SurgSpace / Specialties / Vascular Surgery
Vascular Surgery
Arteries and veins outside the heart: aneurysms repaired from within by stent graft or from without by sew, carotid disease and the strokes it threatens, and the ischaemic limb, where the six Ps and the clock decide everything.
Apply it
Cases & Practice
Patients to decide on, images to interpret, and the first day on the rotation.
Patients to decide on, images to interpret, and the briefing for the first day on the rotation.
Decisions, one patient at a time
Cases
Imaging practice
Read the image, then decide
Surgical decision-making
Does this patient need surgery?
A 6.1 cm AAA in a 78-year-old with COPD; CT shows a 12 mm infrarenal neck. Endovascular or open repair?
EVAR
Groin punctures, a stent graft, and a hospital stay in days: lower early mortality, bought with lifelong surveillance and a reintervention rate.
Open repair
A laparotomy and a sewn graft: the bigger early hill, the more durable summit. Favoured in younger, fitter patients and hostile endovascular anatomy.
Conservative
For the patient whose fitness makes any repair worse than the rupture risk: honest surveillance and honest conversation.
Anatomy and physiology split this decision: the neck and access vessels decide whether EVAR is possible; age and fitness decide whether its early advantage or open repair's durability matters more to this patient.
An acutely ischaemic leg, sensory loss but intact movement: sudden onset in AF versus long claudication history. Same leg, two diseases, one decision.
Femoral embolectomy
For the embolic leg: a balloon catheter retrieves the clot from healthy vessels, often under local anaesthetic.
Thrombolysis
For thrombosis on chronic disease with a still-viable limb: hours of catheter-directed lysis reveal the underlying lesion that then needs fixing.
Primary amputation
For the irreversible limb: mottled, rigid, insensate. Revascularising dead muscle trades a limb already lost for a life put at risk.
The history chooses the operation: emboli block clean pipes and come out with a balloon; thrombosis sits on a diseased segment that lysis uncovers and a bypass or stent must fix. The viability stage decides whether there is time for either.
A 75% symptomatic carotid stenosis, TIA five days ago, list pressure everywhere. When does this operation happen?
Within two weeks
The evidence's answer: stroke risk is front-loaded after a TIA, and the operation's benefit shrinks with every week of delay.
Next available routine slot
A false economy: by six to eight weeks much of the preventable stroke risk has already happened, operated on or not.
Carotid endarterectomy is stroke prevention with an expiry date: the number needed to treat rises steeply with delay. A symptomatic carotid is an urgent case, and the system's job is to make the two-week window real.
The rotation
Your first day here
- Present every patient as inflow, outflow, conduit: it is the specialty's sentence structure, and it works for every artery from carotid to pedal.
- Feel pulses systematically and write down what you found: femoral, popliteal, posterior tibial, dorsalis pedis. Tomorrow's emergency is diagnosed against today's baseline.
- Learn the hand-held Doppler early: where pulses vanish, the probe and an ABPI are the examination.
- A cold painful leg or a pulsatile mass with pain interrupts whatever else you are doing: vascular surgery's emergencies are measured in hours.
- In theatre, watch the anticoagulation choreography: heparin before the clamp, ACT checks, and the protamine conversation are as much a part of the operation as the sewing.
- Diabetic feet are team sport: know who the podiatrist, the diabetologist and the microbiologist are, because the referral you write will involve all three.
Hub shaped by the Surgical Specialties Lead with the Vascular surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.