Vascular

Question 1

Which part of the aorta is most likely to be affected in aortic dissection?

Answer 1

Ascending aorta + aortic arch - blood between tunica initma & tunica media → false lumen

Question 2

Which genetic condition is most commonly associated with aortic dissection?

Answer 2

Marfans syndrome

Question 3

Other RF

Answer 3

HTN (stress, ↑ volume, coarctation), weak vessel call - connective tissue disease, smoking, Fhx, cardiac Hx, drug abuse, trauma

Question 4

AD in R subclavian

Answer 4

↓ pulse in R arm and ↓ BP

Question 5

AD in Descending aorta

Answer 5

Limb ischaemic, mesenteric ischaemia, renal artery involvement

Question 6

AD in carotids

Answer 6

stroke like presentation

Question 7

Classification of AD

Answer 7

Stanford
A - Ascending aorta + arch
B - everything else

Question 8

Mgmt

Answer 8

HDU/ICU
Aggressive BP control (aim 100-120SBP - IV antihyper)
ECG - incase MI (thrombolysis)
CT-angiogram

Stamford A - surgery
Stamford B - medically, TEVAR (Thoracic Endovascular Aortic Repair)

Question 9

Complications

Answer 9

Death 
Rupture 
Cardiac Tamponade - low bp
MI
severe hypertension
compress branching arteries - renal or subclavian

Question 10

INV of AD

Answer 10

Widened mediastinum on CRX
TOE - transoesophageal ECHO
Angiograms

Question 11

What is a true aneurysm?

Answer 11

Involves all three levels of arterial wall

Question 12

Pseudoaneurysm - where mostly commonly found, what is it important to differentiate between

Answer 12

Blood outer 2 laters - often after trauma IVD, femoral artery, differentiate between abscess

Question 13

What is the width of normal aorta, width of aneurysm

Answer 13

2cm, 3cm

Question 14

RF

Answer 14

Male, age, smoking, HTN, ↑lipids. COPD, connective tissue disorders

Question 15

Mgmt

Answer 15

Regular USS monitoring

Question 16

Triad for rupture

Answer 16

Hypotension, pain in flank/back, pulsatile mass

Question 17

Inv

Answer 17

USS vs CTA

Question 18

Mgmt

Answer 18

X match, transfer to theatre, ICU input

Question 19

What are the indications for repair

Answer 19

Male >5.5cm
Female > 5cm
Symptomatic
Growth >1cm/year

Question 20

Who is offered screening?

Answer 20

Men > 65 years

Question 21

How often screening for the following AAA’s:

a) 3-4.5 cm
b) 4.5 cm

Answer 21

Yearly

Every 3 months

Question 22

Mortality of ruptured AAA after repair and overall

Answer 22

50%, 80%

Question 23

What types of repairs for elective, common complication

Answer 23

EVAR - Endovascular aneurysm repair
Open repair

Risk - AKI and renal impairment due to proximity to renal arteries.

Question 24

When give anaesthetic for the repair in rupture AAA?

Answer 24

With patient prepped and ready on the table, don’t want drop in BB and muscle relaxant.

Question 25

pain out of proportion with injury, paraesthesuia , swelling

Answer 25

Compartment syndrome

Question 26

causes

Answer 26

fractures, trauma, plaster cast

Question 27

management

Answer 27

release pressure, fasiotomy

Question 28

Chronic compartment syndrome

Answer 28

after exercise, extreme tightness

Question 29

Claudication Hx - essential qs

Answer 29

When it comes on, after how long of walking, does it wake then up at night

Question 30

P’s of critical limb

Answer 30

Pallor, pulseness, perishingly cold, pain, paraesthesia

Question 31

Investigation

Answer 31

ABPI

MRA

Question 32

Mgmt

Answer 32

Lifestyle
Antiplatelets - stop acute occlusion
Angioplasty
Bypass

Question 33

Describe arterial ulcers

Answer 33

punched out loss hair, over bony prominence

Question 34

Acute limb iscaemic causes

Answer 34

Thromboembolic disease, more rarely dissection, trauma

Question 35

Mgmt

Answer 35

Heparin infusion
CTA, MRA (best) or USS Doppler (quick)
Embolectomy