Vascular Surgery

Question 1

Normal size of the abdo aorta?

Question 2

What is a generalised enlargement of an artery termed?

What about a localised enlargement that is between 1 and 1.5 x normal?

Answer 2

Arteriomegally

Ectasia

Question 3

Differentiate true and false aneurysms?

Answer 3

True - pathological degeneration of all or part of the vessel wall
False - leakage of blood from artery into the adventitia.

Question 4

Causes of aneurysms

Answer 4

Congenital
Degenerative
Familial 
Connective tissue disease 
Trauma
Arthroma 
Infection 
Inflammation

Question 5

What is the characteristic of a AAA swelling?

Answer 5

Expansile

Question 6

At what point should a AAA be considered for repair?

Answer 6

> 5.5 cm or expanding >1cm per yr or symptomatic

Question 7

Complications of AAA repair

Answer 7

Death 5%
Spinal or viceral ischemia
Distal trash

Question 8

Advantages and disadvantages of stenting an AAA rather than open repair

Answer 8

Lower mortality

Increased complications such as stent failure (leakage into aneurysm)

Question 9

Types of thoracic aortic aneurysm

Answer 9

Type A - arch

Type B - decending

Question 10

Signs of critical ischemia in pvd

Answer 10

Rest pain - night time relieved by hanging leg off edge of bed
Ulceration
Gangrene

Question 11

Classification system for peripheral arterial disease

Answer 11

Fontaine
1 - asymptomatic
2 - intermittent claudication
3 - ischemic rest pain
4 - ulceration or gangrene

Question 12

Presentation of arterial ulcers

Answer 12

Punched out - dry necrotic bed
Painful - increases on leg elevation
Distal over pressure points
In the situation of pallor, pulseless limb

Question 13

Normal ABPI

Answer 13

0.9-1.3

Question 14

Blood tests to run on a suspected periperal arterial disease patient and why?

Answer 14

FBC - anaemia
U+Es - renal involvement
Glucose - DM
Lipids - dyslipidaemia

Question 15

What imagining in suspected peripheral arterial disease?

Answer 15

Duplex uss

Angiography if considering intervention

Question 16

Management of peripheral arterial disease

Answer 16

Conservative - stop smoking, exercise,
Medical - htn DM and cholesterol control, clopidogrel, pain relief
Surgical - bypass graft, angiography (balloon, stent), amputation

Question 17

Reasons for amputation in peripheral arterial disease?

Answer 17

Irritractable pain

Risk of sepsis from gangrene or ulcers

Question 18

Signs of leg venous insufficiency

Answer 18

Oedema
Eczema 
Ulcers
Haemosiderin staining
Phlebitis
Varicosity 
Lipodermosclerosis 
Atrophie blanche

Question 19

Presentation of venous ulcers

Answer 19

Gaiter region
Sloping
Sloughy and exudative 
Large 
Little pain

Question 20

Examination tests for varicose veins?

Answer 20

EXAMINE STANDING
Inspect - signs of venous insufficiency 
Palpate - tenderness (thrombophlebitis), hardness (thrombosis), tap (percussion wave to SFJ) 
Auscultate - bruits 
Special tests - trendelenbergs

Question 21

Treatment options for varicose veins

Answer 21

Underlying cause
Conservative - Avoid prolonged standing, elevate legs, compression stockings, loose weight, exercise
Endovascular - radiofrequency ablation, lazer ablation, injection sclerotherapy
Surgical - ligation, multiple avulsions,

Question 22

Secondary causes of varicose veins

Answer 22

Obstructions - DVT, ovarian tumours
Valve destruction
AV malformation
Constipation

Question 23

Definition of an aneurysm

Answer 23

Permanent localised dilation of an artery greater than 50% of normal