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.
After, and when it goes wrong
Post-op & Emergencies
The expected course, the ward reads, and the calls that cannot wait.
The expected course and the ward reads, then the complications and the calls that cannot wait.
On the ward
Three boards, three reads
POD 0 · carotid endarterectomy
Hourly neuro obs
BP 168/90
Wound soft, drain 20 mL
New headache
What is the pressure doing to the operation?
The read
Threatening it twice: hypertension strains the arteriotomy and drives cerebral hyperperfusion syndrome, the headache-seizure-haemorrhage sequel of a brain suddenly re-pressurised. Post-CEA blood pressure is treated to target aggressively, the headache is escalated rather than paracetamol-ed, and any new neurology means the artery gets re-imaged today.
POD 0 overnight · femoral embolectomy
Foot warm, pulses present by Doppler
Calf soft on the hour
Urine darkening
K+ 5.6
What are the hourly checks actually looking for?
The read
Two failures: re-occlusion (a foot going cold and quiet again means the clot re-formed or a source re-embolised) and reperfusion injury, where the darkening urine and rising potassium are myoglobin and cell death washing out. The calf check is the compartment question. Fluids, an alkalinised urine conversation, and a low threshold to re-explore or open fascia.
POD 1 · EVAR
Groins soft, no expansile swelling
Distal pulses as pre-op
Creatinine bumped 20%
Mobilising
What does follow-up mean after a stent graft?
The read
Forever, formally: EVAR trades a smaller operation for lifelong surveillance, because endoleaks can quietly re-pressurise the sac years later. Today's jobs are the groins (haematoma, pseudoaneurysm), the feet (embolisation), and the kidneys recovering from contrast; the discharge letter's most important line is the surveillance imaging schedule.
Emergencies
The calls that cannot wait
Ruptured AAA
Recognise: Back or abdominal pain, collapse, hypotension and a pulsatile mass in the right demographic: the triad is the diagnosis.
First move: Permissive hypotension, activate the vascular team and blood bank, and move: CT only if stable enough, theatre directly if not.
Acute limb ischaemia
Recognise: The six Ps on a clock: sensory loss says the window is closing; fixed mottling says it has closed.
First move: Heparin now, senior review now, and the embolectomy-versus-lysis decision made within the hour, not the shift.
Compartment syndrome after reperfusion
Recognise: Pain out of proportion, worse on passive stretch, in a tense calf hours after revascularisation. Pulses may still be present.
First move: Fasciotomy is the treatment and the deadline is muscle death: escalate on clinical suspicion, remembering that pressures confirm but the story convicts.
Neck haematoma after carotid surgery
Recognise: A swelling neck, voice change, stridor or agitation in the hours after endarterectomy: the airway is being pushed shut.
First move: Open the wound at the bedside if the airway is threatened, skin clips out, haematoma released, and theatre and anaesthetics called in the same breath.
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.