ABC | Volume 114, Nº1, January 2019

Statement Position Statement of the Brazilian Cardiology Society and the Brazilian Society of Hemodynamics and Interventional Cardiology on Training Centers and Professional Certification in Hemodynamics and Interventional Cardiology – 2020 Arq Bras Cardiol. 2020; 114(1):137-193 in the literature. One motive which justifies this difficulty is that we are dealing with procedures which are less prevalent in all services. It is however, recommended, as an analogy of the proposed volume for maintaining trainee competence, that preceptors perform at least 50 therapeutic endovascular interventions annually. 6.3.1.2. Trainees The prerequisites and basic obligations of trainees have been previously described. For specific acquisition of competence in extracardiac interventions, trainees must act as first operators in: • 100 diagnostic exams (including aortographies; angiographies of carotid, vertebral, subclavian, upper- member, lower-member, abdominal, and renal arteries; venous angiographies; cavographies, and pulmonary artery catheterizations). • 50 endovascular interventions in different peripheral beds (miscellany). • 12 carotid angioplasties. 6.3.1.3. The Theoretical-Practical Program • The minimum specific training period is 12 consecutive months, with 30 days of vacation per year, scientific improvement, and participation in congresses and reunions related to the specialization. • The year of extracardiac training may simultaneously correspond to the second year of specialization at the training center, in the event that the center routinely performs this type of intervention. • In the event that the training does not routinely perform the extracardiac vascular procedures necessary for the acquisition of abilities on the part of the trainee, specific training may take place by means of improvement courses, sanctioned by the SBHCI, concomitant to or after the second year of specialization. The minimum syllabus for trainees in hemodynamics and interventional cardiology has already been described. In relation to specific aspects of training for the peripheral bed, the following are also necessary: • Mastery of alternative vascular accesses, such as anterograde puncture of the common femoral artery, brachial puncture, radial puncture, fistula puncture, superficial femoral puncture, popliteal puncture, distal vessel puncture in the lower limbs, whether ultrasound- guided or not. • Comprehensive knowledge of peripheral vascular anatomy. • Accompanying theoretical discussions of extracardiac cases for one year with preceptors in the specialization or with SBHCI endovascular course coordinators. • For training in the improvement course, the minimum theoretical course load is 200 hours/year. 6.3.2. Individualized Knowledge for Each Type of Intervention 6.3.2.1. Interventions in Lower Limbs 6.3.2.1.1. Basic Knowledge • Knowledge of the natural history of atherosclerosis and its manifestations in lower members, differentiating the needs of claudicating patients from those who have critical ischemia, whether acute or chronic. • Clinical treatment of ischemia of the lower limbs. • Differentiation of conduct for inflow and outflow diseases. • Diagnostic exams required for image interpretation. • Indications for invasive intervention. • How to proceed with follow-up. 6.3.2.1.2 Interventional Cardiologists’ Abilities • Definition and execution of the best vascular access: anterograde or retrograde. • Selection of introducers, sheaths, guides, and catheters. • Selection of appropriate balloons; whether or not prostheses are necessary and their characteristics, balloon- or self-expandable, coated or uncoated. • Mastery of management of complications by means of rescue of distal occlusions or embolisms with or without the use of local thrombolysis or perforations with embolotherapy techniques. 6.3.2.2. Aortic Interventions (Aneurysms) 6.3.2.2.1. Basic Knowledge • Natural history of the disease. • Differentiation of conduct based on the affected segment of the aorta. • Diagnostic exams required for image interpretation. • Indications for invasive intervention and technical knowledge for prevention and treatment of leaks. • Planning, indication, andmanagement by amultidisciplinary team (heart team). • How to conduct follow-up. 6.3.2.2.2 Interventional Cardiologists’ Abilities • Definition of the best vascular access and mastery of totally percutaneous techniques and hemostatic devices. • Selection of introducers, sheaths, guides, and catheters. • Selection of endoprostheses and their characteristics. • Mastery of management of complications by means of rescue of occlusions or perforations with techniques for covered prostheses. 156