Surgery sub-i stuff in general:
Show up early, stay late. Know your patients' surgical history, pertinent medical history pertinent labs (Hgb, plt and for vasc this often includes K, Cr - either bc you're going to be doing grafts/fistulas or dialysis catheters or bc you're hitting them with a dye load recent lit on CIN notwithstanding....). Know the relevant anatomy for the case. Know indication for the surgery, potential complications. Write your name on the board, introduce yourself, get your gloves. Don't touch non-sterile things, but if you do just say you did and re-scrub. Don't pimp your residents. If everyone is silent, it's probably not a great time to pipe up with a question.
Vascular topics and patients in specific:
Big topics are going to be PAD, aneurysmal disease, ESRD for dialysis access, and carotid disease/CEA.
PAD
-History: is it acute limb ischemia or chronic limb ischemia? Know how to differentiate the two. Know claudication symptoms (and be able to differentiate from say spinal/neuropathic etc. symptoms). Know signs of acute ischemia. Know the Rutherford classification, particularly IIA, IIB, and III. Are they on meds? Specific meds you will always want to know about are antiplatelets (are they on aspirin? Are they on Plavix? *Ask*) and anticoagulants. Previous interventions? Lots of the chronic limb ischemia patients will have previous bypasses and stents, etc. Look at TASC criteria.
-Exam: When in clinic, consults or rounding you have to be able to do the pertinent exam. I don't trust my fingers and I wouldn't trust yours....you'll need to know where the hand-held dopplers are in clinic/on floors/ED. Check for DP, PT, popliteal, femoral pulses and signal. (You'll need to know the difference between monophasic, biphasic, triphasic signals). Look for signs of acute or chronic ischemia - motor, sensation, dry or wet gangrene, etc. Is there chronic venous stasis? What about their basic cardiac exam - are they in sinus or irregular rhythm, and what is their BP? How functional are they at baseline and if you have to do an amp, how will it affect them?
-Imaging: ABIs, duplex, toe pressures
-Surgery stuff: look at aortoiliac disease vs. runoff. Is it going to be open vs. endovascular? What vessels are you looking at? I would know the difference between wires, stents, sheaths. For doing leg angios, you usually get contralateral access, cross the aorta and shoot the angio down the other leg. Big vessels to identify will be common and superficial femoral artery, profunda, aorta (well, duh), ant and post tib and peroneal.
Aneursymal disease
-Focus on abdominal aortic stuff. You will probably see a lot of EVARs. You may see some TEVARs. Might see some ruptures.
-History: What are their risk factors? Do they smoke?
-Exam: Abdominal exam and pulses.
-Imaging: CTA, abdominal US
-Pimp questions: Know indications for surveillance. Indications for operative intervention. Know your distances for EVAR landing zone, angulation, and iliac size criteria.
ESRD
-History: Are they already on dialysis? What's their K, Cr? Who's their nephrologist and when did they dialyze last? What do they have for access and what other access attempts have they had? Are they in cardiac failure from their fistula? Do they have steal from their fistula
-PE: Check pulses, incisions. You should be able to feel a thrill/hear a bruit if they have a fistula. Is their graft or fistula clotted? If they have a DLDC, is it working? Is it IJ or femoral, tunneled or non? If there's an infection in the catheter is it exit site or blood stream?
-Imaging: duplex US of upper usually if going for fistula/graft. If doing an IJ I always look for prior CXR bc I don't want to be surprised by any fluoro or post procedure findings. Always review any previous CTAs, etc w/ particularly attention to the vessel you're going to be accessing.
Surgery: know size criteria for artery, vein for making a fistula. Have a general idea of when to do a fistula v. graft. Know the steps to do an IJ or femoral -DLDC. Have an idea of how fast your flow rate has to be for dialysis. Basic types of fistulas are: radiocephalic, brachiocephalic, brachiobasilic (this one will have to be 'transposed').
Carotid disease
-History: What are their symptoms? If a stroke - when and really specific symptoms. You need to know motor and side; memory loss; verbal symptoms etc. Loss of vision?
-Imaging: carotid duplex, CTA neck, MRA. Have an idea of which one you would order when. If they've had a stroke, be familiar with their head CT/MRI findings. Know the criteria for PSV/EDV and internal carotid ratios and cut-offs for when you do surgery
-Pimping: attendings like to ask basic questions about NASCET and ACAS trials.
-Surgery: Know cut-offs for stenosis for when you operate on symptomatic and asymptomatic patients. If they've had a stroke or TIA know time-frame of when you operate.
-Anatomy: know branches of external carotid. Know the first branch of internal carotid (hint: intracranial). Know the layers of the artery you remove in a carotid endarterectomy. Know what vein you divide to find the bifurcation. Know what stump pressure would cause you to shunt at. (Some attending shunt everything, some are selective.) Know: marginal mandibular, vagus, recurrent laryngeal, hypoglossal where they are in relation to the surgery and what injury to them does. Know your muscle layers (ie, you divide the platysma and you're operating along the medial border of the SCM).
-Post op: I/we always stay with the patient to make sure they wake up without significant neurodeficit. If they have an on-table or shortly post-op stroke, the board answer is it's a technical issue and you stay/go back to the OR to look for a flap, etc.
Also, I'd know basic MOA of big-time playa anticoagulants and antiplatelets. Know indications for IVC filter. Know basic tx for DVT. Know what HIT is. Mycotic aneurysms aren't fungal aneurysms. Oh, if you have a question about severe abdominal pain after EVAR or open AAA repair - be concerned about ischemic colitis and do a sigmoidoscopy.
Know where the lead is and get comfy, you'll probably be wearing a lot of it. Good luck and have fun!