Vascular surgery

Question 1

What is the screening for AAA?

Answer 1

Single abdominal ultrasound for MALES aged 65

Question 2

Screening outcomes: 
<3 cm: 
3-4.4 cm: 
4.5-5.4 cm: 
>=5.5 cm:

Answer 2

<3 cm: NO further action
3-4.4 cm: Rescan every 12 months
4.5-5.4 cm: Rescan every 3 months
>=5.5 cm: Refer w/in 2 weeks to vascular surgery

Question 3

High rupture risk (>5.5 cm or rapidly enlarging) mx.

Answer 3

2 week referral

Treat with EVAR (endovadcular repair)

Question 4

ABPI > 1.2:

Answer 4

Calcified stiff arteries: advanced age or PAD

Question 5

ABPI <0.9:

Answer 5

Likely PAD. <0.5 is severe disease and must referred urgently

Question 6

At which ABPI is compression bandgaing generally considered acceptable?

Answer 6

ABPI > 0.8

Question 7

What is a Marjolin’s ulcer:

Answer 7

Squamous cell carcinoma which occurs at sites of chronic inflammation:
Mainly in the lower limb

Question 8

Arterial ulcer location:

Answer 8

In between toes and heel

Question 9

Neuropathic ulcer location:

Mx.

Answer 9

Metatarsal head and plantar surface of big toe - pressure locations

Cushioned shoes

Question 10

Pyoderma gangrenosum
Association?
Where else can this occur?

Answer 10

Inflammatory bowel disease/RA

Can occur at stoma sites

Question 11

PAD - acute limb ischaemia first investigation:

Answer 11

Handheld arterial doppler.

Question 12

PAD - acute limb ischaemia second investigation (if doppler signals present)

Answer 12

ABPI

Question 13

Acute limb ischaemia initial management:

Answer 13

ABCDE approach
Analgesia: IV opioids
IV Unfractioned Heparin
Vascular review

Question 14

Acute limb ischaemia definitive management:

Answer 14

Thrombolysis
Surgical embolectomy
Angioplasty
Bypass surgery

Question 15

What ABPI is suggestive of critical limb ischaemia:

Answer 15

<0.5

Question 16

Critical limb ischaemia

Should contain 1 or more of the following symptoms:

Answer 16

Rest pain in foot for more than 2 weeks
Ulceration
Gangrene

Question 17

PAD mx.:

Answer 17

STOP smoking
Exercise training
Treat co-morbidities: Htn, DM, Obesity
Statin (80 mg atorvastatin) 
Clopidogrel

Question 18

Which anti-platelet should be used as first-line in pts. w/ PAD:

Answer 18

Clopidogrel

Question 19

Severe PAD tx.:

Answer 19

EVAR - used for short segment stenosis (<10cm)

Surgical revascularisation - open surgical techniques are used for long segment lesions

Question 20

Drugs for PAD:

Answer 20

Naftidrofuryl oxalate - vasodilator

Cilostazol: PDE III inhibitor

Question 21

Ruptured AAA diagnosis
Stable pts.
Unstable pts.

Answer 21

CT angiogram

Clinical - straight to theatre for emergency surgical repair

Question 22

Superficial thrombophlebitis mx.

Answer 22

US to exclude concurrent DVT
Compression stockings
LMWH for 30 days or Fondaparinux 45 days
If LMWH is contraindicated - 8-12 days oral NSAIDS are recommended

Question 23

Possible definitve tx. for varicose veins

Answer 23

Endothermal ablation
Foam sclerotherapy
Surgical stripping or ligation

Question 24

What comes first ABPI or doppler scan in suspected acute limb ischaemia

Answer 24

Doppler US

Question 25

All pts. w/ peripheral arterial disease get:

Answer 25

Clopidogrel and atorvastatin

Question 26

Claudication affecting the femoral vessels likely to present w/ ___ pain.
Claudication affecting the iliac vessels causes ___ pain.

Answer 26

Femoral

Buttock