Miscellaneous

Question 1

How can a popliteal aneurysm present?

What are the main RF that may allow it to present bilaterally?

Answer 1

Similar to PAD (claudication, leaning foot from bed at night…)
Distal ischaemia (blue toe)
Easy to feel popliteal pulse

RF: ADPKD, Marfan’s, Ehler danlos, AAA (you can also mention typical CVD RF but thats probably not gonna cause it to be bilateral)

Question 2

Give 3 examples of vascular bypasses and state which is best for those with a lot of comorbidities

Answer 2

Aorto-femoral/bifemoral
Femoral-popliteal
Femoral-femoral
Axillo-bifemoral (best for comorbidities)

Question 3

What are the complications of a bypass surgery?

Answer 3

General:
Infectious: Wound site infection, sepsis, UTI (catheter use during surgery), pneumonia
Bleeding: Post-op bleeding, haematoma
Thromboembolic: DVT, PE, stroke
Cardiovascular: MI, arrhythmia, A.fib, stroke
Anaesthetics: Atelectasis/barotrauma from intubation, GA intolerance, if spinal, LP (traumatic, incorrect)
Other: Chronic pain, delayed wound healing, Adhesions!!

Specific:
Graft infection, occlusion, thrombosis, failure/leak
Pseudoaneurysm
Distal embolisation (blue toe)
Claudication

Question 4

Give 3 elective and 3 emergency indications for an amputation

Answer 4

Elective:
1) Locally unresectable tumour
2) Paralysis of extremity
3) Congenital limb deformity

Emergency:
1) Ischaemia where revascularization not possible or contraindicated
2) Infection (osteomyelitis, nec fasc)
3) Frost bite gangrene
4) Trauma causing mangled limb with failed attempt at salvaging

Question 5

What is worse? Dry or wet gangrene?

Answer 5

Dry

Question 6

What is Allen’s test? Explain how its performed

What are some indications for this?

Answer 6

It is a clinical test used to assess the patency of the ulnar artery before procedures that involve the radial artery (e.g. dialysis)

Occlude both the ulnar and radial arteries. Ask the patient to make a fist multiple times until the palm turns pale. Then release the ulnar artery and check to see for reperfusion within 5-15 seconds.

Interventional radiology (anything with radial artery access)
ICU
Scaphoid fracture

Question 7

What is the most common artery affected in PAD?

Answer 7

Superficial Femoral artery

Question 8

With regards to the pulses, what signs would indicate aortic dissection? (3)

Answer 8

Carotid-radial delay
Radio-radial delay
Widened pulse pressure

Question 9

What is and Go through the Seldinger technique

Answer 9

The seldinger technique is a minimally invasive technique for gaining access to vessels and hollow organs. It may or may not be guided by US or fluoroscopy

It involves
1) inserting a small gauge needle (with an attached syringe) into the vessel and confirming with an aspirate of blood
2) withdraw the syringe and advance the guide wire -confirm location of guide wire with free movement/US/Fluoroscopy
3) withdraw needle and advance dilator
4) withdraw dilator and advance catheter over guide wire
5) withdraw guide wire and aspirate + flush with saline to ensure patency

Question 10

When should the Seldinger technique be performed?

Answer 10

Any reason to obtain
Venous access (meds, fluids, food)
Arterial line (BP/serial BP, Repeat ABG)
Perm cath (haemodialysis)
Insertion of a drain or tube (chest drain, pleural effusion, biliary drainage