3.4 Vascular Surgery

Question 1

Acute limb ischemia definition

Answer 1

Sudden loss of perfusion of an extremity of a duration of less than 2 weeks

Question 2

Acute Limb ischemia
Etiology

Answer 2

• embolism (lodge in artery bifurcation)
• thrombosis (situ formation eg Atherosclerosis)

Question 3

Sources of embolism

Answer 3

Cardiac
- AF
- mural thrombus (MI)
- ventricular aneurysm
- valvular heart disease
- endocarditis
- atrial myxoma (benign tumour)
- paradoxical (from right side of heart through ovalea)

Aterial
- aortic mural thrombus
- aneurysms

Other
- wires
- coils
- bullets

Question 4

Thrombosis
Etiology

Answer 4

• atherosclerosis
• previous bypass/stent occlusions
• trauma
• hypercoagubility
• vasculitides
• HIV vasculopathy
• aortic dissection (tear in intima of aorta)
• peripheral aneurysms
• rare conditions (popliteal entrapment)

Question 5

Atherosclerosis RF

Answer 5

• smoking
• DM
• hypertension
• hyeprlipidemia
• old age
• obesity
• male
• low socio-economic status
• insulin resistenace
• chronic renal fail
• chronic inflam
• hyperhomocysteinemia
• air pollution

Question 6

Other causes of peripheral vascular disease (other than atherosclerosis)

Answer 6

• accelerated atherosclerosis
• embolization
• buerger’s disease
• vasculitides
• hypercoagubility
• HIV associated vasculopathy
• fibromuscular dysplasia
• radiation arteritis
• trauma
  -vasospasm
• popliteal antrapment
• popliteal adventitial cysts
• persistent sciatic artery complications
• Iliac endocarditis

Question 7

Arterial aneurysms
Def
Classification
Etiology

Answer 7

Def - permanent, focal dilation of artery greater than 1.5 times the normal diameter of spesific vessel

Classification
- pathology (true {all 3 layer} or false)
- morphology (fusiform {symmetrical} or saccular {assymetrical})
- anatomical location
- etiology

Etiology
- degenerative
- infective
- inflam
- trauma
- HIV
- connective tissue disorders
- dissection
- post anastomotic
- post stenotic

Question 8

Varicose veins
Def
Risk factors

Answer 8

Def - subcutaneous veins in lower limb dilated to more than 3 mm in upright position

Risk factors
- old age
- female gender
- family history
- standing occupation
- obesity

Question 9

Chronic venous disease CEAP classification

Answer 9

Clinical
Etiology (congenital, prim, sec, no cause identified)
Anatomy (superficial, perforator, deep veins, no venous location)
Pathophysiology (reflux, obstruction, reflux+obstruction, no venous pathophysiology)

Question 10

Pathophysiology of chronic venous insufficiency

Answer 10

• valvular reflux; venous obstruction; calf muscle pump dys
• ambulatory venous hypertension
• capillary changes and ⬆️ permeability leads to leakages of fluid, macromolecules, RBC
• edema, hyperpig, lipodermatosclerosis
• ulceration

Question 11

Differential diagnosis for lower leg ulcer

Answer 11

• venous ulcer
• arterial ulcer
• neuropathic ulcer
• pressure ulcer
• malignancy
• vasculitis
• hematological disease (sickle cell anaemia)

Question 12

Deep venous thrombosis
Classification
RF

Answer 12

Classification
-anatomical (proximal & distal)
- etiology (provoked & unprovoked)

RF
- transient (trauma, surgery)
- permanent (age, history)