So, as we've discussed already, the role of the interventional cardiologist has evolved since the last document was published, and in point of fact, the types of procedures that we're doing now in the cath lab are quite varied. Many of us, including some of us on this panel and out there in the audience, spend a significant percentage of our time doing peripheral vascular interventions as broadly defined, and we thought it was important in this document to set the standards for what would be considered minimum competencies for cognitive knowledge as well as procedural skills. In this table, you'll see some of the broad stroke outlines, but I encourage everyone to read the documents where all the nitty-gritty details are encapsulated, and I think that what one should understand is that the vascular intervention numbers are additive and are on top of the competencies that Dawn already reviewed for coronary intervention, so this is considered in addition to one's coronary competencies. Once those are accomplished or simultaneously accomplished, we would expect that those fellows interested in performing vascular interventions in their clinical practice would have experience in a variety of different vascular interventions in the arterial and venous circulations. So, for example, as you can see here, what was delineated in the last document and series of manuscripts from the Societies of Vascular Medicine and others are the document numbers for peripheral arterial interventions as broadly defined, and this would be 100 diagnostic procedures and 50 interventional procedures as the bare minimum competency numbers, and this would be in lower extremity, subclavian and ominate, renal or mesenteric intervention, and then the treatment of chronic limb ischemia as well as chronic limb-threatening ischemia and also called CLI. In addition, for those that are interested in or willing to put in the time and effort for additional training, those that want to pursue carotid stenting, there's a multispecialty document that's been published many years ago that has established standards of 25 carotid stent procedures with at least half as first operator as a minimum number. This is a high bar in the current environment, although there are movements afoot that may change that. Similarly, as designated by many operators as well as manufacturers of endovascular aneurysm repair technologies, a minimum competency number of 20 EVAR procedures with 10 as first operator, if your program can train you with that volume of numbers, would be considered the de minimis for that procedure. And then finally, there's been an explosion of venous interventions over the last decade, predominantly in the area of pulmonary embolism treatment as well as in caval and thrombotic deep and superficial venous disease. And so while not everybody will be interested in pursuing any or all of those venous interventions, if one were to elect a career in which that would be part of your practice, we would recommend that at least 20 venous procedures be done during fellowship. And if you were going to do, for example, pulmonary embolism intervention, you have to do at least five of those as part of your venous training. And you can read the others, but that includes deep venous intervention, for example, for venous compression disease, dialysis access maintenance, or IVC filter placement or retrieval. And so these are evolving areas where we expect that the program directors will have a great deal of discretion. In the document, we've also made the express comment that the program director may or may not be an expert in peripheral vascular interventions, but there should be a faculty member in the core teaching faculty who is responsible for oversight of this specific peripheral vascular training. And so not every program will have all of these opportunities available, but to the extent possible, fellows who are in training programs interested in doing peripheral vascular intervention should look forward to achieving these minimum numbers to have adequate competency at the conclusion of their fellowship. With that, I'll hand it off to Dr. Mahmood, who has an even longer laundry list of procedures.

interventional cardiologists

cath lab procedures

peripheral vascular interventions

minimum competency numbers

venous interventions