Chapter 6: Vascular Surgery

DISEASES AND CONDITIONS

• Acute limb ischemia (c), arterial embolectomy (c)

• Peripheral arterial disease (c), lower extremity bypass (a)

• Popliteal artery aneurysm (a)

• Diabetic foot infection (c)

• Nonhealing foot wound, lower extremity amputations (c)

• Cerebrovascular disease (c), carotid endarterectomy (a)

• Acute mesenteric ischemia (c), SMA embolectomy/thrombectomy (a)

• Chronic mesenteric ischemia, operations for mesenteric occlusive disease (a)

• Central venous access (c), port placement (c)

• Venous thromboembolism (c), IVC filter placement (a)

• Hemodialysis access (c), arteriovenous graft/fistula creation (a)

• Lower extremity swelling, venous disease (c)

• Aortoiliac occlusive disease, aortoiliac reconstruction for occlusive disease (a)

• Acute aortic dissection (a)

• Abdominal aortic aneurysm (a), abdominal aortic aneurysm repair (a)

• Splenic artery aneurysm (a)

• Thoracic outlet syndrome (a)

• Vascular graft infection and graft-enteric fistula (a), extra-anatomic bypass (a)

• Femoral artery pseudoaneurysm

GENERAL VASCULAR SURGERY TIPS

• - Be familiar with common vascular exposures—these will help you get through many of the vascular scenarios. Descriptions of the most common vascular exposures are included in this chapter.

• - You are also expected to be familiar with the basics of endovascular intervention and the use of ultrasound in the diagnosis and management of vascular disease.

• - Work-up of vascular patients frequently includes duplex U/S because it is useful for rapidly identifying venous or arterial disease, so don’t forget this as part of your work-up, if indicated.

• - Don’t forget to heparinize!

• - Consider HIT if the examiners present you with a patient with a drop in platelets and thrombosis while on heparin—send HIT assay, stop heparin, start argatroban or bivalirudin.

• - Be familiar with how and when to obtain an ankle brachial index (ABI).

• - Have a low threshold to perform fasciotomy when patient has had limb ischemia >4-6 h.

• - Consider obtaining cardiac work-up (ECG, ECHO, +/− stress test) in patients undergoing elective vascular operations as many of these patients will have underlying cardiac disease.