Venous surgery

Question 1

May Thurner Syndrome

Answer 1

iliofemoral thrombophlebitis caused by a compression of the iliac artery.
TTT : Heparin, dilatation and stenting

Question 2

Paget Schrotter Disease

Answer 2

Thrombosis of V. subclavia and V. axillaris
Effort induced thrombosis
TTT : thrombolysis if early enough, classic for DVT

Question 3

Venous aneurysm

Answer 3

Increased risk of thrombosis

TTT : resection or interponat (PTFE Prosthesis)

Question 4

AAA Definition

Answer 4

Dilation sagital > 30 mm

Question 5

AAA Classification

Answer 5

supra renal
juxta renal
infra renal (90%)

30-50% go down to iliacal arteries

Question 6

AAA Ruptured trias

Answer 6

pulsating abdominal mass
pain
schock

Question 7

AAA Type of rupture

Answer 7

20% intra-abdominal ruptures
75% retroperitoneal ruptures
5% rupture in Duodenum, or V.cava

Question 8

AAA Risk of rupture according to size

Answer 8

20% > 5cm
40% > 6cm
50% > 7cm

Question 9

Size to operate (3)

Answer 9

5cm
> 1cm/year
symptomatic

Question 10

AAA Heparin intra-operative

Answer 10

60 IE / Kg infrarenal before clamping aorta
- Lumbal artieries are tied
- IMA patch excised
Dacron (polyterephtalate, polyester) or PTFE (polytetrafluoroethylène, fluoropolymere)

Question 11

Complication of AAA

Answer 11

Pseudo-aneurysm in the area of anastomosis

Question 12

EVAR

Answer 12

Typically for older patients

Question 13

Inflammatory AAA

Answer 13

Wall thickened with perianeurysmal fibrosis in the retroperitoneum
Not an infection
SR is elevated
Weight loss
More complication with the operation

Question 14

Infectious AAA (mycotic)

Answer 14

Staphylococcus 40%
Salmonella 30%

Hematogen
Contiguous (spondylodiszitis)
ATB + Operation