Arterial diseases: diagnostic modalities, acute and chronic ischemia, revascularization syndrome

1. Big picture

Arterial disease becomes surgical when blood flow is insufficient to keep tissues alive or when a vascular lesion threatens rupture, embolization, or organ loss. For this topic, the core exam focus is limb ischemia, especially:

Acute limb ischemia
→ sudden arterial occlusion
→ limb threatened within hours
→ emergency heparin + urgent revascularization if viable

Chronic limb ischemia / peripheral arterial disease
→ progressive atherosclerotic narrowing
→ claudication, rest pain, ulcers, gangrene
→ risk-factor control ± elective revascularization

Revascularization syndrome
→ reperfusion injury after restoring flow to an ischemic limb
→ hyperkalemia, acidosis, myoglobinuria, renal failure, compartment syndrome

The key surgical question is always:

Is the limb viable, threatened, or already irreversible?

This determines whether the patient needs urgent revascularization, thrombolysis, bypass, fasciotomy, or primary amputation.

---