Vascular Surgery Field Guide
Compiled by Hashim Salar Medical trainee at the Aga Khan University with an interest in vascular surgery, who put this guide together to make the first weeks on the service easier for whoever comes next.
What you need to be useful on the vascular service: the list and the pager, the operating room and the CTV ICU, the anatomy you will be asked and the notes you will write. Written for residents first, and for every sub-intern and student who joins them.
The runoff, aorta to foot
The sequence you will be asked for most often, usually while holding a retractor.
- Abdominal aorta
- Common iliac
- Internal iliac
- External iliac
- Common femoral
- Profunda femoris
- Superficial femoral
- Popliteal
- Anterior tibial
- Tibioperoneal trunk
- Posterior tibial
- Peroneal
- Dorsalis pedis
Start where you are
Pick your role for a reading order that fits it. Everything else can wait until a case or a page makes it relevant.
Intern or resident
You will carry the list, answer the pager and write most of the notes. Read the first four before your first call night, then keep the rest open on your phone.
- Your first dayPowerChart access, the pager, sign-out times and who to call for what. The week before.
- History, exam and chartingCopy-ready consult, brief op, post-op check, progress and discharge notes, ready to save as PowerChart Auto Text.
- On call and cross-coverThe overnight calls that come up again and again, the first moves for each, and when to wake your senior. Before your first night.
- The CTV ICUWho goes there, the OR-to-ICU handoff, admission orders, CSF drains, and what to watch after each operation.
- Rounds and presentingThe numbers the team wants every morning and how they want them presented.
- Wires, catheters and devicesSo that “give me a Bentson” or “go up and over with an Omni” means something the first time you hear it. Before your first angio day.
- Quick referenceClassifications, thresholds and reversal agents on one screen. Keep it open.
Sub-intern
You will carry patients, present them like an intern and take some first calls with backup. Everything you practice here is what intern year asks of you in July.
- Your first dayBadge, scrubs, PowerChart and where the team meets. The week before.
- Rounds and presentingPre-rounding, the vascular numbers, and a presentation that ends on a plan.
- History, exam and chartingThe focused vascular exam and the notes you will be writing, with templates.
- PresentationsPAD, CLTI, acute limb ischemia, aneurysm, carotid, dissection, mesenteric and venous disease. First week.
- Open operationsSteps, consent risks and what to watch after each case. The night before you scrub.
- On call and cross-coverHow residents triage the pager overnight. Learn it now and your first call night as an intern is far less frightening.
- Questions you'll be askedAnswer out loud, then reveal. Ten minutes before rounds.
Third-year student
You will follow a few patients closely, pre-round, present and scrub. Aim to be useful and to learn the logic of the service; the habits you build here (a specific pulse exam, a note that is true today, a plan you commit to) carry straight into residency.
- Your first dayThe logistics that decide whether your first morning goes smoothly. The week before.
- Rounds and presentingHow to pre-round, what to gather, and how to present a vascular patient.
- FoundationsAnatomy, the pulse exam, the ABI and the anticoagulants. First week.
- PresentationsThe diseases behind the consult pager.
- Open operationsRead the case the night before and name the structures in the wound. Before each case.
- EndovascularAccess, angiography and radiation safety, so the angio suite makes sense.
- Questions you'll be askedThe classic teaching questions with the answers attendings want.
Built to make the service easier to run
Most of what goes wrong for a new resident on vascular is predictable: a stale pulse exam, a groin bleed nobody expected, an ICU handoff missing the clamp time. These pages are organized around those moments.
Fewer 2 a.m. guesses
First moves for the lost pulse, the groin hematoma, the swollen neck and the low urine output, and a clear list of when to call. On call and cross-cover
Notes in minutes
Consult, brief op, post-op check, progress and discharge templates you can paste into PowerChart Auto Text once and reuse all rotation. Charting
Clean ICU handoffs
The items the CTV ICU team will ask for, in the order they ask, plus targets for blood pressure, MAP and CSF drains. The handoff
Devices by name
What a Rosen, a KMP, an Omni Flush or a ProGlide is, so you can hand the right thing over and follow the case. Devices
Answers on rounds
Classifications, thresholds and reversal agents on one page, and the teaching questions as self-tests. Quick reference
Search every page
Press / anywhere, or tap the search icon, and type HIT, Rutherford, endoleak or Bentson.
Contents
Start here
Running the service
- 3History, exam and chartingNewThe vascular history by complaint, the focused exam, and copy-ready notes.
- 4The CTV ICUNewAdmission, the OR-to-ICU handoff, orders, CSF drains, and what to watch after each operation.
- 5On call and cross-coverNewPager triage, sign-out, and first moves for the calls that come up again and again.
The knowledge
- 6FoundationsAnatomy, hemodynamics, the exam, noninvasive testing, imaging, anticoagulation, and cardiac risk.
- 7PresentationsPAD, CLTI, acute limb ischemia, aneurysm, carotid, dissection, mesenteric, and venous disease.
- 8Open operationsSteps, consent risks, and what to watch afterwards for every major open case.
- 9EndovascularAccess, angiography, radiation and contrast, stenting, EVAR and TEVAR, and clot management.
- 10Wires, catheters and devicesNewSheaths, wires, catheters, balloons, stents, grafts and closure devices, by name.
The vascular mindset
Before the facts, the frame. Vascular is a small, intense service with a logic of its own. Get the logic and the facts hang on it.
Everything reduces to inflow, outflow and conduit. A leg, a graft, a bypass, a fistula, all of it. Is enough blood arriving (inflow), is there a healthy bed for it to drain into (outflow, or runoff), and is the channel between the two intact (conduit)? When a graft clots or a wound will not heal, the question is always which of the three failed.
The vascular patient is a cardiac patient who happens to have a leg or carotid problem. Atherosclerosis is systemic. The person with claudication almost certainly has coronary disease too, which is why the leading cause of death after nearly every vascular operation is myocardial infarction rather than anything in the operated territory. Optimize the heart, and treat the limb in that context.
Time is tissue. Acute limb ischemia, a ruptured aneurysm, acute mesenteric ischemia, a cold mottled foot after a catheterization: these are clocks running against muscle, bowel and brain. The reflex is to anticoagulate early, image fast, and call for help before the window closes.
How to read the guide
Each section heading carries a short colored bar that tells you which vascular bed it is about.
- Arterial
- Venous
- Both
- General or logistics
The boxes recur on every page, and each one means something specific.
Questions look like this. Try to answer before you open one.
The answer is the one an attending wants to hear, usually followed by the reason. If you can answer these cold, you are ahead of most rotators.