What's the patient population like in Vascular Surgery?

[LebronManning]

Just wondering what the patient population is like in regards to the etiology of their disease. Are they mostly caused by lifestyle decisions? i.e. smoking, obesity, etc? What percentage of patients have vascular problems without any poor lifestyle habits?

How does this patient population compare with interventional cardiology in this regard?

Also, how many vascular surgery patients are "emergent" compared to other surgical specialties?

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[Redpancreas]

Just wondering what the patient population is like in regards to the etiology of their disease. Are they mostly caused by lifestyle decisions? i.e. smoking, obesity, etc? What percentage of patients have vascular problems without any poor lifestyle habits?

How does this patient population compare with interventional cardiology in this regard?

Also, how many vascular surgery patients are "emergent" compared to other surgical specialties?

I’m interested in Interventional Cardiology and picked Vascular Surgery as my Surgical subspecialty elective and I enjoyed it quite a bit. I spent a month on it at an academic center in an underserved area as a medical student. There’s a term known as vasculopath that refers to these patients. I saw the same patients over and over again for that month. It’s basically a mix of genetics, but mostly choices DM/HTN/Smoking. I think the patients in vascular surgery are far more advanced than those with ischemic heart disease. You don’t suddenly develop peripheral artery disease. These patients generally have the typical HTN, previous MIs, stentsx3, +/-DM and then the PAD comes later. A lot of clinic patients have severe lymphedema and venous insufficiency. It’s not a field I’d go into specifically for the patient population. The carotid endarctectomies were my favorite, but the routine amputations and bypasses with grafts were meh and the graft bypasses were extremely time consuming and required a ton of patience. What I learnt was that on the floor, I better check for pulses and be damn sure they’re diminished before consulting vascular surgery because these guys are swamped and it’s not a service to consult lightly. That said there were some very cool things too. We had this one guy who had a aneurysm rupture and there was like an 18 hr. operation and they had to clamp multiple vessels off the aorta (kidneys, intestines, etc.) and he lived, only to die a few months later from an MI :/


That said I’m just a medical student and I could be wrong. @mimelim is an actual vascular surgeon (trainee) who serves on the admission committee and is SDN’s vascular person.

 

[Psai]

Fat diabetic smokers who take so little care of themselves that their toes literally fall off.

 

[evilbooyaa]

Doing heroic operations (extensive bypass grafts) only for the patient to suddenly stop their antiplatelet therapies and continue smoking and have uncontrolled diabetes (see above) and then you have to amputate them somewhere around the knee anyways.

 

[TraumaLlamaMD]

Most realistic scene in an awful show should give you an idea!

 

[LucidSplash]

Just wondering what the patient population is like in regards to the etiology of their disease. Are they mostly caused by lifestyle decisions? i.e. smoking, obesity, etc? What percentage of patients have vascular problems without any poor lifestyle habits?

How does this patient population compare with interventional cardiology in this regard?

Also, how many vascular surgery patients are "emergent" compared to other surgical specialties?

Yes, caused largely by lifestyle choices. While genetics do play a role, DM, ESRD, smoking are the most common denominators. Those without are typically trauma patients with acute injuries or are gifts from interventional cards after procedural misadventures that cause complications.

Vascular emergencies include the aforementioned traumas as well as ruptured aneurysms, acute mesenteric ischemia, and acutely ischemic limbs with motor/sensory deficits. Compared to Gen Surg emergencies, true vascular emergencies are a race against time. While dead bowel or bad cholecystitis can kill you, they won’t do so as efficiently as a ruptured aorta.

 

[Jolie South]

Agree with above. You have to pick your poison with any specialty.

I could never do surg onc. Generally nice people with horrible cancers that aren’t their fault. Long surgeries for in some cases dubious benefits with EC fistula, pancreatic fistula, etc as complications.

I’ll take self created problems in crotchety old men and no butt stuff/poop/EC fistulas any day. The threat of bleeding and dead limbs are our main emergencies and I don’t mind them.

 

[TypeADissection]

Most realistic scene in an awful show should give you an idea!

Important to also note another accurate part of that scene: We as vascular surgeons are also that goodlooking +/- liberal use of the word "bro." Cheers.

 

[r4111]

Sick fragile patients, but incredibly cool procedures from head to toe

 

[mimelim]

Just wondering what the patient population is like in regards to the etiology of their disease. Are they mostly caused by lifestyle decisions? i.e. smoking, obesity, etc? What percentage of patients have vascular problems without any poor lifestyle habits?

How does this patient population compare with interventional cardiology in this regard?

Also, how many vascular surgery patients are "emergent" compared to other surgical specialties?

While we talk all the time about the smoking, over eating, etc, a good portion of the pathology we see is not grossly lifestyle related. The reality is that the majority of Americans have poor lifestyle habits. Maybe not crazy bad, but the number of 50-70 year olds that can routinely take medications on time or eat 'properly' is relatively limited. I'm certainly not a PCP and don't see the people who do well controlling DM, HTN, HLD etc with lifestyle modifications, but I see plenty of reasonable adults who are as good or better than I would be as patients who still have those diseases. So, the answer is a little complicated. It is easy to blame poor outcomes or bad disease on patients, but there is far from a linear correlation between the two. I would say that our population is slightly sicker than interventional cardiology on average, but not by a huge margin and certainly within the practice variations of both.

Vascular surgery has more emergencies than any other surgical specialty outside of trauma and the lifestyle reflects that. The vast majority of the operations that I book need to happen within a day or two and every week there are at least 2-3 that need to happen yesterday.

 

[Pir8DeacDoc]

While we talk all the time about the smoking, over eating, etc, a good portion of the pathology we see is not grossly lifestyle related. The reality is that the majority of Americans have poor lifestyle habits. Maybe not crazy bad, but the number of 50-70 year olds that can routinely take medications on time or eat 'properly' is relatively limited. I'm certainly not a PCP and don't see the people who do well controlling DM, HTN, HLD etc with lifestyle modifications, but I see plenty of reasonable adults who are as good or better than I would be as patients who still have those diseases. So, the answer is a little complicated. It is easy to blame poor outcomes or bad disease on patients, but there is far from a linear correlation between the two. I would say that our population is slightly sicker than interventional cardiology on average, but not by a huge margin and certainly within the practice variations of both.

Vascular surgery has more emergencies than any other surgical specialty outside of trauma and the lifestyle reflects that. The vast majority of the operations that I book need to happen within a day or two and every week there are at least 2-3 that need to happen yesterday.

I'd wager that the neurosurgeons might disagree with you in terms of urgency and emergency of surgical intervention. But maybe you meant of the general surgical specialities.