Vascular Surgery - Surgical Finals Flashcards
Stem applies to next three flash cards
79 year old man presents to the Emergency department with a 4 hour history of sudden onset of severe pain and numbness in his left leg extending up to his mid-thigh.
State your working diagnosis and predisposing vascular diseases (3 marks)
- Diagnosis: acute limb ischaemia as a result of left common femoral arterial occlusion
- Predisposing factors:
- AF leading to embolism
- Thrombus on previously diseased artery
- Aortic dissection
List the clinical findings in the limb supporting your diagnosis (3 marks)
- Pallor
- Skin mottling
- Cold, puslelessness and pain
- Reduced sensation
- Loss of function (toes cannot move)
- Venous guttering
What is your treatment plan (4 marks)
- Emergency surgical work-up
- FBCs
- U&Es
- CXR
- ECG
- Urethral catheterisation
- Group and crossmatch 4 units
- Treate as acute or acute-on-chronic occlusion with systemic anticoagulation,arterial embolectomy or thrombectomy (request angiogram)
- Sometimes thromboembolytic therapy can be given to avoid surgery
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68 year old man complains of gradual onset of right calf claudication radiating up to his thigh on walking distances exceeding 75m.
State your likely diagnosis and anatomical site of lesion (2 marks)
- Peripheral vascular disease producing stenosis of the arteries of the right lower limb
- Right common femoral artery or superificial and profunda femoral arteries
Write a short explanation of the disease process underlying his pathology (3 marks)
- Process is atherosclerosis
- Adherent microthrombi and subintimal cholesterol deposits lead to atheromatous plaque formation and luminal narrowing
- Plaque haemorrhage leads to intimal ulceration
- Thrombi form on the ulcerated surface
- Give rise to thromboemboli producing distal vessel occlusion
Give five common risk factors for this disease (5 marks)
- Smoking
- Diabetes
- Hypercholesterolaemia
- Hypertension
- Family history
What advise would you give this patient to stop progression of this disease? (3 marks)
- Smoking cessation
- Close monitoring of diabetes and hypertension
- Exercise to develop collateral circulation
- Weight reduction
- Low cholesterol diet
- Foot care - podiatry
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A 59 year old woman complains of rest pain in her left foot, keeping her awake at night. She also has difficult in walking.
List the clinical findings that would lead to a working diagnosis (4 marks)
- Pale, cold limb with loss of sensation, ischaemic skin changes
- Reduced or absent femoral, popliteal, dorsalis pedis, posterior tibial pulse
- Reduced ABPI
- Neurological signs - reduced senation, tone, power and reflexes accompanied by muscle wasting.
Discuss briefly the surgical options available to relieve her symptoms (3 marks)
- Removal of arterial occlusive disease by endarterectomy
- Bypass of occlusion using native vein or synthetic vascular grafts
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A 68 year old man underwent a femoral arteriogram and balloon angioplasty for an external iliac arterial stenosis
List the symptoms and clinical findings that would have led to this procedure (3 marks)
- Claudication or rest pain extending up to the buttock
- Weak or absent distal pulses
- Low resting and exercise ABPIs
- Loss of muscle power
Soon afterwards he complained of severe pain in the limb, which had become blanched and pulseless
State two likely causes for this complication (2 marks)
- Thrombosis, dislodgement of atheromatous plaque
- Intimal dissection during or after angioplasty producing arterial occlusion
State your management (3 marks)
- Analgesia - anticoagulation with intravenous heparin
- Infusion of prostaglanding-derived thrombolytic agent (tPA)
- Thromboembolectomy - repair or removal of intimal flap
List the risk factors involved in the development of peripheral vascular disease
- Smoking
- Diabetes
- Hyperlipidemia
- Hypertension
- Family History
Stem applies to next five flash cards
A 76 year old man presents with a pulsatile swelling in his right groin 3 days after a coronary angioplasty at the site where the cardiac catheter was introduced
State the most likely diagnosis (1 mark)
Pseudoaneurysm of the femoral artery
State one non-invasive investigation for confirmation (1 mark)
Duplex doppler scan
