Surgical Shorts

Question 1

Define varicose veins

Answer 1

Abnormally dilated and lengthened superficial veins

Question 2

Mx of varicose veins?

Answer 2

Conservative

• TED stockings
• Weight loss and exercise
• Compression

Surgical
Phlebectomy:
- Avulsion
- Stripping 
Injection sclerotherapy
SEPS; subfascial endoscopic perforator surgery

Question 3

What does the site indicate about the location of the varicose veins?

Answer 3

Medial and above knee: great saphenous

Posterior and below knee: short saphenous

Question 4

At what sites does valve incompetence commonly occur?

Answer 4

Sapheno femoral junction
Sapheno popliteal junction
Perforators

Question 5

Indications for varicose vein surgery?

Answer 5

SFJ incompetence
Major perforator incompetence
Symptomatic: ulceration, skin changes, pain

Question 6

How can varicose veins be classified?

Answer 6

CEAP classification

Clinical disease (i.e. stage of venous disease)
Etiology (congenital/primary/secondary)
Anatomical distribution
Pathophysiology (reflux/obstruction or both)

Question 7

What is klippel trenaunay weber syndrome?

Answer 7

Varicose veins
Port wine stain
Bony and soft tissue hypertrophy of limbs

Question 8

What is the classification used for limb ischaemia?

Answer 8

Fontaine classification

1: pain free
2: claudication
3: rest pain
4: gangrene

Question 9

What defines critical limb ischaemia?

Answer 9

Fontaine classification 3 or 4, i.e. rest pain > 2 weeks or gangrene and an ankle artery pressure of <40mmHg

Question 10

Managements of chronic limb ischaemia?

Answer 10

Conservative
Optimise risk factors: smoking, HTN, lipids, weight loss

Medical:
Antiplatelet and statin

Surgical:
Angioplasty +/- stenting 
Endarterectomy
Bypass grafting
Amputation

Question 11

Indications for bypass grafting?

Answer 11

Very short claudication distance (<100m)
Symptoms affecting QOL greatly
Rest pain

Question 12

Types of bypass graft?

Answer 12

Anatomical: fem-pop, fem-distal, aortobifemoral

Extra anatomical: axillo-fem, bi-fem, fem-fem crossover

Question 13

Define a AAA, what is investigation of choice?

Answer 13

Abnormal dilatation of abdominal aorta to >50% of its normal diameter (> or = 3cm)

CT/MRI is investigation of choice

Question 14

Mx of AAA?

Answer 14

EVAR, or endovascular aneurysm repair

Question 15

Causes of aneurysms?

Answer 15

Congenital:
PKD
Marfan’s
Ehler’s Danlos

Acquired:
Atherosclerosis
Trauma
Inflammatory (HSP, Takayasu’s aortitis)

Question 16

Types of aneurysm?

Answer 16

True: dilatation involving all layers of vessel >50% of normal diameter

False: collection of blood around vessel wall that communicates the vessel lumen, usually iatrogenic

Question 17

Types of mastectomy

Answer 17

Simple (breast tissue only)
Modified radical (plus nodes)
Radical (plus pecs)

Question 18

Neurogenic vs spinal shock

Answer 18

Neurogenic shock is classically characterised by hypotension, bradycardia and peripheral vasodilatation.

Spinal shock is not a true form of shock. It refers to the flaccid areflexia that may occur after spinal cord injury