Part two - vascular

Question 1

Anatomy of GSV

Answer 1

• Longest vein in the body
• Many valves - more below the knee
• Withstand pressure of up to 300mmHg normally
• Upward continuation of medial marginal vein of the foot * (dorsal venous arch)
• In front of medial malleolus
• Hands breadth behind the medial border of the patella
• Passes through cribiform fascia (3.5cm below and lateral to the pubic tubercle) to join the femoral vein
• Runs within saphenous fascia with the saphenous nerve
• Duplication - 25% in calf, 8% in thigh

Question 2

Tributaries of GSV

Answer 2

• Anterolateral branch
  * Posteromedial branch
  * Superficial circumflex iliac vein
  * Superficial epigastric vein
  * Superficial external pudendal vein
  * Deep external pudendal vein

Question 3

Anatomy of SSV

Answer 3

• Continuation of lateral veins of the foot
• Behind the lateral malleolus
• Penetrates the deep fascia of the calf
• Terminates in the popliteal vein in 75%
• SPJ highly variable
• Duplication much less common (4%) than the GSV

Question 4

Grades of compression for venous disease

Answer 4

0 - < 15mmHg -> OTC
I - 15-20mmHg -> DVT prophylaxis/minor symptoms
II - 20-30mmHg -> moderate symptoms
III - 30-40mmHg -> severe symptoms
IV - >40mmHg -> lymphoedema

Question 5

Surface anatomy of common femoral artery/SFA

Answer 5

Line from midpoint of the inguinal ligament (ASIS -> PT) to the femoral medial condyle

Question 6

Femoral artery

Answer 6

Continuation of EIA as passes underneath inguinal ligament
Within femoral sheath
Ends as passes through add. hiatus in adductor magnus
Branches CFA:
* Superficial epigastric
* Superficial circumflex
* Superficial external pudendal
* Deep external pudendal
Branches SFA;
* Muscular branches
* Descending geniculate branch

Question 7

Profunda femoris

Answer 7

Main branch of femoral artery
Origin posterolateral and 3.5cm below inguinal ligament
Runs under add. longs on pectinous and brevis
Supplies posterior and medial compartments
Branches:
* Lateral circumflex
* Medial circumflex
* 4 perforating branches
- anastomose with genicular branches of popliteal artery

Question 8

Rutherford classification of acute limb ischaemia

Answer 8

Viable - not immediately threatened
–> no deficit
Marginal threat - time for angiography
–> minimal sensory loss
Immediate threat - salvageable with immediate treatment
–> rest pain, sensory loss, motor weakness
Irreversible - amputation
–> severe anaesthesia, paralysis with muscle rigor

Question 9

Management of vascular trauma

Answer 9

Consider damage control - shunt 4-6 hours
Proximal and distal control
Repair
- primarily +/- patch, may require mobilisation
- interposition graft, autologous in trauma
- bypass
- amputate
On-table angiogram
Consider fasciotomy
Anticoagulate if necessary

Question 10

Stages of pressure ulceration

Answer 10

Stage I - erythema
Stage II - breakdown of dermis
Stage III - full-thickness skin breakdown
Stage IV - bone, muscle, and supporting tissue involved