Fellowship - vascular

Question 1

“A 75-year old man presents with an acute dissection of the descending thoracic aorta. His blod pressure measures 190/110 mmHg
Justify your plan for his preoperative blood pressure management (30%)
Describe the potential complications of thoracic endovascular aortic repair (TEVAR) and how you would mitigate them (70%)”

Question 2

“A 75-year-old man is scheduled for elective endovascular repair of a thoraco-abdominal aortic aneurysm.
List the potential complications of this procedure in this patient and discuss your strategies to mitigate these complications.”

Question 3

A 75-year-old patient presents for lower limb angioplasty and stenting for peripheral vascular disease. Discuss the challenges in providing anaesthesia for this patient.

Question 4

Outline risk factors for spinal cord ischaemia in a patient undergoing endovascular repair of a thoraco-abdominal aortic aneurysm. (50%) Discuss your approach to minimising spinal cord ischaemia in this setting. (50%)

Question 5

“An 80 year old man is scheduled for endovascular abdominal aortic aneurysm repair (EVAR). a. What are the likely risk factors for acute kidney injury in this setting? (30%)b. Describe and evaluate the methods available to preserve his renal
function in the perioperative period. (70%)”

Question 6

(a) Describe the arterial blood supply of the spinal cord. (50%) (b) Why is spinal cord function at risk during open repair of a thoracic aortic aneurysm and what measures are available to reduce this risk? (50%)

Question 7

Discuss the significance of anticipated changes in blood pressure during anaesthesia and in the post anaesthesia care unit in a patient undergoing carotid endarterectomy. (50%) Outline strategies to manage these changes. (50%)

Question 8

Describe the complications that can occur post carotid endarterectomy and how these may present in the post anaesthesia care unit (PACU).

Question 9

What are the advantages and disadvantages of general versus local anaesthesia for carotid endarterectomy?

Question 10

An otherwise fit 30 yr old man is having microvascular reimplantation of his forearm. Describe methods available to optimise the perfusion of the reimplanted limb in the post-operative period.

Question 11

Describe the cardiovascular changes which occur during clamping and unclamping of the supra-renal aorta during repair of an abdominal aortic aneurysm in a patient with normal ventricular function and outline your strategies to maintain critical organ perfusion during these times.

Question 12

Discuss the principles underlying the management of a general anaesthetic for carotid endarterectomy.

Question 13

Discuss the strategies you would consider in order to protect renal function during a laparotomy for an abdominal aneurysm repair.

Question 14

“A 68 yo man presents for repair of a rapidly expanding AAA. He has been a heavy smoker (80 pack years) until 5 months previously when he had a myocardial infarction. He has been treated for hypertension for the last 13 years and is currently taking atenolol, nitroglycerine and diltiazem. What clinically significant information can be obtained if a pulmonary artery catheter is placed for his operation and how would it influence the anaesthetic management?

Compare the use of a pulmonary artery catheter and transoesophageal echo in evaluating cardiac function intraoperatively in this patient.

Describe the management of a rise in CVP from 15 to 23 mmHg two minutes after aortic cross clamping”

Question 15

“A patient is to have surgery for resection of a AAA. what advantages does TOE have over ECG monitoring for intra-operative myocardial ischaemia?

Justify the measures you would use to minimise the risk of acute tubular necrosis if the surgeon is to clamp the supra-renal aorta.

What are the relative merits of sodium nitroprusside vs glyceryl trinitrate for control of hypertension when the aorta is cross clamped?”

Question 16

“A patient was scheduled for elective repair of an abdominal aortic aneurysm.
During preparation for anaesthesia, the 8.5 french gauge introducer sheath intended for the internal jugular vein was inserted into the carotid artery.
How could the risk of this incident occurring be minimised?
When the problem has been recognised, what is the appropriate management?
Discuss the choice of the internal jugular vein as the initial site to attempt central vein cannulation in this patient.”