine, but we now have really expanded the scope of vascular medicine. It certainly includes PAD, chronic limb ischemia, acute limb ischemia, wound healing, but it also encompasses diseases of the aorta, inflammatory diseases of the blood vessels, and it includes venous thromboembolism, pulmonary embolism, deep vein thrombosis, and lymphedema. These areas now are really considered mandatory for training of the cardiovascular medicine specialist.

Training Cardiologists in Vascular Medicine

The current guidelines for a general cardiology fellowship require at least 2 months of vascular medicine training during the 24 months of the clinical part of any fellowship rotation. The question comes up: Are we really equipped, across the board, to train our fellows and to update our faculty on what they need to know in the field of vascular medicine? Because it's really progressing at a rapid pace.

In addition, we don't have any official board certification that is recognized by the government where the government is going to reimburse hospitals to have specific vascular medicine programs. There was a training grant initiative that lasted for 10 years funded by the National Heart, Lung, and Blood Institute, but this has been discontinued, and now most vascular medicine fellowship programs are self-funded by the institution or aided by generous philanthropic gifts.

I do think that the knowledge base of vascular medicine is essential for anyone who goes into cardiology. It's certainly important for the general cardiologist, and it is important for those in internal medicine as well. We have to start to retool our training programs and our CME programs and follow the plea of Dr Creager to really incorporate, in a much heavier way, vascular medicine into our various curricula. We also have to make sure that we have a way to update our physicians—both those who are well into their careers and the new trainees within cardiovascular medicine. This is Dr Sam Goldhaber signing off for the Clot Blog.

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