General Vascular Surgery
Core concepts
Know the evaluation of peripheral arterial disease, carotid disease, aortic aneurysm, and venous disease. Understand ankle-brachial index interpretation, claudication versus critical limb ischemia, and indications for revascularization. Carotid endarterectomy is indicated for symptomatic high-grade stenosis; asymptomatic disease is more selective.
Aortic and venous disease
- AAA: surveillance thresholds by size, repair indications, and rupture presentation.
- Acute limb ischemia: the six Ps, immediate heparin, and urgent revascularization.
- Venous thromboembolism: anticoagulation as the mainstay; intervention for massive PE or phlegmasia.
Traps
- Confusing claudication with critical limb ischemia (rest pain, ulceration, gangrene).
- Forgetting that acute limb ischemia is a time-critical emergency.
- Assuming all carotid stenosis needs surgery.
- Missing the difference between ruptured AAA and other causes of back pain with hypotension.
Worked example
A patient with a painful, pale, pulseless leg and sensory loss: acute limb ischemia - heparinize and arrange urgent revascularization; do not wait for imaging if the limb is threatened. Rule of thumb: motor deficit means the limb is threatened and time is tissue.
Study strategy
Memorize ABI categories and aneurysm size thresholds. Practice distinguishing acute from chronic presentations.