Vascular

Question 1

Summarise the indications for abdominal aortic aneurysm repair

Answer 1

3 indications: Diameter >5.5cm Diameter growing by >1cm /y Symptomatic

Question 2

Identify the possible complications of abdominal aortic aneurysm repair

Answer 2

• Normal surgical complications (infection, bleeding, wound dehisence, adhesions)
• EVAR
  
  • access site infection (much less than open) -
  • endograft complications: endoleak, device migration, limb kinking/occlusion, separation of components, infection
  • systemic: cardiopulmonary (MI), contrast reaction, ischaemia (renal, gut, spine)
• Open
  
  • perioperative: bleeding, ischaemia (renal, gut, spinal)
  • postoperative: cardiopulmonary (heart failure, MI), graft infection
  • reduced risk of reintervention than for EVAR (UpToDate)

Question 3

Identify the possible complications of an abdominal aortic aneurysm

Answer 3

• Immediate: rupture
• Early: thromboembolic (–> acute limb ischaemia etc), DVT
• Long: fistulation

(lecture)

Question 4

Define abdominal aortic aneurysm

Answer 4

Permanent pathological dilatation of the aorta with a diameter >1.5x the expected anteroposterior diameter of that segment (~3cm)

Question 5

Summarise the epidemiology of an abdominal aortic aneurysm

Answer 5

5-10% of 65-79y males

M:F 6:1

Question 6

Explain the risk factors of an abdominal aortic aneurysm

Answer 6

RFs:

• age, male
• lifestyle: smoking, HTN, obesity
• PHx: connective tissue disoders, hyperlipidaemia

(BMJ)

Question 7

Summarise the prognosis for patients with an abdominal aortic aneurysm

Answer 7

Mortality: 90% if rupture

Morbidity: most with open-repair remain w/o complications. EVAR is higher risk of delayed complication and re-intervention

(BMJ)

Question 8

Outline screening for AAA

Answer 8

Screening

in men >65y, USS abdo

Results:

<3cm = normal

3-5.5cm = follow up 1 year

>5.5cm = consider intervention

Question 9

Identify appropriate investigations for an abdominal aortic aneurysm

Answer 9

Confirm diagnosis:

• Imaging:
  
  • USS abdo (diagnostic, high sensitivity high specificity)
  • CT abdo (idenitify relation to renal arteries, any thrombus, impending rupture)
• Identify fitness for surgery:
  
  • Bloods: FBC, UEs, clotting, LFTs

(BMJ)

Question 10

Generate a management plan for an abdominal aortic aneurysm

Answer 10

• Surgical (if >5.5cm)
  
  • Open repair or EVAR
  • • peri-operative: beta blocker (metoprolol, short acting) + statin
  • • peri-operative antibiotics)broad-spectrum)
• Conservative
  
  • Risk factor modification: stop smoking
• Medical:
  
  • Risk factor modification: statins +/- beta blocker

(BMJ)

Question 11

What are the different kinds of endoleak?

Answer 11

Endoleak = persistent bloody flow outside the graft and w/i the aneurysm sac. Risk following EVAR is 1/4

5 types:

I: leak at attachment site. Repair indicated on discovery

II: patent branch leak. Can spontaneously resolve, r/v at 6m, consider transarterial coil embolisation

III: graft defect leak. Repair indicated on discover

IV: graft porosity leak. Rare, self-limiting

V: No leak visualised on CT but increased endotension. Only tx if aneurysm expands

(BMJ)

Question 12

Identify the possible complications of an abdominal aortic aneurysm

Answer 12

• Immediate: rupture, surgical complications (infection, bleeding etc)
• Early: thromboembolic (–> acute limb ischaemia etc), DVT
• Long: fistulation, recurrence, endoleak in EVAR

Question 13

What is the classification system for chronic venous disease?

What are it parameters?

Answer 13

CEAP Classification of Chronic Venous Disease

Parameters:

• clinical
• aetiology
• anatomy
• pathophysiology

(AS)

Question 14

What are the indications for an amputation?

Answer 14

4Ds

• Dead: peripheral vascular disease (90%), thromboangitis migrans
• Dangerous: sepsis, malignancy
• Damaged: trauma, burns, frostbite
• Disruptive: pain, neurological damage

(AS)