VASCULAR SURGERY

Question 1

Subclavian steal syndrome

Answer 1

Arteriosclerosis at subclavian - fine flow during rest
During exercise: claudication and posterior neurologic symptoms

Duplex scanning –> reversal of flow

Treat with bypass surgery

Question 2

Abdominal aortic aneurysm…. WHEN TO FIX?

Answer 2

Pulsatile abdominal mass on exam

WHEN TO FIX?

Question 3

Tender AAA?

Answer 3

Rupture within a day or two so do immediate repair

Question 4

Back pain with an AAA?

Answer 4

Aneurysm is leaking!!!

Retroperitoneal hematoma forming –> blowout into peritoneal cavity in minutes/hours

Question 5

Intermittent claudication

Answer 5

Arteriosclerosis of the lower extremities

Early fix: stop smoking, exercise, use cilostazol

ANKLE-BRACHIAL INDEX
If it’s

Question 6

Penultimate stage of arteriosclerosis of lower extremities?

Answer 6

Patient can’t sleep and leg goes from white to deep purple

Shiny atrophic lower extremity without hair
No peripheral pulses

Question 7

Arterial embolization from distant source to lower extremity

Answer 7

Often due to atrial fibrillation

P's
Painful
Pale
Poikilothermic (cold)
Pulseless
Parasthetic 
Paralytic 

Fix within 6 hours - use Doppler and an embolectomy with Fogarty catheter

Question 8

Treatment for aortic dissection

Answer 8

Ascending aorta
SURGICAL
Aortic valve might have been damaged and needs repair

Descending aorta
MEDICAL
Treat by controlling hypertension in the ICU

Question 9

When is FNA (fine needle aspiration) contraindicated?

Answer 9

Liver hemangioma - patient might move and that can lead to fatal bleeding

Testicular mass - almost always malignant and you will seed malignancies by sticking the needle in