Vascular Surgery

Lesson Objectives

By the end of this topic, learners should be able to:

1. Identify common vascular surgical conditions and their pathophysiology.

2. Recognize indications for surgical intervention.

3. Understand diagnostic approaches including imaging modalities.

4. Describe perioperative and post-operative care for vascular surgery patients.

5. Apply nursing and medical principles for optimal outcomes.

 Key Glossary Terms

1. Peripheral Arterial Disease (PAD)

• Definition: Narrowing or obstruction of peripheral arteries, often due to atherosclerosis.

• Clinical Features: Claudication (pain on walking), weak pulses, cold extremities, ulcers

• Management: Lifestyle modification, antiplatelets, revascularization (angioplasty, bypass grafting)

2. Aneurysm

• Definition: Abnormal dilation of a blood vessel.

• Common Sites: Abdominal aorta (AAA), thoracic aorta, peripheral arteries

• Complications: Rupture → hemorrhagic shock

• Management: Elective repair for symptomatic or large aneurysms, endovascular stent grafting, open surgical repair

3. Varicose Veins

• Definition: Dilated, tortuous superficial veins due to valve incompetence.

• Clinical Features: Leg swelling, aching, skin changes, ulcers

• Management: Conservative (compression stockings), sclerotherapy, vein stripping, endovenous ablation

4. Deep Vein Thrombosis (DVT)

• Definition: Formation of blood clot in deep veins, commonly lower limb.

• Clinical Features: Leg pain, swelling, redness, warmth

• Complications: Pulmonary embolism (PE)

• Management: Anticoagulation (heparin, warfarin, DOACs), thrombolysis in selected cases, IVC filter

5. Thrombectomy

• Definition: Surgical removal of thrombus from a blood vessel.

• Indications: Acute limb ischemia, failure of anticoagulation, large clot burden

6. Carotid Endarterectomy

• Definition: Surgical removal of atherosclerotic plaque from the carotid artery to prevent stroke.

• Indications: Symptomatic carotid stenosis (>50%) or asymptomatic (>70%)

7. Vascular Grafts

• Definition: Synthetic or autologous vessel used to bypass occluded arteries.

• Materials: PTFE, Dacron, saphenous vein

• Post-Op Care: Monitor distal pulses, bleeding, infection, graft patency

8. Nursing & Medical Student Focus

• Nursing: Monitor pulses, capillary refill, wound care, anticoagulation therapy, patient education on lifestyle changes

• Medical Students: Recognize indications for surgery, interpret vascular imaging (Doppler, CT angiography), plan perioperative management

9. Vascular Surgery Mnemonics

• “PAD VETS” for Peripheral Arterial Disease risk factors:

  • Prolonged hypertension

  • Atherosclerosis

  • Diabetes

  • Vascular smoking

  • Elderly

  • Tobacco use

  • Sedentary lifestyle

• “ABCDE” for Acute Limb Ischemia:

  • Arterial pulse absent

  • Brisk skin changes

  • Cool limb

  • Distal paresthesia

  • Emergency revascularization

 Tables

Table 1: Common Vascular Surgical Conditions

Table 2: Post-Operative Nursing Care in Vascular Surgery