VAS

Question 1

SFJ

Answer 1

Saphenofemoral junction

2cm lateral and below pubic tubercle

Question 2

CEAP classification of VV

Answer 2

Clinical: Grading 0-6

Etiology: Congenital / Primary / Secondary

Anatomic: Superficial / Perforator / Deep

Pathophysiology (Reflux / Obs / Both)

Question 3

Cx of VV

Answer 3

Bleeding

Thrombophlebitis

Question 4

Tx of VV

Answer 4

Principle = Reduce venous pressure

Conservative

• Elevation, postural adjustments
• Graduated compression stockings

Surgery
- Ligate incompetent perforators
- Removed diseased veins
   o Sapheno-femoral flush ligation
   o Avulsion/Excision of varicosities
   o Stripping
   o Ligation of perforators (open/endoscopic)
- Injection sclerotherapy (not for primary tx)

Question 5

Leg ulcers

Answer 5

Arterial: signs, pain, pressure areas

Venous: signs of CVI, good pulse, less painful, typical site

Neurogenic: painless, neuropathy (DM etc.)

Malignant: SCC, irregular raised edges, biopsy, Marjolin’s ulcer, LNs

Infection: chronic osteomyelitis, syphilis

Trauma

Question 6

Virchow’s triad for DVT

Answer 6

Stasis
Endothelial injury (trauma)
Hypercoagulability

Question 7

Sx of Chronic LL ischemia

Answer 7

1. Intermittent claudication
2. Rest pain
3. Tissue loss

Intervention if Rest pain or tissue loss

Question 8

Ankle-brachial index ABI

Answer 8

Ankle over Arm systolic pressure
Normal >=1
<0.9 = Chronic arterial disease
0.3/0.4 = Rest pain, critical limb

Question 9

Buerger’s disease (Thromboangiitis obliterans)

Answer 9

Male, 30-40y, Smoker
Pan-arteritis
LL > UL
Rest pain, digital ulcer, gangrene

Stop smoking

Question 10

6P for acute arterial occlusion

Answer 10

1. Pain
2. Paresthesia
3. Pallor
4. Pulselessness
5. Paralysis
6. Perishing cold