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Vascular Surgery > Aneurysm & Gangrene & ECCD > Flashcards

Aneurysm & Gangrene & ECCD Flashcards

1
Q

Mention CCC o f arterial aneurysms

A
  1. Ruptue (mc in abdominal aorta), most serious
  2. Thrombosis w/distal embolzation mc in popliteak aneurysm
  3. Infection can lead to rupture &2ry hge
  4. Pressure on surrounding structures e.g. bone erosion w/ large aortic aneurysm
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2
Q

Mentiom INV for arterial aneurysms

A
  1. US for screening
  2. Diagnostic: CT
  3. Spiral CT preop
  4. MRI can be useful in renal impairment
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3
Q

INV & TTT of subclavian steal $

A

INV: duplex scan reveals reversal of flow in vertebral a, arteriography shows proximal subclavian stenosis or occlusion
TTT: Carotid subclavian artery bypass OR PTA or subclavian (BEST)

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4
Q

MC cause of AAA…..
MC site is……
MC presentation is…..

A

Atherosclerosis (degenerative)
Infra-renal
Asymptomtic

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5
Q

Mention timing of surgery & its indications in AAA

A
  1. Immediate: rupture
  2. Urgent: symptomatic aneurysms, acute expansion,
  3. Elective: asymptomatic aneurysms more than 5 in females & 5.5 in males, inc diameter by 5 mm in 6 months
    Also, saccular aneurysms regardless of size should be repaired
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6
Q

Mention indications for EVAR

A

High risk pts w/ multiple comorbidities
Pts w/ hostile abdomen

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7
Q

Describe management for popliteal aneurysm

A
  1. Repair is indicated for all complicated aneurysms & for asymptomatic aneurysms exceeding 2 cm
  2. This is usually done by ligation of aneurysm proximal,y & distally & bypass graft bypassing the excluded aneurysm
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8
Q

DD of aneurysms

A
  1. Swelling overlying an artery may elicit transmitted arterial pulsations, pressure on proximal artery doesn’t change size, if swelling can be mived away pulse disappears
  2. Highly vascular tumor can develop pulsations
  3. Tortuous artery
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9
Q

Mention manifestations of congenital AVF

A

Hyperdynamic circulation in growing limb: local gigantism, VV, multiple affecting small vessels associated w/ port wine stain (Klippel Trenaunay $)

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10
Q

Mention & compare pathological types of AVF

A
  1. Arteriovenous aneurysm: communication is via organized hematoma
  2. Aneurysmal varix: communication is direct w/out swelling in between
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11
Q

What is Branham’s sign?

A

Bradycardia on compression of feeding artery of an AVF

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12
Q

Describe TTT of AVF

A
  1. Reconstruction of artery & vein, repair of each separately then insertion of fascia in between
  2. Preferred technique is transcatheter embolization to occlude sites of comm , surgery is very difficult dt multiplicity of communicating sites & the extremely high vascularity (used in congenital type)
  3. Quadruple ligation: if difficult reconstruction or unimportant artery
  4. Surgical repair of artery & vein w/ excision of intervening aneurysm if present
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13
Q

Define:
1. TIA
2. Stroke

A
  1. Temporary focal neurological or visual deficits lasting less than 24 hrs end in complete recovery within 24 hrs
  2. Pts has residual neurological deficits that could be minimal or profound depending on extent of brain damage, may be fatal
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14
Q

First line INV for extracranial CVD is…..
Mention another inv & when is it done?

A

Duplex scan
Conventional arteriography only in cases where assessment of the aortic arch or intracranial circulation is needed

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15
Q

Describe medical ttt & its indications in extracranial cerebrovascular disease

A

All pts w/ carotid artery disease are started on medical ttt regardless of further inv:
Antiplatelet drugs namely aspirin. Clopidogrel only for pts undergoing stenting
Lifestyle modifications

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16
Q

Mention indications for carotid endarterectomy

A
  1. Cases of tight stensosis (>70%) presenting with TIAs
  2. Asymptomatic >80% esp if undergoing major cardiac or vascular procedure
  3. Selected cases of stroke if pt recovers good function with corresponding significant vascular lesion
17
Q

Mention ind for carotid artery stenting

A
  1. Pts w/ hostile neck
  2. Recurrent carotid stenosis
  3. High carotid bifurcations
18
Q

Mention the 5 cardinal signs of local death

A

Loss of pulsations, sensation, heat, function, fixed colour changes

19
Q

Mention causes of moist aspeptic gangrene

A

Acute ischemia (i.e. emobiolism), chronic ischemia w/ pre-existing edema (cardiac, DVT)

20
Q

What is TTT OF venous gangrene?

A

Elevate limb, AC, thrombectomy or fibrinolytic TTT should be started

21
Q

Mention CCC of superficial thromophlebitis

A
  1. Suppuration & local abscess formation
  2. Extension to deep vein esp in case of proximal thrombolphlebitis
  3. Pulmonary emolism (RARE)
22
Q

What is Trousseau sign?

A

Throbophlebitis migrans ass w/ visceral cancer esp pancreas

23
Q

Mention CCC of DVT

A

General: PE
2. Local: phlegmasia alba/ceruela dollens, post-thrombotic limb w/ 2ry VV, venous gangrene

24
Q

Mention indications of IVC filter

A
  1. CI to AC, intracerebral hge or bleeding PU
  2. Recurrent pulmonary embolism despite adequate AC
  3. CCC of AC that necessitate cessation of therapy
25
Q

Describe DD of DVT

A
  1. Calf muscles hematoma
  2. Rupture contusion of plantaris tendon
  3. Ruptures Baker’s cyst
  4. Cellulitis
26
Q

Correlate size of emolus to manifestations in case of PE

A
  1. Small emboli: impacted in peripheral arterioles, silent, recurrent cause pulmonary HTN
  2. Mid-sized emboli: impacted in branches of pulmonary a, pulmonary infaction, cause dypnea (MC), severe pleuritic pain, hemoptysis.
  3. Large-sized: main stem cause sudden death, obstruct main branch causes acute RHF CP: severe pre-cordial pain, tightness in chest, marked dyspnea, marked hypotension & tachycardia, may end also in sudden death
27
Q

Inv of choice in PE is….

A

CT pulmonary angio/spiral CT

28
Q

Cause of death after PE in 1st 24 hrs is……
Describe curative TTT of massive pulmonary embolism

A

Arrhythmia
1. Cardiac catheterization
2. Thrombolytics
3. Assess cardiac functions every 6 hrs
4. If no imroovement: urgent pulmonary embolectomy after 6 hrs

29
Q

Compre LN pathology in blood borne & lymphatic borne TB lymphadenitis

A

In blood borne, Organism reaches LNs through blood hilum, affects medulla, no affection of capsule no matting caseation, no cold abscess
In lymphatic borne, organism reaches LNs through afferent lymphatics, affects cortex LNs are enlarged, firm, matted, not tender, early affection of capsule, caseation & cold abscess, collar stud abscess perforated deep fascia, sinus if abscess breaks down

30
Q

List CCC of TB lymphadenitis

A
  1. Systemic spread
  2. Cold abscess, sinus, hot cold abscess (2ry infection), ulcer
  3. Pressure manifestations (mediastinal $)
  4. Calcification
31
Q

Describe TTT of cold abscess & TB sinus

A

For both senatorial & medical TTT
CA: aspiration by Z technique + injection of streptomycin, incision w/out application of drain if infected or imminent rupture, excision with LN
S: repeated dressing w/ streptomycin, excision

Vascular Surgery (3 decks)

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