Vascular

Question 1

When is stent placement, aortobifemoral bypass, and axillobifemoral bypass used for vascular disease?

Answer 1

short-segment stenosis in the common iliac artery = angioplasty and/or stent placement

long-segment stenosis and good risk patient treatment options = aortobifemoral bypass

long-segment stenosis and HIGH risk/poor general condition = axillobifemoral bypass

Question 2

An aneurysm should be repaired, regardless of symptomology, if it is what size in the following locations?
abdominal:
iliac:
splenic:

Answer 2

abdominal: >5cm
iliac: >4cm
splenic: >2cm

Question 3

The first investigation

with patients where colonic ischemia is suspected is to perform

Answer 3

sigmoidoscopy

Question 4

An endarterectomy is performed if there is __% carotid stenosis in an asymptomatic patient.

Answer 4

> 60%

Question 5

What is thromboangiitis obliterans? What is the pattern of involvement?

Answer 5

Buerger’s disease
Panvasculitis affecting artery, vein, and nerve. Involvement of superficial veins early in course of disease (migratory superficial phlebitis) and involves peripheral arteries (beyond popliteal/distal to forearm). Most important aspect of treatment is cessation of smoking!

Question 6

On examination, the popliteal, dorsalis pedis, and posterior tibial pulses are normal; but they disappear on dorsiflexion of the foot. What is the most likely diagnosis?

Answer 6

popliteal artery entrapment syndrome (abnormal relation of that artery to the muscles, usually the medial head of the gastrocnemius muscle). Angiography to establish diagnosis.

Question 7

What is the treatment for phlegmasia cerulae dolens?

Answer 7

venous thrombectomy (esp if impending gangrene noted)> Standard treatment for post-op thrombosis is anticoagulation and bed rest.

Question 8

What are the two most important steps in managing varicose veins of the lower extremity?

Answer 8

A through clinical evaluation followed by a venous duplex examination. Will help the valvular incompetence and guide the extent of surgical intervention if needed

Question 9

What is effort thrombosis, also called Paget-von

Schroetter syndrome? What is the treatment?

Answer 9

The development of thrombosis of the axillary-subclavian vein as a result of injury or compression. Treatment is thrombolytic therapy (followed by cervical rib resection if it is due to thoracic outlet syndrome)

Question 10

Blue, red, or purple nodules with satellite lesions in the arm of a patient who has previously undergone radical mastectomy:

Answer 10

Lymphangiosarcoma (Stewart-Treves syndrome), a rare complication of long-standing lymphedema. Early metastasis (mainly to lung) may develop if it is not recognized early and widely excised.

Question 11

Popliteal aneurysms are usually arteriosclerotic and are bilateral in __% of cases.

Answer 11

50%

Question 12

A popliteal artery aneurysm >__cm should be repaired to avoid thrombosis or embolism.

Answer 12

> 2cm

Question 13

Nonocclusive ischemic disease is characterized by spasm of the major mesenteric arterial vessels, with a characteristic beading effect. Early recognition can lead to treatment with ______________, avoiding operative intervention.

Answer 13

papaverine (a vasodilator)

Question 14

How is renal vascular fibromuscular dysplasia treated?

Answer 14

percutaneous transluminal angioplasty

Question 15

Which is the most common site at which an arterial embolus lodges?

Answer 15

Just proximal to bifurcation at the common femoral artery

Question 16

What is the treatment for combined aortoiliac and

femoropopliteal occlusive disease?

Answer 16

aortofemoral bypass (proximal disease, first!). Only 20% will then require treatment for the distal disease with femoropopliteal bypass

Question 17

What is Leriche syndrome?

Answer 17

Manifestations of aortoiliac occlusive disease, including thigh and buttock claudication, atrophy of leg muscles, diminished femoral pulses and impotence in men

Question 18

What is the Nicoladoni-Brandham sign?

Answer 18

occlusion of an AV fistula or the artery proximal to the fistula results in a slowing of the heart rate (increases peripheral resistance = decreases venous return)

Question 19

What are the tissues most sensitive to anoxia in the extremity?

Answer 19

peripheral nerve endings

Question 20

Carotid body tumors arise from chemoreceptor cells, which are of what tissue origin?

Answer 20

neuroectodermal. These tumors usually present as a painless neck mass (but may cause compression of vagus or hypoglossal nerves)

Question 21

___________ dislocation of the knee is often associated with popliteal artery thrombosis and normal X ray findings despite severe knee trauma.

Answer 21

Posterior

Question 22

What is the first intracerebral branch of the carotid artery?

Answer 22

The retinal artery

Question 23

What is “ischemia-reperfusion” syndrome characterized by?

Answer 23

Hyperkalemia, lactic acidosis, and myoglobinuria as myoglobin, lactic acid, potassium, and other products of ischemia go back into the blood stream. Treat with alkalinization of urine to prevent myoglobin precipitation, mannitol diuresis, and correction of hyperkalemia

Question 24

Despite receiving optimal treatment for DVT, up to 50% of patient will develop ___________

Answer 24

post-thrombotic syndrome (postphlebitic syndrome). Recanalization of deep veins = deformity = incompetence of venous valves

Question 25

While early failure in vein grafts is usually due to ___________, late failure is usually attributed to ___________

Answer 25

early failure: technical error, inadequate outflow tract

late failure: progression of disease distally or proximally

Question 26

What is Milroy’s disease?

Answer 26

familial inherited form of lymphedema from birth (different from congenital and different from praecox (which is starting at age 1-35). Meigs syndrome is a form of lymphedema praecox that is inherited in families