1. Vascular Surgery for Final Medical
Vascular Surgery UnitVascular Surgery Unit
AMNCHAMNCH
www.perfuse.net
Introduction

2. Scope
Occlusive Vascular
disease
Aortic aneurysm
Carotid disease
Varicose veins
Occlusive venous
disease
Lymphoedema
Visceral arterial
occlusion
Peripheral
aneurysms
Arterial Trauma
Diabetic Foot
Hyperhidrosis
Venous access

3. Topics
Occlusive Vascular
disease
Aortic aneurysm
Carotid disease
Varicose veins
Occlusive venous
disease
Lymphoedema
Visceral arterial
occlusion
Peripheral
aneurysms
Arterial Trauma
Diabetic Foot
Hyperhidrosis
Venous access

4. Lecture topics
• Introduction
– History
– Physical examination
– Differential diagnosis
– Presentation
• Leg Ulcers
– clinical description
– clinical reasoning
– differential diagnosis
– Bayesian approach to
diagnosis
• Peripheral arterial occlusive
disease
– systemic disease
– differing end organ
manifestation
– holistic approach to therapy
– Indications for surgery
• Aortic aneurysms
– preparing patients for
complex surgery
– clinical decision making

5. Lecture topics
• Carotid disease
– evidence based medicine
– randomised trials in surgery
– choosing therapy
• Varicose veins
– relationship between
symptoms & conditions
– Risk/benefits in surgery
– Informed consent
• Diabetic foot
– systemic disease
– Warning signs
– Interventions
– Preventing amputations

6. Perfuse.net

7. Perfuse.net

8. Elements
• Theoretical knowledge
– anatomy
– physiology
– pathology
– pharmacology
– medicine
– surgery etc.
Normal & disease

9. Clinical skills
• History
• Physical examination
• Diagnosis
• Investigation
• Treatment
Patients present with symptoms and signs
rather than disease
Patients present with symptoms and signs
rather than disease

10. History
• Presenting problem
• Context
– personal
• age
• sex
• occupation
– social
• domestic
arrangements
• lifestyle
– medical
• chronic
illness
• medications
• previous
surgery
Process of communicationProcess of communication

11. History - II
• Obtain information from the patient
– listen
– identify precise symptoms
– avoid leading questions initially
– ask questions to fill in the gaps
• Collateral history
– trauma, confused, paediatric etc
All the information that cannot be
obtained by examining the patient
All the information that cannot be
obtained by examining the patient

12. Art of History Taking
Translate

13. Common language
• Standard formula
• Common among clinicians
• Precise terminology vs
– “haemorrhoids”
– “can’t breathe”
– “trouble passing water”

14. Physical examination

15. Differential diagnosis
• Consider all the possibilities
• Weight them
Diagnosis
• Test the hypothesis
• Re prioritise
Diagnosis
• Treat
• Evaluate response