Vascular Surgery
Core concepts
Understand arterial anatomy and the pathophysiology of atherosclerosis, aneurysm formation, and thromboembolism. Know the presentation and management of peripheral arterial disease, acute limb ischemia (the six Ps), carotid stenosis, aortic aneurysm, and venous disease including deep vein thrombosis and varicose veins. Master the role of duplex ultrasound, CT angiography, and ankle-brachial index. Understand indications for intervention, endovascular versus open repair, and perioperative anticoagulation. Know compartment syndrome after revascularization.
Traps in questions
Questions often test the difference between claudication and critical limb ischemia, and when to intervene. Distinguish acute limb ischemia from chronic disease; acute requires urgent revascularization. Another trap is confusing carotid endarterectomy indications for symptomatic versus asymptomatic stenosis. Watch for questions about aneurysm size thresholds for repair and about ruptured AAA presentation. Be careful with anticoagulation reversal before surgery.
Worked rule of thumb
For acute limb ischemia, assess motor and sensory function; if a limb is threatened, revascularize emergently. For asymptomatic carotid stenosis, medical therapy is usually preferred unless stenosis is severe and risk is acceptable.
Exam strategy
Use the six Ps and the ankle-brachial index to classify severity. Link treatment to symptom severity and limb threat.