Doctors academy - Vascular COPY

Question 1

What is Leriches syndrome and what are the common features

Answer 1

Leriches syndrome is aortoileac occlusive disease

Features

• Buttock and thigh claudication
• no femoral pulse
• erectile dysfunction

Question 2

if patient has multiple comorbidities and frail and wants relief of symptoms what is the most appropriate procedure?

Answer 2

Axillo-femoral bypass

Question 3

What are the features of Takyasu’s Arteritits?

Answer 3

• Affects asian women <45yrs old
• it is a large cell arteritis

Features:

• aortic arch and its vessels are affected
• Upper limb claudication
• Elevated ESR

Question 4

What are the features of Buergers disease?

Answer 4

• Affects young male smokers
• Medium cell arteritis

Features:

• Causes clots in lower limb vessels + fingers and toes
• loss of peripheral pulses
• Tortuous corkscrew collateral vessels often seen
• they present with lower limb claudication

Question 5

What are the features of Giant Cell Arteritits

Answer 5

• Affects older women
• Large cell arteritis

Features:

• Pain on eating / brushing hair
• granuomas form
• it is a segmental disease

Question 6

What are the features of Polyarteritis nodosa?

Answer 6

• Transmural inflamation
• A necrotising vasculitis
• causes mulitple small aneurysms
• renal disease seen in 70% of cases

Question 7

What are the freatures of Wegners granulomatosis?

Answer 7

• Affects middle aged males
• A systemic necrotising granulomatous vasculitis
• may get skin lesiosn / ulcerations
• affects nasopharynx, lungs and kidneys

Question 8

What vessels does kawsaki disease affect?

Answer 8

coronary arteries

Question 9

What do the following values for ABPI represent and what symptoms would be present?

• 1 - 1.3
• 1.3
• 0.7-0.9
• 0.5
• <0.3

Answer 9

1 - 1.3 = normal

>1.3 = calcification

0. 7-0.9 = mild disease. Intermittant claudication
1. 5 - 0.7 = moderatte disease. Possible Rest pain

<0.5 = severe disease. Rest pain

<0.3 = critical limb ichaemia

Question 10

What are the contraindications of a stent?

Answer 10

• Long section
• crosses a joint
• involving osetum

Question 11

what are the contraindications for an EVAR?

Answer 11

Not enough landing zone:

• min 5mm above
• min 1.5cm below

Question 12

What are the risk an abdominal aneurysm?

Answer 12

• HTN
• Smokers
• Connective tissue disorders e.g. marfans

Question 13

What are the indications for a aortic aneurysm repair?

Answer 13

• Symptomatic aneurysms
• Size >5.5cm
• Rupture

Question 14

What are some of the complications following a AAA repair?

Answer 14

• Embolism to foot or gut
• cardiac problems??
• fraft infection
• aorto-enteric fistula
• renal failure if it was a suprarenal AAA
  *

Question 15

where is the most common site for AAA rupture?

Answer 15

Retroperitoneal (80%)

Question 16

Where is a Gritti Stokes amputation

Answer 16

through the knee

Question 17

where is a symes amputation

Answer 17

through the ankle

Question 18

what is the treatment for raynauds disease

Answer 18

calcium agnoists

Question 19

Which patients is subclavian steel sydnrome common in?

Answer 19

Subclavian Steal Syndrome occurs in patients who have undergone an Internal Mammary Artery (IMA) Graft

Question 20

What is subclavian steel syndrome

Answer 20

this is where you have a narrowing of the subclavian artery, commonly on the left.

This means you get retrograde blood flow from the vertibral arteries to supply the upper arm

Question 21

What are the symptoms fo sub clavian steel syndrome

Answer 21

• Most often Males
• Most often Left sided

Symtpoms occur on use of arm:

• upper arm claudication
• Syncopy, vertigo and neurological defects
• numbness and tingling upper arm and fingers
• BP difference between arms
• weakness of affected side
• weak pulse in affected arm

Question 23

What are the features of Sturg Webber syndrome

Answer 23

arteriovenous malformation affecting the face and CNS

Question 24

What are the features of Klippel-Trenaunay-Weber syndrome

Answer 24

• varicose veins and port wine staining affecting one limb, commonly the leg
• varicose veins often spare the saphenous distribution

Also:

• Hypertrophy of bony and soft tissues, that may lead to local gigantism or shrinking.
• An improperly developed lymphatic system

Question 25

What malignancy can arise from an area of chronic lymphoedema?

Answer 25

Lymphangiosarcoma

Question 26

what is the difference between millroys and meiges lymphoedema

Answer 26

millroys is confenital

meiges develop after birth

Question 27

what different operations can be offered for lymphoedema?

Answer 27

Homans operation - Reduction procedure with preservation of overlying skin (which must be in good condition)

Charles operation - All skin and subcutaneous tissue around the calf are excised down to the deep fascia. Split skin grafts are placed over the site. May be performed if overlying skin is not in good condition. Larger reduction in size than with Homans procedure.

Lymphovenous anastamosis - Identifiable lymphatics are anastomosed to sub dermal venules. Usually indicated in 2% of patients with proximal lymphatic obstruction and normal distal lymphatics.

Question 28

what is the treatment of an axillary vein thromboisis?

Answer 28

1. catheter directed tPA is first line
2. Heparin and Warfarin prevent clot propergation

Question 29

What dose of heparin should be given during bypass surgery? And when should this be given?

Answer 29

3,000 units of unfractionated heparin should be given 3-5 mins prior to claiming of the vessels

Question 30

What vessels are commonly used as grafts for coronary bypasses

Answer 30

Internal mammary artery (this is the preferred option)

long saphenous Vein

radial artery