Vascular Medicine

A

• Acrocyanosis & Achenbach Syndrome — Recognition & Management

  Primary acrocyanosis is benign distal cyanosis; Achenbach syndrome causes sudden painful finger bruising. Rule out serious mimics (Raynaud, emboli, vasculitis) and reassure.
• Acute Limb Ischemia - Recognition and Initial Anticoagulation

  Recognize the six Ps, start systemic anticoagulation promptly, classify severity, and obtain urgent vascular consultation for revascularization.
• Anticoagulation Reversal - Warfarin and DOAC Major Bleeding

  Identify the agent and timing, control bleeding source, reverse anticoagulation with targeted antidotes or prothrombin complex concentrate, and restart thoughtfully after hemostasis.
• Antithrombotic Therapy in PAD — Single vs Dual Pathway

  Choose antithrombotic therapy by PAD phenotype and bleeding risk: single antiplatelet for most; consider dual pathway inhibition (rivaroxaban 2.5 mg BID + aspirin) in symptomatic PAD and post‑revascularization.

B

• Buerger Disease (TAO) — Diagnosis & Smoking Cessation

  Thromboangiitis obliterans (Buerger disease) is a non‑atherosclerotic, segmental vasculitis in young tobacco users causing distal ischemia. Absolute tobacco cessation is the only disease‑modifying therapy.

C

• Cholesterol Embolization Syndrome — Diagnosis & Management

  Look for livedo reticularis/blue toe, eosinophilia, AKI after vascular procedures. Management is supportive: stop anticoagulation if suspected procedure‑related plaque disruption, control BP, statins, and renal support.

D

• Deep Vein Thrombosis - Outpatient Anticoagulation Selection

  Stable patients without high risk features can start outpatient anticoagulation; choose a direct oral anticoagulant for most and consider low molecular weight heparin in active cancer or pregnancy.
• Deep Vein Thrombosis - Probability and Ultrasound Diagnosis

  Use pretest probability and D dimer to guide imaging; compression ultrasound is first line and repeat imaging is needed in selected high risk patients with negative initial study.
• Deep Vein Thrombosis — Evaluation & Treatment

  Deep vein thrombosis is diagnosed by integrating clinical probability, D-dimer when appropriate, and compression ultrasonography. Proximal DVT generally requires anticoagulation unless bleeding risk is prohibitive. Distal calf DVT can be anticoagulated or followed with serial imaging in carefully selected lower-risk patients. Treatment choice depends on renal function, pregnancy, cancer, drug interactions, bleeding risk, and the likelihood that the patient can adhere safely to outpatient therapy.

E

• Extended VTE Therapy — Who Needs It & How

  After initial 3–6 months, extend anticoagulation in unprovoked VTE or persistent risk factors if bleeding risk is acceptable; use reduced‑dose DOACs for long‑term prevention.

H

• Heparin Induced Thrombocytopenia - 4T Score and Management

  Heparin-induced thrombocytopenia is an immune prothrombotic disorder caused by antibodies to PF4-heparin complexes, typically producing a platelet fall beginning 5 to 10 days after heparin exposure and a high risk of new venous or arterial thrombosis. Use the 4Ts score to estimate pretest probability. With intermediate or high probability, stop all heparin and begin an appropriate non-heparin anticoagulant while laboratory testing proceeds; do not start warfarin until platelet recovery.

I

• IVC Filters — Indications, Retrieval & Complications

  Reserve IVC filters for acute VTE with absolute contraindication to anticoagulation or recurrent VTE despite adequate anticoagulation. Plan retrieval early to reduce complications.

L

• Lipodermatosclerosis — Recognition & Care

  Inflammatory panniculitis from chronic venous insufficiency. Treat with compression, ambulation, weight management, and address reflux; topical steroids for acute phase; pentoxifylline as adjunct.
• Lymphedema vs Venous Edema — Differentiation & Care

  Differentiate lymphedema (non‑pitting, Stemmer sign) from venous edema (pitting, worse at day’s end). Treatments differ: CDT for lymphedema vs compression/elevation for venous disease.

P

• Peripheral Artery Disease - Medical Therapy and Supervised Exercise

  Lower-extremity peripheral artery disease is systemic atherosclerotic disease with high risk of myocardial infarction, stroke, limb ischemia, and amputation. Core therapy includes high-intensity statin treatment, antiplatelet therapy for symptomatic disease, aggressive blood-pressure and diabetes management, smoking cessation, structured exercise, and preventive foot care. Low-dose rivaroxaban 2.5 mg twice daily plus low-dose aspirin reduces cardiovascular and limb events in selected patients without high b
• Post‑Thrombotic Syndrome — Prevention & Management

  Chronic symptoms after DVT (pain, swelling, heaviness, ulcers). Prevent with appropriate anticoagulation and early mobilization; manage with compression, exercise, and ulcer care.
• Pulmonary Embolism - Risk Stratification and Disposition

  Use validated tools with clinical judgment to identify low risk patients for outpatient care and high risk features for admission and escalation.
• Pulmonary Embolism - Submassive Thrombolysis Decision

  Intermediate-risk pulmonary embolism describes a normotensive patient with evidence of right-ventricular strain, myocardial injury, or other features associated with early deterioration. Anticoagulation is the foundation. Routine systemic thrombolysis is not recommended for a stable intermediate-risk patient because major bleeding and intracranial hemorrhage offset benefit, but rapid escalation to systemic thrombolysis, catheter-based therapy, surgery, or mechanical support is appropriate when hemodynamic d

S

• Superficial Vein Thrombosis - Treatment and Risk Stratification

  Superficial venous thrombosis is not always benign. Duplex ultrasound should define clot length, proximity to the deep venous junctions, and concomitant DVT. Anticoagulation is recommended for many lower-extremity SVTs that are extensive, close to the saphenofemoral or saphenopopliteal junction, or associated with high-risk features. Fondaparinux 2.5 mg daily for 45 days is a well-established regimen for eligible higher-risk SVT away from the deep junction; clot within roughly 3 cm of a deep junction is com

U

• Upper Extremity DVT - Catheter Associated Management

  Upper-extremity DVT commonly involves the axillary or subclavian veins and may be catheter-associated, cancer-associated, or effort-related. Duplex ultrasound is first-line diagnosis. Proximal UEDVT is treated with therapeutic anticoagulation, usually for at least 3 months. A functioning needed central catheter can often remain in place during anticoagulation; remove it when infected, malfunctioning, no longer needed, or when anticoagulation cannot be given safely.

V

• VTE in Pregnancy — Diagnosis & Treatment

  Use compression US for DVT; V/Q or CTPA for suspected PE with pregnancy‑adapted protocols. Treat with LMWH throughout pregnancy and 6 weeks postpartum; avoid warfarin and most DOACs.