Vascular Surgery

Hi there,
I am back on my beloved Vascular Surgery as I bring this year to a close. Previously, I did a Laparoscopic rotation with one of the most brilliant surgeons that I have ever encountered. He immediately had so much faith in my abilities that I felt so comfortable doing many cases on my own with just a PA or a junior resident as MY assistant. It was such a sweet feeling to do a case from beginning to end and totally be in control of every suture. He was just the best and I am forever changed by having him as a mentor. Sometimes you just get in the zone and for two months under his guidance, I was in the zone. Wa-hoo! I am actually a good surgeon!
Now I have returned to my first love which is vascular surgery. My cases have been complex and challenging especially the AV fistulas and grafts. In general, people who have end stage renal disease never have the greatest veins and arteries. Their vessels have been destroyed by multiple blood draws and careless insertions of central venous catheters. It is often a challenge to find a suitable vein and artery for creating a good fistula.
I also love carotid endarterectomies too. This is the vascular surgical equivalent of cleaning out the pipes. Without this surgery, most patients have up to a 50% chance of stroke after a mini-stroke or TIA. With this surgery, the risk goes down to 3%. There is no medication that can compete with this surgery. It is a most elegant case to perform.
My other vascular favorites are amputations. It is sad that a patient has to end up losing a leg but often amputation enables a person to walk with a prosthesis where previously, they had a non-healing foot ulcer that was so badly infected that they were bedridden. I have learned to carefully craft the stump for optimal prosthesis fitting so that they have the best chance of good mobility.
Vascular surgery gives me plenty of creative cases that few general surgeons can do well. Most general surgeons would rather not ever perform a revascularization procedure. I also do plenty of stenting (endovascular work) too.
While I really miss my laparoscopic surgery mentor and all of his encouragement, I have really grown as a surgeon in many ways. His influence has carried over into my other rotations as he said it would.

I just wanted to say that i love your posts. They give me a nice window into the profession that is refreshing to have as a premed. I can take a break from Chem 103 homework and read about the day-to-day of a surgical resident, and that is awesome. Even the minutae are fascinating to me.
Thanks for keeping it up.
Now I should probably get back to the Chem homework.

I enjoy vascular surgery too. The patients are among some of our sickest & hence, most challenging anesthetic cases. I am especially enthralled by the “big whacks”, i.e: open AAA, aorto-bifems, aorto-birenals…of course, many of these huge surgeries are being usurped by endovascular techniques. EVGs (endo-vascular grafting) are way boring for the anesthesiologist - unless something large, red & pulsitile goes POP!
Glad to hear you are back in the saddle Nat. I cannot imagine how rough it would be for me to have had to sit out for a spell.