Vascular SAQs 6 Flashcards
A 68yo man underwent a femoral arteriogram and balloon angioplasty for an external iliac arterial stenosis
a) List the symptoms and clinical findings that would have led to this procedure
Symptoms—rest pain or claudication extending up to the buttock, limb numbness, muscle weakness
Clinical findings—absent or weak distal pulses, increased capillary refill time, low ankle brachial pressure index
A 68yo man underwent a femoral arteriogram and balloon angioplasty for an external iliac arterial stenosis
Soon afterwards he complained of severe pain in the limb, which had become blanched and pulseless.
a) State two likely causes for this complication and state your management.
Likely causes—thrombosis, dislodgement of atheromatous plaque, or intimal dissection during or following balloon angioplasty, leading to arterial occlusion
Management—analgesia
Anticoagulant e.g. heparin IV
Intra-arterial infusion of tissue plasminogen activator, or surgical thrombo-embolectomy
a) List the risk factors in the development of PVD
Smoking, hypertension, hyperlipidaemia, diabetes mellitus, family history
A 76yo man presents with a pulsatile swelling in his right groin three days after a coronary angioplasty at the site where the cardiac catheter was introduced.
a) State the most likely diagnosis
False aneurysm (pulsatile haematoma produced by bleeding from arterial puncture) of femoral artery (Also iatrogenic arteriovenous malformation)
Causes: penetrating trauma, iatrogenic (e.g. femoral catheter, surgery), infection
a) State one non-invasive investigation for conformation
False Aneurysm
Colour duplex Doppler ultrasound
a) How would you treat this?
False Aneurysm
External pressure occlusion.
If no good, consider surgical repair of arterial wall defect
The patient developed a cold, painful and pulseless lower limb immediately after the coronary angioplasty.
a) State two probable causes and how would you treat each of these complications.
False Aneurysm
Causes: arterial thrombosis, dislodgement of atheroma or intimal dissection during or following angioplasty.
Treatment: thrombosis: intra-arterial thrombolysis or thrombectomy
Emboli: embolectomy under radiological guidance
Intimal dissection: surgical intimal repair
A 75yo man is referred to the surgical clinic with an incidental finding of a palpable, pulsatile and expansile upper abdominal mass of approximately 10cm in diameter
a) State the likely diagnosis
Abdominal aortic aneurysm
a) Discuss the pathological changes that produced this lesion
Abdominal aortic aneurysm
Atherosclerotic changes to vessel wall with intimal ulceration and destruction of elastic and muscular coats with intraluminal thrombosis
a) State one non-invasive investigation you would request
Abdominal aortic aneurysm
Abdominal ultrasound
a) Write a short note on the treatment of this patient
Abdominal aortic aneurysm
Endovascular abdominal aneurysm repair with stent
Open surgical repair with synthetic Dacron graft
a) Write a short notes on the pre-operative preparation of the patient (3)
Abdominal aortic aneurysm
FBC, U&E, LFT
Crossmatch 10 units of blood
CXR, ECG
Control hypertension
