Vascular Surgery

A

• Acute Limb Ischemia — Diagnosis and Revascularization

  Acute limb ischemia is a sudden decrease in arterial perfusion that threatens limb viability. Classic findings include pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia, but early presentations may be incomplete. Immediately assess sensory and motor function and obtain Doppler signals, start IV unfractionated heparin unless contraindicated, and obtain emergent vascular-surgery consultation. A threatened limb requires urgent revascularization; imaging should define anatomy only when it
• Acute Mesenteric Ischemia - Arterial Revascularization

  Arterial acute mesenteric ischemia is a time-critical vascular emergency caused most often by embolic or thrombotic occlusion of the superior mesenteric artery. Early CT angiography, prompt IV unfractionated heparin when not contraindicated, broad-spectrum antibiotics, correction of shock, and immediate vascular and surgical consultation are central. Revascularization should occur rapidly using open, endovascular, or hybrid techniques according to anatomy, peritonitis, bowel viability, and local expertise.
• Aortoenteric Fistula - GI Bleeding Diagnosis and Management

  Aortoenteric fistula is a catastrophic communication between the aorta or an aortic graft and the gastrointestinal tract. In a patient with prior aortic reconstruction, unexplained gastrointestinal bleeding, sepsis, or a herald bleed must trigger immediate concern. Resuscitation, urgent CTA when feasible, broad-spectrum antibiotics, and rapid vascular and gastrointestinal surgical coordination are required; definitive treatment requires control of the aortic source and management of contaminated bowel or gr
• Arteriovenous Access Thrombosis - Endovascular and Surgical Salvage

  Thrombosis of an arteriovenous fistula or graft is a dialysis-access emergency because access salvage is most successful when performed promptly and the underlying stenosis is corrected. Evaluation focuses on loss of thrill or bruit, access anatomy, duration of thrombosis, infection, and prior interventions. Endovascular thrombectomy with angioplasty is common, while surgical thrombectomy or revision is favored for selected anatomy, recurrent lesions, infected grafts, or failed endovascular salvage.

C

• Carotid Endarterectomy After Stroke or TIA - Timing and Patient Selection

  Carotid endarterectomy reduces recurrent stroke risk in appropriately selected patients with recently symptomatic extracranial carotid stenosis. Benefit is greatest for nondisabling stroke or TIA with severe ipsilateral stenosis when surgery can be performed by an experienced team after neurologic stabilization, generally within 14 days and often earlier in selected stable patients. Stenosis severity, infarct size, hemorrhage, anatomy, age, life expectancy, and procedural risk determine selection.
• Critical Limb Threatening Ischemia - Revascularization and Wound Plan

  Chronic limb-threatening ischemia is advanced peripheral arterial disease manifested by ischemic rest pain, nonhealing ulceration, or gangrene attributable to arterial insufficiency. Management combines objective perfusion testing, WIfI limb-threat staging, anatomic imaging, infection and wound control, cardiovascular risk reduction, and timely revascularization. Endovascular therapy, bypass, hybrid repair, or amputation are selected according to patient risk, limb severity, anatomy, conduit, and functional

D

• Dialysis Access Steal Syndrome - Diagnosis and Management

  Dialysis access steal syndrome, also termed hemodialysis access-induced distal ischemia, results when an arteriovenous fistula or graft diverts enough arterial flow to cause hand ischemia. Diagnosis combines symptoms, examination, access compression maneuvers, physiologic testing, and duplex imaging. Severe rest pain, tissue loss, motor dysfunction, or threatened hand viability requires urgent vascular access evaluation and a flow-preserving or flow-reducing corrective procedure tailored to access flow and

E

• EVAR Endoleaks - Types, Detection, and Management

  Endoleak is persistent blood flow outside the endograft lumen but within the aneurysm sac after EVAR. Management depends on endoleak type, sac behavior, timing, and rupture risk. Type I and III endoleaks represent failure of seal or graft integrity and generally require prompt repair. Type II endoleaks are often observed unless the aneurysm sac enlarges, while type IV and type V require confirmation of mechanism and surveillance or treatment based on sac expansion.

P

• Popliteal Aneurysm - Thrombosis and Embolization Management

  Popliteal artery aneurysm becomes limb-threatening when thrombosis or distal embolization produces acute ischemia. Management depends on limb viability, thrombus burden, runoff, aneurysm anatomy, and physiologic risk. Immediate anticoagulation and vascular consultation are followed by urgent revascularization for threatened limbs, often combining thrombolysis or thrombectomy to restore runoff with exclusion and bypass or endovascular repair of the aneurysm.

R

• Ruptured Abdominal Aortic Aneurysm - Resuscitation and Transfer

  Ruptured abdominal aortic aneurysm is a vascular emergency in which survival depends on rapid recognition, controlled hemorrhagic-shock resuscitation, immediate vascular-surgery activation, and definitive aortic control. Bedside ultrasound can confirm an aneurysm but cannot reliably prove rupture. CT angiography is reserved for patients stable enough that imaging will not delay repair.

T

• Type B Aortic Dissection - Blood Pressure Control and TEVAR Indications

  Acute type B aortic dissection involves the descending thoracic aorta without primary ascending-aortic involvement. Initial treatment is ICU anti-impulse therapy with rapid heart-rate and blood-pressure control, analgesia, and surveillance for rupture or malperfusion. Uncomplicated cases are usually treated medically, while rupture, refractory symptoms, uncontrolled hypertension, rapid expansion, or organ malperfusion favor urgent endovascular repair when anatomy is suitable.