Outcome: (if Morbidity, please indicate the specific morbidity if not just indicate N/A on the blank)
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PATIENT's OPERATION's DATA:
Outcome: Date
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MM
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DD
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YYYY
PATIENT's OPERATION's DATA:
Please choose one: Case Type:
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PATIENT's OPERATION's DATA:
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PATACSI INDEX CASE REQUIREMENT DATA:
Please choose one per case per patient:
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Aneurysm Open Surgery (AAA / Visceral Aneurysm / Iliac Aneurysm) - PATACSI Case Requirements: 10
Endovascular Arterial Revascularization (as primary or secondary operator) - PATACSI Case Requirements: 5
Lower Extremity Open Revascularization: Anatomic and Extra-Anatomic Bypass (as primary or secondary operator)- PATACSI Case Requirements: 5
Thromboembolectomy - PATACSI Case Requirements: 5
Carotid Surgery (Carotid Endarterectomy with patch angioplasty / Carotid subclavian bypass / Carotid cross-over bypass / Tumor resection) (as primary or secondary operator) - PATACSI Case Requirements: 2
GSV Harvesting - PATACSI Case Requirements: 15
Vena Cava Surgery (Filter / Tumor resection / Shunt) (as primary or secondary operator & can be achieved in other institutions) - PATACSI Case Requirements: 1
Venous Ablation Procedures (as primary or secondary operator) - PATACSI Case Requirements: 5
Arteriovenous Fistula / AV Graft - PATACSI Case Requirements: 10