Clinical decision support that reasons like a vascular surgeon: save the acutely ischemic limb inside the window, move the ruptured aneurysm to theatre, time the carotid endarterectomy, and lead with medical therapy in claudication — with the decision rule and exactly what would change it. Built for verified physicians.
Two real vascular-surgery questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
A sudden cold, painful, pulseless and pale leg with new paresthesia — the emergency plan?
This is acute limb ischemia, a surgical emergency with a narrow window — roughly six hours before muscle and nerve damage becomes irreversible. Assess the six Ps and classify the limb by Rutherford: sensory loss with an early motor deficit marks a threatened limb needing immediate revascularization. Start systemic heparin at once, arrange urgent vascular imaging and revascularization — embolectomy, catheter thrombolysis or bypass by the anatomy — and do not delay for imaging when the limb is clearly threatened. Look for the source, often a cardiac embolus.
Decision ruleAcute limb ischemia (six Ps) → systemic heparin immediately + Rutherford classification; threatened limb (sensory + motor deficit) → urgent revascularization (embolectomy/thrombolysis/bypass) within ~6 h; do not delay for imaging when clearly threatened; find the embolic source.
Not established from this alone — the Rutherford category, the anatomy and the source change the revascularization.
Sudden severe back and abdominal pain with hypotension and a pulsatile abdominal mass in an older man — the move?
The triad of pain, hypotension and a pulsatile abdominal mass is a ruptured abdominal aortic aneurysm until proven otherwise, and it is a true emergency with very high mortality. Do not over-resuscitate — permissive hypotension, keeping the patient conscious with a low systolic pressure, limits further bleeding — and move immediately toward repair, endovascular or open, activating massive transfusion. Reserve CT for the stable-enough patient when it will not delay the operation. Every minute of hemorrhage counts.
Decision rulePain + hypotension + pulsatile mass → ruptured AAA; permissive hypotension (conscious, low systolic — do not over-resuscitate); immediate repair (endovascular or open) + massive transfusion; CT only if stable and it will not delay; speed is survival.
Not established from this alone — the hemodynamics, the anatomy and the stability change the resuscitation and the repair.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Recognize it by the six Ps — pain, pallor, pulselessness, paresthesia, paralysis and a cold, poikilothermic limb — and grade its viability with the Rutherford classification, because a limb with sensory and early motor loss is threatened and time-critical. Anticoagulate with systemic heparin immediately, then revascularize urgently by the anatomy and category: surgical embolectomy for an embolus, catheter-directed thrombolysis or bypass for thrombosis. The window before irreversible injury is short, around six hours, so image and treat in parallel, and hunt the embolic source.vascular emergency
Decision ruleSix Ps + Rutherford grade → systemic heparin now; revascularize by category and anatomy (embolectomy vs thrombolysis vs bypass); ~6 h window before irreversible injury; image and treat in parallel; identify the embolic source.
Missing data: the Rutherford category, the imaging and the embolic source change the revascularization.
Screen with a one-time ultrasound in men aged 65 to 75 who have ever smoked. Repair the intact aneurysm electively at a diameter of about 5.5 cm in men or 5.0 cm in women, for rapid growth, or when it becomes symptomatic, choosing endovascular or open by the anatomy and fitness. A rupture — sudden pain, hypotension and a pulsatile mass — is an emergency managed with permissive hypotension and immediate repair, not a CT that delays theatre. Below the threshold, survey by size and control the cardiovascular risk.SVS · AAA
Decision ruleScreen (one-time ultrasound, men 65–75 ever-smokers); elective repair at ~5.5 cm men / 5.0 cm women, rapid growth or symptomatic (endovascular vs open by anatomy/fitness); rupture (pain + hypotension + pulsatile mass) → permissive hypotension + immediate repair; below threshold → surveillance + risk control.
Missing data: the diameter, the growth rate and the anatomy change the repair decision.
A recent transient ischemic attack or non-disabling stroke with an ipsilateral internal carotid stenosis of 50 to 99 percent is the strong indication, and the benefit is greatest when carotid endarterectomy is done early — ideally within two weeks of the event. Optimize medical therapy in parallel: an antiplatelet, a high-intensity statin, blood-pressure control and smoking cessation. Carotid stenting is an alternative in selected patients. Asymptomatic stenosis is a more nuanced, individualized decision weighed against best medical therapy.carotid guidelines
Decision ruleSymptomatic (recent TIA / non-disabling stroke) + ipsilateral 50–99% stenosis → carotid endarterectomy early, ideally within 2 weeks, on top of best medical therapy (antiplatelet, high-intensity statin, BP, smoking cessation); stenting in selected patients; asymptomatic → individualized.
Missing data: the symptom status, the degree of stenosis and the timing change the intervention.
Confirm peripheral arterial disease with the ankle-brachial index, then lead with medical therapy for intermittent claudication: aggressive risk-factor modification — smoking cessation, a statin, an antiplatelet, and blood-pressure and diabetes control — plus a supervised exercise program, which improves walking distance as much as many procedures. Reserve revascularization, endovascular or surgical, for lifestyle-limiting claudication that fails this, and treat chronic limb-threatening ischemia — rest pain, ulceration or gangrene — urgently to save the limb.PAD guidelines
Decision ruleConfirm with the ankle-brachial index; claudication → medical first (smoking cessation, statin, antiplatelet, BP/diabetes control, supervised exercise); revascularization for lifestyle-limiting failure of medical therapy; chronic limb-threatening ischemia (rest pain/ulcer/gangrene) → urgent revascularization.
Missing data: the ankle-brachial index, the symptom severity and the tissue loss change the plan.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist vascular-surgery colleague across the limb emergency, aortic disease, carotid disease, peripheral arterial disease, venous disease and the diabetic foot — cited, non-directive, always with the decision rule.
Deep specialist agents for aortic and peripheral arterial disease, the limb-threatening emergency, carotid and cerebrovascular disease, and venous disease — each its own soul and knowledge base — plus your own uploaded materials.
From the ischemic-limb clock to the ruptured-aorta call the margin is thin. Only one of these reasons like a vascular-surgery colleague whose every claim you can trace.
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It reasons in the frameworks you use — the six Ps and Rutherford grading, the AAA screening and rupture pathway, the carotid-stenosis criteria and the PAD medical-first approach — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion on call and in clinic. Access is gated to verified physicians.
Aortic and peripheral arterial disease, the limb-threatening emergency, carotid and cerebrovascular disease, and venous disease each have their own deep specialist agent on the Pro plan, on top of the full vascular-surgery scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited vascular-surgery knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
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