vascular SAQs

Question 1

critical limb ischemia definition

Answer 1

rest pain present for over 2 weeks with or without ulceration or gangrene, worse at night, improved by hanging off bed

Question 2

1st and 2nd line Ix for for PAD?

Answer 2

1. ABPI
2. Duplex USS
3. MR angiography before any investigations

Question 3

Mx of PAD?

Answer 3

1. pharmocological: statin + clopidogrel + exercise training
2. Critical limb ischemia:
   - endovascular revascularization (percutaneous transluminl angioplasty + stent placement)
   - surgical revascularisation
   - amputation

Question 4

indications for surgery in AAA?

Answer 4

1. > 5.5cm
2. increased by >1cm in a year
3. symptomatic
4. rupture

Question 5

AAA screening

Answer 5

• all males over 65 yrars offered USS
• > 3cm = 12m screening
• > 4.4cm = 3m screening
• > 5.5cm = 2w wait for elective aneurysm repair

Question 6

other than aorta where else can aneurysms be found

Answer 6

1. intracranial = berry aneurysms
2. popitheal
3. femoral
4. iliac

Question 7

virchows triad

Answer 7

1. endothelial injury: trauma, surgery, atheresclerosis
2. stasis of blood flow: AF, LV dysfunction, immobility, varicose veins
3. hypercoagulability: malignancy, pregnancy, sepsis, thrombophilia

Question 8

pt with medial mallous ulcer, presents with rolled up edges + large amt of granulomatous tissue =

Answer 8

A Marjolin ulcer is a cutaneous malignancy that arises in the setting of previously injured skin, longstanding scars, and chronic wounds.

Question 9

criticial limb ischemia definition

Answer 9

Critical limb ischaemia is defined as rest pain which is present for over 2 weeks with or without ulceration or gangrene.

worse at night, better when hanging off bed

Question 10

Ix for CLI?

Answer 10

handheld arterial doppler, MR angiography

Question 11

4 Tx for CLI

Answer 11

1. stenting
2. angiplasty
3. bypass grafting
4. amputation

Question 12

AAA: who receives once-yearly follow ups?

Answer 12

aneurysm 3-4.4cm

Question 13

Virchow’s triad + examples of each

Answer 13

Endothelial injury: trauma, surgery, atherosclerosis, venepuncture, cardiac valve disease.

Stasis of blood flow: AF, left ventricular dysfunction, immobility, varicose veins.

Hypercoagulability: malignancy, pregnancy, oestrogen therapy, sepsis, thrombophilia.

Question 14

Ix for venous leg ulcer?

Answer 14

Doppler ultrasound

Question 15

Tx options for acute limb ischemia

Answer 15

Thrombolysis. ● Embolectomy. ● Angioplasty. ● Arterial bypass grafting.

Question 16

Describe the three subgroups of limb viability for the acute ischaemic limb

Answer 16

Viable: Doppler pulses present, limb not immediately threatened, sensation intact.

Threatened: loss of sensory and motor function, urgent treatment required.

Irreversible: fixed mottling with muscle paralysis, requires amputation.

Question 17

2 types of classification used in aortic dissection?

Answer 17

Stanford, DeBakey

Question 18

IMMEDIATE steps for a stab wound?

Answer 18

● Direct pressure on the wound. ● Elevate limb. ● Urgent vascular review. ● Tourniquet.

Question 19

signs that may lead you to suspect a vascular injury

Answer 19

● Bruit. ● Active haemorrhage. ● Pulsatile haemorrhage. ● Haematoma formation.

6Ps

Question 20

What is permissive hypotension and how may this be beneficial for this patient?

Answer 20

Permissive hypotension is a strategy used in the resuscitation of bleeding trauma patients. This advocates the cautious use of fluid to maintain a blood pressure lower than normal but that can sustain sufficient organ perfusion. It is believed to prevent a large increase in blood pressure to disrupt clot formation, avoid further tearing to the aorta and limit blood loss.

Question 21

classification of varicose veins?

Answer 21

Classified as primary which is the degeneration of the valve annulus and leaflets

secondary which is due to valve destruction or venous outflow destruction.

Question 22

common sites for varicose veins to occur?

Answer 22

Long saphenous-femoral vein junction. ● Short saphenous-popliteal vein junction. ● Perforating veins.

Question 23

Tx options for varicose veins

Answer 23

watchful waiting
compression bandaging
sclerotherapy
laser ablation
ligation and stripping