Vascular Surgery
Vascular Surgery tests arterial and venous disease, aneurysms, peripheral ischemia, vascular access, and lymphatic disorders. The exam rewards anatomic localization and threshold-based intervention.
Arterial and venous
- AAA: repair when ≥5.5 cm in men or ≥5.0 cm in women, rapid growth (>0.5 cm/6 months), or symptoms. Rupture = hypotension, back pain, pulsatile mass; do not delay for CT if unstable.
- PAD: ABI ≤0.90 is abnormal; claudication is managed with exercise, statin, antiplatelet, and smoking cessation; critical limb ischemia needs urgent revascularization.
- Acute limb ischemia: six Ps, Rutherford classes; give heparin immediately and revascularize; watch for reperfusion compartment syndrome.
Access and lymphatics
- Fistula first for hemodialysis; avoid subclavian catheters if possible.
- Lymphedema: compression, skin care, infection prevention.
Worked example: A 60-year-old smoker has calf claudication at 200 m; ABI is 0.65. Reasoning: ABI <0.90 confirms PAD; 0.65 is moderate. Start supervised exercise, high-intensity statin, antiplatelet, and smoking cessation; angiography only if symptoms limit lifestyle or limb threat.
Traps: repairing a 5.0 cm AAA in an asymptomatic man; missing acute limb ischemia because pulses are palpable; using ABI in a heavily calcified diabetic artery without recognizing falsely high values; ignoring compartment syndrome after embolectomy.