Vascular Surgery

Question 1

Subclavian Steal Syndrome

Answer 1

Stenotic plaque at subclavian limiting blood supply to arm when exercising. Arm sucks blood away from the brain.

Question 2

AAA

Answer 2

If

Question 3

Tender AAA

Answer 3

Going to rupture within a day or two; immediate repair is indicated.

Question 4

Excruciating back pain in patient with large AAA

Answer 4

Already leaking. Retroperitoneal hematoma is already forming and will blow out into peritoneal cavity.

Emergency surgery.

Question 5

Arteriosclerotic Occlusive Disease of LE

Answer 5

Surgery disables symptoms and save LE from impending necrosis.
Pain brought on by by walking and relieved by rest.
Cilostazol (PDE inhibitor) can vasodilate vessels

Question 6

Workup of disabling intermittent claudication

Answer 6

Doppler study to look for ankle brachial index.

• AB index 1= vessels to small; can’t so surgery
• AB index of

Question 7

Rest Pain from Arterioocclusive disease

Answer 7

Ulceration and gangrene. LE is pale until rest and dangle and turns purple.
PE will show shiny atrophic skin without hair and no peripheral pulses.

Question 8

Arterial Embolization from Distant Source

Answer 8

A-fib or MI; LE becomes painful, pulseless, cold, and paresthetic.
Within 6 hours, need doppler. Incomplete occlusions: clot breakers. Embolectomy with Fogarty catheter is done for complete obstruction and fasciotomy should be added before revascularization.

Question 9

Dissecting Aneurysm of Thoracic Aorta

Answer 9

Xray will show wide mediastinum. Spiral CT (CT angio) to dx.
Ascending needs to be surgically managed. Descending managed medically.