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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.

3 operations in depth5 interactive cases

Backdrop: Contrast-enhanced axial CT of an infrarenal abdominal aortic aneurysm with calliper measurements across the sac · James Heilman, MD · CC BY-SA 3.0

See the disease

Conditions

The diseases, each with the image that defines it.

Each disease with the image that defines it: what it looks like, what the scan shows, and which operation answers it.

Abdominal aortic aneurysm

A silent dilation with a diameter-shaped risk curve.

The disease
Degeneration of the aortic wall's media dilates the vessel; wall tension rises with radius (Laplace), so growth begets growth and rupture risk climbs steeply past 5.5 cm.
Finding it
Most are silent: found by screening ultrasound, or incidentally. Pain in a known aneurysm is a symptomatic aneurysm, which is a different, urgent disease.
Surveillance and thresholds
Small aneurysms are watched on ultrasound at intervals set by size; repair is offered around 5.5 cm, at rapid growth, or at symptoms, where repair risk finally undercuts rupture risk.
Learn more
EVAR versus open
Endovascular repair relines the aorta through the groins: less early mortality, lifelong surveillance and reintervention risk. Open repair sews a graft in once: bigger operation, more durable result. Anatomy (the neck) and age decide.
Rupture
Back or abdominal pain, collapse and a pulsatile mass: permissive hypotension, activate the team, and CT only if stable enough to earn it.
EVAR (endovascular aneurysm repair)Case: Collapse with a pulsatile mass
CT
Contrast-enhanced axial CT slice of the abdomen showing a dilated aorta with calliper measurements across it
CT · abdominal aortic aneurysm

Carotid artery disease

A plaque that throws clots at the brain.

Mechanism
Atherosclerosis at the carotid bifurcation embolises platelet aggregates and plaque debris to the ipsilateral eye and hemisphere: most carotid strokes are embolic, not flow-limited.
Presentation
Transient monocular blindness (amaurosis fugax), hemispheric TIA, or completed stroke; the symptomatic side is defined by the territory, not the louder bruit.
The evidence shape
Symptomatic stenosis over 50% benefits from endarterectomy, and the benefit is front-loaded: operate within two weeks of symptoms. Asymptomatic disease gains far less and leans on best medical therapy.
Learn more
The operation's own risks
Endarterectomy carries a small stroke and death rate, cranial nerve injuries (hypoglossal, vagus), and the reperfusion syndromes: the consent conversation is the epidemiology made personal.
Carotid endarterectomyCase: A curtain over one eye
Educational illustration
Medical illustration of the carotid artery in the neck with an inset showing plaque narrowing the bifurcation, beside a normal bifurcation
Carotid disease, illustrated · plaque at the bifurcation against a normal vessel

  • Acute limb ischaemia

    Six hours between a salvageable limb and a lost one.

    Causes
    Embolus (AF, mural thrombus) lodging at bifurcations, thrombosis of a diseased segment or graft, and trauma. The embolic leg had normal vessels yesterday; the thrombotic leg has collaterals and a history.
    Assessment
    The six Ps, staged by what still works: sensation and movement present means viable; sensory loss means threatened, operate now; fixed mottling and rigor mean irreversible, and revascularisation would poison the patient.
    Treatment
    Heparin immediately, then by cause and stage: embolectomy for embolus, thrombolysis or bypass for thrombosis, and primary amputation for the unsalvageable limb.
    Learn more
    Reperfusion's bill
    Restored flow releases potassium, myoglobin and acid, and swells muscle inside fixed fascial boxes: watch the ECG, the urine and the compartments, and keep fasciotomy on the table.
    Femoral embolectomyCase: The cold white leg

  • Chronic limb-threatening ischaemia

    The end-stage of peripheral arterial disease, measured in rest pain and tissue loss.

    The spectrum
    Claudication (pain on walking, relieved by rest) is stable and managed with exercise, statins and antiplatelets; rest pain, ulceration or gangrene is limb-threatening and needs revascularisation.
    Assessment
    Pulses, Buerger's test, ABPI (with the diabetic caveat that calcified vessels flatter the number), toe pressures, then duplex and angiography to map the level of disease.
    Revascularisation
    Endovascular angioplasty and stenting versus surgical bypass: the plumbing sentence again, with vein as the best conduit below the knee, chosen by anatomy, conduit availability and fitness.
    Learn more
    The team disease
    In diabetes this is a multidisciplinary foot: debridement, offloading, infection control and glycaemic care beside the revascularisation. No single specialty saves these feet alone.
    Case: Rest pain and a heel ulcer

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.