Vascular and Endovascular Surgery
Vascular surgery tests urgency, anatomy and revascularization choice. The exam expects you to recognise threatened limb, rupture risk and when endovascular repair is appropriate.
Core rules
- Acute limb ischemia is a vascular emergency; assess sensory and motor deficit, Doppler signals and proceed to revascularization without delay.
- Abdominal aortic aneurysm repair is considered by size, growth, symptoms and fitness; ruptured AAA requires resuscitation and urgent control.
- EVAR versus open repair depends on anatomy, rupture status, comorbidity and durability; EVAR needs suitable neck and access.
- Carotid disease management depends on symptoms, stenosis severity and best medical therapy; do not operate on asymptomatic disease without individualized risk review.
Worked example
A 70-year-old with sudden painful pale leg, absent popliteal pulse and reduced sensation has Rutherford IIb threatened limb. The correct action is urgent heparin, vascular surgery review and revascularization, not duplex-waiting for a day. The sensory deficit converts this from routine claudication to a limb-threatening emergency.
Traps
Do not miss compartment syndrome after revascularization; do not treat all AAA by EVAR without neck anatomy; do not delay embolectomy for an insensate limb; do not confuse venous claudication with arterial ischemia.