Vascular Surgery ABSITE Review 2026: Aneurysms, PAD, and Venous Disease

Aneurysm Management and Indications

• 🎯 Splenic artery aneurysms are most common, with repair indicated if > 3 cm or in females of childbearing age; rupture is a surgical emergency.
• 💡 Hepatic artery aneurysms require resection and reconstruction due to the need to preserve liver blood flow; SMA aneurysms should always be repaired due to their common association with mycotic causes.
• 📌 Iliac artery aneurysms are repaired if > 3.5 cm, often with endovascular stents, and are strongly associated with abdominal aortic aneurysms (AAAs) and smoking.
• 🚀 Femoral artery aneurysms are repaired if > 2.5 cm and can embolize or thrombose, leading to critical limb ischemia; popliteal artery aneurysms (repair > 2 cm or symptomatic) are treated with exclusion and bypass, with a high association with AAA.

Arterial Disease and Revascularization

• ⚡ Abdominal aortic aneurysms (AAAs) in men require repair if > 5.5 cm, in women if > 5 cm, or with rapid growth; symptomatic AAAs (e.g., blue toe syndrome) or mycotic aneurysms also need repair.
• 🧠 For AAA repair, open surgery is considered for younger patients (<70) with good risk factors or complex anatomy, while endovascular repair (EVAR) has specific criteria including neck diameter (<32mm), angle (<60°), length (>10mm), and iliac diameters (>7mm).
• ⚠️ Endoleaks (Type I-IV) are complications of EVAR, requiring specific management based on type and aneurysm sac pressure; Type II (lumbar/IMA filling) only needs intervention if the aneurysm is growing.
• 🩺 Peripheral arterial disease (PAD), particularly claudication, is primarily managed with lifestyle changes (smoking cessation, exercise) and medical therapy (high-dose statins, antiplatelets); intervention is reserved for lifestyle-limiting symptoms or critical limb ischemia (rest pain, tissue loss).

Venous Disease and DVT Management

• 🌟 Greater saphenous vein reflux can be treated with heat ablation (above the knee) or chemical ablation (below the knee) to manage symptoms and prevent complications.
• ⚠️ Superficial thrombophlebitis near the saphenofemoral junction or longer segments may require anticoagulation to prevent DVT progression.
• 🩸 Deep vein thrombosis (DVT), most common in the iliofemoral veins of the left leg, is treated with anticoagulation; IVC filters are an option for contraindications to anticoagulation.
• 🩹 Phlegmasia cerulea dolens, a severe DVT causing limb swelling and potential compromise, requires urgent catheter-directed thrombolysis or thrombectomy to prevent limb loss.