Vascular

Question 1

Peripheral arterial disease with critical limb ischaemia: low-risk patients with long-segment/multifocal lesions

Answer 1

surgical revascularization
- surgical bypass with an autologous vein or prosthetic material
- endarterectomy

Question 2

Peripheral arterial disease with critical limb ischaemia: short segment stenosis (e.g. < 10 cm), aortic iliac disease and high-risk patients

Answer 2

endovascular revascularization
- Angioplasty with stenting

Question 3

AAA high rupture risk

Answer 3

symptomatic
aortic diameter >=5.5cm
rapidly enlarging (>1cm/year)

Question 4

AAA open vs EVAR

Answer 4

open unless:
- hostile abdomen
- anaesthetic risk
-pt specific factors e.g. elderly

Question 5

The initial management of acute limb ischaemia includes

Answer 5

analgesia, IV heparin and vascular review

Question 6

chronic venous insufficiency, reasons for referral:

Answer 6

significant/troublesome lower limb symptoms e.g. pain, discomfort or swelling
previous bleeding from varicose veins
skin changes secondary to chronic venous insufficiency (e.g. pigmentation and eczema)
superficial thrombophlebitis
an active or healed venous leg ulcer

Question 7

chronic venous insufficiency initial Tx

Answer 7

leg elevation
weight loss
regular exercise
graduated compression stockings

Question 8

chronic venous insufficiency Tx

Answer 8

endothermal ablation: using either radiofrequency ablation or endovenous laser treatment

foam sclerotherapy: irritant foam → inflammatory response → closure of the vein

surgery: either ligation or stripping

Question 9

Marjolin’s ulcer

Answer 9

squamous cell carcinoma occurring at sites of chronic inflammation or previous injury

Question 10

thrombus vs embolus acute limb ischaemia

Answer 10

embolus=
sudden onset of painful leg (< 24 hour)
no history of claudication
clinically obvious source of embolus (e.g. atrial fibrillation, recent myocardial infarction)
no evidence of peripheral vascular disease (normal pulses in contralateral limb)
evidence of proximal aneurysm (e.g. abdominal or popliteal)

Question 11

PAD Tx

Answer 11

statin 80mg
clopidogrel 75mg
structured exercise training programme
smoking cessation
modify RF (HTN, DM, obesity)

Question 12

superficial thrombophlebitis Tx

Answer 12

compression stocking
prophylactic doses of LMWH for up to 30 days or fondaparinux for 45 days
NSAID

Patients with superficial thrombophlebitis at, or extending towards, the sapheno-femoral junction can be considered for therapeutic anticoagulation for 6-12 weeks.

Question 13

long saphenous vein superficial thrombophlebitis Ix

Answer 13

venous ultrasound scan to exclude an underlying DVT

Question 14

Hyperaemia

Answer 14

severe vascular disease
ABPI 0.3-0.5

Question 15

Acute limb ischaemia first Ix

Answer 15

Hand held doppler
then
CT angiogram- (locate the arterial occlusion and provide more detailed imaging)