Vascular

Question 1

Anatomical location of the SFJ

Answer 1

2 finger breaths below and lateral to the pubic tubercule

Question 2

Definition of a varicose vien

Answer 2

Torturous dilated vien of the superficial venous system

Question 3

Cause of varicose veins

Answer 3

Primary/idiopathic- RF: prolanged standing, OCP, pregnancy obesity Secondary 5% - valve destruction: DVT, thrombophlebitis - obstruction: pelvis mass, DVT - Avm - klippel - trenaunary - weber - parkes - weber syndrome

Question 4

Klippel- trenaunary - weber syndrome

Answer 4

Abnormality of the deep venous syndrome causing - varicose vein - port wine stain - bony and soft tissue hypetrophy of the limbs

Question 5

Parkes-weber syndrome

Answer 5

Multiple AVM with limb hypetrophy AVM can lead to highout out heart failure

Question 6

Types of minimally invasive therapies for varicose viens

Answer 6

Injection sclerotherapy - 1% Na tetradecyl sulphate Endovenous laser or radio frequency abalation

Question 7

Indication for minimally invasive therapy for varicose veins

Answer 7

Small below knee varicosities not involving the Great saphenous vien or short saphenous vien

Question 8

Indications for surgical management of varicose viens

Answer 8

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

Question 9

Surgical intervention for varicose veins

Answer 9

Trendelenburg: saphenofemoral ligation SSV Ligation: in the popliteal fossa LSV STRIPPING - No longer performed Multiple adulation Cockett’s operation: perforator ligation SEPS: subfascial endoscopic perforator surgery

Question 10

Complications of varicose viens

Answer 10

Early: heamatoma, wound sepsis, nerve damageLate- superficial thrombophlebitis - DVT - reoccurrence: 10% at 15years

Question 11

Cause of chronic venous insufficiency

Answer 11

Reflux following DVT - 90% Obstruction following DVT - 10%

Question 12

Surgical management of chronic venous insufficiency

Answer 12

Reflux - trahere transplantation: axillary vein transplant - kistner operation: valvuloplasty of damaged valve Obstruction - Palma operation

Question 13

Leriche syndrome

Answer 13

Buttock claudication and wasting Erictile dysfunction Absent femoral pulses

Question 14

Risk factor for peripheral vascular disease

Answer 14

Modifiable: smoking, BP, DM control, Hyperlipidemia, decreased exercise Non-modifable: FHx, PMH, Male, increased age, ethnicity

Question 15

Fontaine classification for chronic limb ischemia

Answer 15

1. Asymptomatic - 0.8-1 2. Claudication - a (>200m) b(

Question 16

Doppler sounds

Answer 16

Normal - triphasic Mild stenosis - biphasic Severe stenosis - Monophasic

Question 17

Increased risk of AAA rupture

Answer 17

High BP Smoker Strong FH Female

Question 18

Defintion of AAA

Answer 18

Abnormal dilatation of the abdominal aorta to >50% of its normal diameter = >3cm

Question 19

Indication for AAA operation

Answer 19

Symptomatic/evidence of complication Rupture Asymptomatic - greater or equal to 5.5cm - expanding greater than 1cm a year

Question 20

Complication of AAA

Answer 20

Death MI Renal failure Spinal or mesenteric ischemia Distal trash from thromboembolism Anastomotic leak Graft infection Aortoenteric fistula

Question 21

Signs of chronic venous insufficiency

Answer 21

HAS LEGS haemosiderosis Atrophie Blanche Swelling Lipodermatosclerosis Eczema Gaiters ulcers Stars - venous

Question 22

Indication for surgical management of popliteal aneurysm

Answer 22

Symptomatic Aneurysm containing thrombus Aneurysm greater than 2 cm

Question 23

Definition of a true aneurysm

Answer 23

Dilation of a blood vessel involving all layers of its wall and is >50% of its normal diameter

Question 24

Definition of a false aneurysm

Answer 24

Collection of blood vessels around a vessel wall that communicates with the vessel lumen

Question 25

Detention or vessel dissection

Answer 25

Vessel dilatation caused by blood splaying apart the media to form a channel within the walls

Question 26

Complication of aneurysm

Answer 26

Luminal:- thrombosis leading to distal embolism- infection of artery thrombosis Mural - rupture, fistulation Extra-mural- external pressure e.g. DVT

Question 27

Management of false anneurysm

Answer 27

Ultrasound compression Thrombin injection Surgical repair

Question 28

Indication for amputation

Answer 28

Dead: PVD, Thromboangitis obliterans Dangerous: infection, sepsis, malignancy Damaged: trauma, burns, frost bites Damned nuisance: pain, neurological damage

Question 29

Complications of endarterectomy

Answer 29

3% risk of stroke or death Heamatoma MI nerve Injury - hypoglossal: ipsilateral tongue deviation - great auricular: numb ear lobe - recurrent laryngeal: hoarse voice, bovine voice

Question 30

Definition of gangrene

Answer 30

Irreversible tissue death from poor vascular supply

Question 31

Cause of gangrene

Answer 31

DMembolism and thrombosis Raynauds Thromboangitis obliterans Injury: extreme cold, heat, trauma or pressure

Question 32

Definition of Raynaud’s phenomenon

Answer 32

Characteristic cold induced changes associated with vasospasm

Question 33

Definition of Raynaud’s disease

Answer 33

Primary Raynaud’s phenomenon occurring in isolation

Question 34

Raynaud’s syndrome

Answer 34

Secondary Raynaud’s phenomenon associated with other disease

Question 35

Secondry causes of Raynaud’s

Answer 35

Blood: polycythemia, cyroglobulinemia, cold agglutinsAterial: atherosclerosis, Thromboangitis obliterans Drugs: beta-blockers, OCP, ergotamine Cervical rib: thoracic outlet obstruction Autoimmune: SLE, RA, systemic sclerosis Trauma: vibration injury

Question 36

Cause of venous ulcers

Answer 36

Valvular disease Varicose veins Deep vein reflux Outflow obstruction Muscle pump failure Stroke Neuromuscular disease