Vascular Surgery

Question 1

The three criteria for aneurysm surgery

Answer 1

• An asymptomatic aneurysm larger than 5.5 cm in diameter.
• An asymptomatic aneurysm which is enlarging by more than 1 cm per year.
• A symptomatic aneurysm. This is the only criteria, apart from emergency rupture, which requires urgent surgery rather than an elective procedure.

Question 2

Actions following AAA screening

Answer 2

< 3 cm: Normal - No further action
3 - 4.4 cm: Small aneurysm - Rescan every 12 months
4.5 - 5.4 cm: Medium aneurysm - Rescan every 3 months
>= 5.5cm: Large aneurysm - Refer within 2 weeks to vascular surgery for probable intervention

Question 3

what is a Marjolin’s ulcer?

Answer 3

Squamous cell carcinoma
Occurring at sites of chronic inflammation e.g; burns, osteomyelitis after 10-20 years
Mainly occur on the lower limb

Question 4

Claudication which affects the buttocks but not the calves - where is the steonsis?

Answer 4

Iliac artery

Question 5

AAA screening

Answer 5

single USS at 65yrs

Question 6

ABPI values

Answer 6

> 1.2: may indicate calcified, stiff arteries. This may be seen with advanced age or PAD, diabetes
1.0 - 1.2: normal
0.9 - 1.0: acceptable
< 0.9: likely PAD.
< 0.5 indicate severe disease which should be referred urgently
<0.3 - critical limb ischaemia, may be necrotic

Question 7

Secondary prevention medications in PAD

Answer 7

Clopidogrel 75mg daily

Atorvastatin 80mg daily

Question 8

Cause of acute upprl limb ischaemia

Answer 8

30% axillary embolus

50% brachial embolus

Question 9

What is subclavian steal syndrome?

Answer 9

Proximal stenotic lesion of the subclavian artery results in retrograte flow through vertebral or internal thoracic arteries. This results in decreaseD in cerebral blood flow and may produce syncopal symptoms
A duplex scan and/ or angiogram will delineate the lesion and allow treatment to be planned

Question 10

What is Takayasu’s Arteritis?
Who gets it?
Presentation?
Mx?

Answer 10

Large vessel granulomatous vasculitis which results in intimal narrowing
Most commonly affects young asian females
Patients present with features of mild systemic illness, followed by pulseless phase with symptoms of vascular insufficiency
Treatment is with systemic steroids

Question 11

Coarctation of the aorta
cause?
who gets it?
presentation?
Mx

Answer 11

Aortic stenosis at the site of the ductus arteriosus insertion
Most common in boys and girls with Turners syndrome
Patients may present with symptoms of arterial insufficiency, such as syncope and claudication
Blood pressure mismatch may be seen, as may mismatch of pulse pressure in the upper and lower limbs - radio femoral delay.
Angioplasty

Question 12

Management of venous ulcers

Answer 12

• compression bandaging

- compression stockings may help to prevent the formation of future ulcers