Vascular Medicine Fellowship

Under the leadership of Dr. Leonardo Clavijo, the Vascular Medicine Fellowship Program is a multifaceted, multidisciplinary, and comprehensive program providing training in all aspects of Vascular Medicine. This is a 1-year program with outstandingly rich training in both clinical and didactic vascular medicine and a wide spectrum of clinical and basic science research opportunities with a strong emphasis on critical limb ischemia (CLI).

Mission Statement

The Keck School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Vascular Medicine and Peripheral Interventions Program, carries out its mission to educate fellows in the study of Vascular Medicine, ensuring a thorough understanding of the etiology, patho-physiology and natural history of disease, as well as knowledge of medical, surgical and interventional technologies and care for the patient with peripheral vascular disease, especially CLI.

Educational Purpose, Rationale, and Value

The educational purpose for the Vascular Medicine training program is to prepare trainees to function at a high level of clinical performance in evaluating and treating all forms of arterial, venous, and lymphatic disorders, cardiovascular risk factor management, and wound care. Primary focus will involve the long-term medical care of patients with diagnosis of CLI.

Educational Goals

The goals of training in the Vascular Medicine training program are:

  1. Be knowledgeable and competent in the process of taking thorough clinical history and performing comprehensive vascular physical examination.
  2. Understand the indications for peripheral endovascular angiography and interventional procedures.
  3. Learn how to evaluate a patient with CLI prior to invasive procedures, performing non-invasive vascular tests, including: Ankle- and Toes-Brachial-Indices, Arterial Profiles, TcPO2 and Vascular Ultrasound.
  4. Be proficient in all aspects of the non-invasive imaging assessment of arterial and venous circulation, including ultrasound, CT and MRI modalities.
  5. Know the complications and risks of invasive and interventional procedures.
  6. Be able to interpret peripheral angiography.
  7. Learn to effectively identify and risk stratify high cardiovascular risks patients, who present with Critical Limb Ischemia.
  8. Know how to manage Critical Limb Ischemia patients after procedures, including wound care of peripheral vascular related ulcers.
  9. Learn to optimize medical therapy in the long-term care and management of patients with Critical Limb Ischemia in efforts to prevent future cardiovascular events in this high risk population.

Teaching Opportunities

The Vascular Medicine fellow must complete an Accreditation Council for Graduate Medical Education (ACGME) accredited internal medicine residency program before starting the fellowship. The Vascular Medicine fellow works under direct supervision of attending Interventional Cardiology and Vascular Surgery staff. During the clinical consult rotation, the Vascular Medicine fellow will serve as a junior attending (in close consultation with the attending) thereby gaining experience in making independent decisions.

The Vascular Medicine fellow proceeds through a 1 st rotation designed to achieve increasing levels of performance in all aspects of vascular medicine. The Vascular Medicine fellow is provided with clinical experience to acquire knowledge of the indications, contraindications, risks, limitations, sensitivity, specificity, predictive accuracy, and appropriate techniques and modalities for evaluating patients with a variety of peripheral vascular disease.

The Vascular Medicine fellow is provided sufficient experience to acquire knowledge in clinical decision making, to include the role of randomized clinical trials, clinical importance of limb salvage revascularization, strengths and limitations of differing endovascular approaches, and the optimization of medical therapy in high cardiovascular risks patient population.

The Vascular Medicine fellow is instructed in invasive diagnostic and treatment methods used to treat patients with critical limb ischemia, peripheral aneurismal vascular disease, refractory hypertension with renal arterial stenosis, fibromuscular dysplasia and veno-occlusive disease.

The principle teaching method is direct teaching from the faculty on a daily basis. Through observation, supervised participation, and consultation with the faculty, the fellow learns the requisite knowledge and skills.

In addition, Vascular Medicine fellow spends time in non-invasive vascular laboratory and wound care clinic to become proficient in all aspects of the non-invasive assessment of arterial and venous circulation and long-term wound care, respectively. Participation in outpatient vascular clinics, conferences, particularly Interventional conference, vascular pre-operative conference, cardiovascular catheterization conference, vascular didactic lectures, vascular core curriculum, vascular journal club further augments the fellows’ learning experience.

Integrated Service

USC Vascular Medicine Fellowship offers a unique integrated training experience with the USC Vascular Surgery Fellowship program. While on rotations at the LAC+USC Medical Center, the Vascular Medicine Fellow, in conjunction with the Vascular Surgical Fellow, Resident, Intern and Medical Students, practice as one combined Vascular Service. Such collaboration serves as the consult and primary service to optimize the care of our patients with peripheral vascular disease, especially in the realm of CLI. The Vascular Medicine Fellow also has opportunity to attend didactic surgical conferences.

Training Sites

USC Vascular Medicine Fellowship provides a wide spectrum of public and private clinical and research experiences through multiple hospital teaching facilities.

LAC+USC Medical Center
Founded in 1878, the LAC+USC Medical Center serves as the primary teaching facility of the Keck School of Medicine of the University of Southern California. The new state-of-the-art LAC+USC Medical Center, 600-bed hospital opened in November 2008, provides world-class medical care to the socially and economically disadvantaged populations in Los Angeles County and surrounding neighborhoods. The Medical Center is responsible for annual admission of 40,000 patients, who have access to a full range of medical and surgical services.

Keck Hospital of USC and USC Norris Comprehensive Cancer Center
Keck Hospital of USC is a private 411-bed referral hospital dedicated to tertiary care and medical research. This modern state-of-the-art facility provides patients with the latest innovations in comprehensive medical and surgical care. The Norris Inpatient Tower opened in 2009 and is now the new inpatient care site for our patients with solid or hematologic malignancies.

