Vascular Surgery

Question 1

What is peripheral vascular disease (PVD)?

Answer 1

obstruction of the large arteries that supply blood to the peripheries

Question 2

What are some causes of PVD?

Answer 2

atherosclerosis (thickening of the artery wall due to accumulation of calcium and fatty materials)

thromboembolism (blood clot occluding the artery)

aneurysm (bulge in artery wall)

inflammatory processes

Question 3

Why is smoking a risk factor for PVD?

Answer 3

causes changes in and damage to the endothelial lining of blood vessels

Question 4

Why is diabetes a risk factor for PVD?

Answer 4

due to peripheral neuropathy

Question 5

What are some risk factors for PVD (other than smoking and diabetes)?

Answer 5

dyslipidemia (high cholesterol)

hypertension

obesity

stroke/CV disease

family history of vascular disease

Question 6

What is claudication?

Answer 6

pain with walking due to decreased circulation (cramping, aching, fatigue, numbness)

Question 7

What are two long standing symptoms patients with PVD might have?

Answer 7

claudication & resting pain

Question 8

What is the classification scale for PVD?

Answer 8

0: asymptomatic
1: mild claudication
2: moderate claudication
3: severe claudication
4: resting pain
5: minor tissue loss, ischemic ulceration not exceeding ulcer of the digits of the foot
6: major tissue loss, severe ischemic ulcers or frank gangrene

Question 9

How is PVD diagnosed?

Answer 9

using an ankle-brachial pressure index (ABPI/ABI)

normal range is 1 to 4
PVD

Question 10

Name some conservative managements for PVD

Answer 10

smoking cessation
diabetic management
management of cholesterol
exercise

Question 11

What is the main outcome measure used to monitor PVD?

Answer 11

progressing treadmill test

recording the claudication pain time onset and maximum walking time

Question 12

What does endovascular surgery entail?

Answer 12

minimally invasive surgery designed to access regions of the body via major blood vessels

involves the inserting a catheter through the skin into a large blood vessel

i.e. angioplasty

Question 13

What is an angioplasty?

Answer 13

a type of endovascular surgery where a collapsed balloon is inserted into a vessel and expanded at narrow points

a stent may also be inserted to ensure the vessel remains open after the balloon is removed

Question 14

Post angioplasty, how long should a patient remain in bed?

Answer 14

4 hours and avoid strenuous activity for a week

Question 15

What are inflow operations?

Answer 15

surgeries to restore blood flow to the top of the leg

also called super-inguinal open surgery

Question 16

What are outflow operations?

Answer 16

surgeries to restore blood flow below the knee

also called infra-inguinal open surgery

Question 17

Name 4 inflow operations

Answer 17

aorto-bifermoral bypass graft

axillo-bifemoral bypass graft

iliofemoral bypass (unilateral or g=femoral-femoral crossover)

femoral endarterectomy and profundaplasty

Question 18

What is a aorto-bifemoral bypass?

Answer 18

used for obstruction of the aorta below the level of the kidneys

incision in the abdomen and bilateral groin, an artificial graft is used to reinforce the aorta

indications:
severe claudication 
non-healing ulcers on the extremities
aortic aneurysms 
acute abdominal aortic occlusion 
critical limb ischaemia

Question 19

What is a axillo-bifemoral bypass?

Answer 19

a surgery where the axillary artery is connected to the femoral arteries using an artificial graft

this is less stress on the heart but more prone to complications

Question 20

What is an ilio-femoral bypass (note can be done unilaterally or with a femoral-femoral crossover)?

Answer 20

a surgery for cases of isolated iliac or proximal common femoral artery occlusion

femoral-femoral crossover involves a graft from a normal femoral artery in the groin on one leg and takes blood to the femoral artery in the other leg

Question 21

What is a femoral endarterectomy? Why is this procedure less risky than others?

Answer 21

a surgery to remove the atherosclerotic plaque in the lining of an artery

there is no prosthetic material being introduced

Question 22

What is a carotid endarterectomy?

Answer 22

a surgery to remove atherosclerotic plaque from the carotid artery (where stroke is likely to occur if the plaque breaks free and moves to the brain)

Question 23

Name 3 outflow operations.

Answer 23

femoro-popliteal bypass
femoro-tibial bypass
femoro-crural bypass

Question 24

What is a femoro-popliteal bypass?

Answer 24

a natural graft is placed from the femoral artery to the popliteal artery to bypass an area of blockage

Question 25

What is a femoro-tibial bypass?

Answer 25

a graft is placed from the femoral artery to the anterior tibial artery

Question 26

What is an abdominal aortic aneurysm?

Answer 26

a localised ballooning of the abdominal aorta

rupture can be life-threatening

Question 27

In relation to vascular surgery, what should be considered in a preoperative assessment (if possible)?

Answer 27

gain rapport with the patient
previous level of mobility 
home set up 
comorbidities that may impact recovery 
provide education

Question 28

In relation to vascular surgery, what should be considered in a post-operative assessment?

Answer 28

circulation
chest review
mobility

Question 29

In relation to vascular surgery, what post-operative treatments should be applied?

Answer 29

circulatory exercises
chest therapy 
mobility starting with a rollator
home exercise program
education and advice re lifestyle changes to support risk factor reduction

Question 30

What are the 6 P’s associated with acute arterial occlusion?

Answer 30

pain
pallor
pulselessness
paraesthesia (pins & needles) 
paralysis
poikilothermy (varying temperature)

Question 31

What causes an acute arterial occlusion and what are the options for intervention?

Answer 31

failed bypass graft
thrombosis of native vessels due to progressive atherosclerosis (plaque build-up)
embolism of the heart (blockage from a clot)
injury

options: revascularisation or amputation

Question 32

Would it take more energy to use a prosthesis with a trans-femoral or trans-tibial amputation?

Answer 32

trans-femoral