Vascular Surgery
What the exam tests
This domain covers abdominal aortic aneurysm, peripheral arterial disease, carotid disease, varicose veins, acute limb ischaemia and the diabetic foot.
Core rules
- Measure the ankle-brachial pressure index in suspected peripheral arterial disease; values below 0.9 support diagnosis, and falsely high values occur in calcified vessels.
- Acute limb ischaemia presents with the six Ps: pain, pallor, pulselessness, paraesthesia, paralysis and perishing cold. Heparinise and revascularise urgently; sensory or motor loss indicates a threatened limb.
- Carotid endarterectomy is considered for symptomatic severe stenosis, ideally within two weeks of the index event.
- Elective abdominal aortic aneurysm repair is generally offered at about 5.5 cm in men, or faster growth or symptoms.
- Diabetic foot disease needs offloading, debridement of infection and vascular assessment; do not simply prescribe antibiotics.
Worked example
A 72-year-old with atrial fibrillation develops a sudden cold, painful left leg. Pulses are absent below the femoral artery, and sensation is reduced. After heparin and imaging, an embolectomy is performed. Postoperatively, check for compartment syndrome and reperfusion injury, including hyperkalaemia and acidosis.
Traps
Delaying decompression of a tension pneumothorax is covered elsewhere, but in vascular surgery the equivalent trap is delaying revascularisation while arranging unnecessary imaging in an irreversible limb; also missing compartment syndrome and failing to examine the contralateral limb.