Rancho Los Amigos National Rehabilitation Center
Rancho Los Amigos National Rehabilitation Center, 395 beds facility, has over 50 years of experience providing quality care for persons with physical disabilities. Rancho Los Amigos National Rehabilitation Center is internationally renowned in the field of medical rehabilitation. With an annual inpatient admission of 2,300 patients, it is one of the largest comprehensive rehabilitation centers in the United States. Outpatient visits number 53,000 among multiple rehab and medical specialty clinics. The medical staff is composed of physicians and dentists representing the major medical, surgical and dental specialties required for the care of the catastrophically disabled.

Clinical and Research Experience

The Vascular Medicine Fellow weekly schedule is organized as follows:

  • Daily teaching rounds from 7AM to 9AM (Mondays to Fridays)
  • Outpatient Vascular Medicine Clinics from 9AM to 12PM on Mondays and Tuesdays.
  • Core Lectures from 7:30 AM – 8:30 AM every other Friday.
  • Non-Invasive Vascular Laboratory from 1PM to 4PM on Mondays and Fridays.
  • Wound Care Clinic from 1PM to 4PM on Tuesdays.
  • Radiology CT/MR Review sessions from 1PM to 4PM on very other Wednesday.
  • Daily Teaching Rounds on New Consults from 4PM to 5PM (Mondays to Fridays).
  • Combined Journal Club from 6PM to 7PM on Thursdays at a monthly basis.
  • Protected Research time from 9AM to 4PM on Thursdays.

Core Curriculum Lectures

Vascular Medicine Core Curriculum lectures are a collaborative effort involving multiple Departments at USC involve in the care of vascular patients, including: Vascular Medicine, Vascular Surgery, Radiology, Hematology, Neurology, Rheumatology, Infectious Diseases, Foot and Ankle Surgery and Wound Care/ Physical Therapy.

Vascular Medicine Lectures
(Fridays, 7:30 AM)

  • Wound bed preparation – principles of debridement and advanced dressings
  • From Head to Toe:  Arterial Vascular Anatomy and Angiography
  • Vascular CT and MR Angiography: General Principles
  • Non-Invasive Vascular Testing, The Basis: Flow Dynamics and Ultrasound Physics
  • Arterial Evaluation: Segmental Pressures, Pletysmography and TcPO2
  • Diagnosis, prevention, and treatment of vascular wounds (arterial and venous)
  • CTA/MRA: Upper and Lower Extremity Arterial Disease
  • Arterial Duplex Assessment of the Carotids and Vertebral Arteries- Introduction to TCD
  • Foot Infections
  • CTA/MRA: Carotid/Vertebral & Cerebral Arterial Disease
  • Diagnosis, prevention, and treatment of neuropathic (diabetic foot) wounds
  • Ultrasound Imaging of the Aorta ,Mesenteric and Renal Arteries including Aneurysmal Disease
  • CTA/MRA: Aortic – Renal and Mesenteric  Arterial  Disease
  • Venous & Arterial Duplex Assessment of the Extremities
  • Venous Disease: CTV/MRV

Vascular Medicine Lectures
(Thursdays, Noon)

  • Vascular Biology and Atherothrombosis
  • Peri-operative Management of Vascular Surgery
  • Acute Arterial Disorders & Unusual Vascular Diseases
  • Aortic  Disease: Aneurysms, Dissection and Dissection-Like Syndromes
  • Renal  and Mesenteric Arterial Disease
  • Lower Extremity Peripheral Arterial Disease: Natural History, Epidemiology, and Prognosis
  • Carotid  and Vertebral Artery Disease
  • Stroke
  • Chronic Venous Disease and Lymphatic Disease
  • Vasculitis and Connective Tissue Disease
  • Thrombophilia & Venous Thromboembolic Disease
  • Clinical Evaluation and Treatment of Peripheral Arterial Disease
  • Upper Extremity Arterial Disease: Raynaud Syndrome, Occlusive Arterial Diseases, and Thoracic Outlet Syndrome

Application

Vascular Fellowship Program Application Form

Current Vascular Medicine Fellow

Noor Al-Asady, MD

Vascular Medicine Faculty

Leonardo Clavijo, MD, PhD
Program Director of Vascular Medicine & Peripheral Interventions
Associate Director of Cardiovascular Research
Interventional Cardiology
Assistant Professor of Clinical Medicine
Division of Cardiovascular Medicine
Keck School of Medicine
Email: lclavijo@usc.edu

Ray V. Matthews, MD
Professor of Clinical Medicine
Chief, Division of Cardiovascular Medicine, Department of Medicine
Director of Interventional Cardiology and Catheterization Laboratories
Division of Cardiovascular Medicine
Keck School of Medicine
Email: Ray.Matthews@med.usc.edu

David Shavelle, MD
Director, Cardiac Catheterization Laboratory LAC+USC Medical Center
Director, Interventional Cardiology Fellowship
Associate Professor of Clinical Medicine
Division of Cardiovascular Medicine
Keck School of Medicine
Email: shavelle@usc.edu

Contact

Leonardo Clavijo, MD
Program Director of Vascular Medicine & Peripheral Interventions
Associate Director of Cardiovascular Research
Program Director of Interventional Cardiology
Assistant Professor of Clinical Medicine
Division of Cardiovascular Medicine
Keck School of Medicine
Email: lclavijo@usc.edu

Sarah Luna
Fellowship Coordinator
Phone: (323) 442-7419
Email: sarahlun@usc.edu