Surgical vascular disease

Question 1

What are the 6 stages to endothelial dysfunction?

Answer 1

Initial lesion, fatty streak, intermediate lesion, atheroma, fibroatheroma, complicated lesion

Question 2

Which cells infiltrate an initial lesion? How is the lesion grown?

Answer 2

Macrophages

Through lipid accumulation

Question 3

What is the histopathological findings of a fatty streak?

Answer 3

Mainly intracellular lipid accumulation

Question 4

What differentiates an intermediate lesion from a fatty streak?

Answer 4

Small extracellular lipid pools

Question 5

What separates an atheroma from an intermediate lesion?

Answer 5

Extracellular lipid core

Question 6

What separates afibroatheroma from an atheroma ?

Answer 6

Single or multiple lipid cores, fibrotic calcific layers, increased smooth muscle and collagen

Question 7

What are the stages of ischaemia? How are they defined?

Answer 7

Acute limb ischaemia (quickly developing or sudden decrease in limb perfusion, usually producing new or worsening symptoms or signs and often threatening limb viability), chronic limb ischaemia (gradually worsening limb pain brought on by exercise and relieved by rest), critical limb ischamia (rest pain, circulation is so severely impaired that there is an imminent risk of limb loss

Question 8

What are the common causes of acute limb ischaemia?

Answer 8

Thrombus
Embolism
Trauma	
Transection
Dissection

Question 9

What is reperfusion injury?

Answer 9

A condition characterized by endothelial damage caused by a returning blood supply after a period of ischemia (e.g., myocardial infarction, ischemic stroke). Causes increased capillary permeability, tissue swelling, and release of reactive oxygen species. Extensive reperfusion injury (reperfusion syndrome) is associated with systemic disturbances such as acidemia, hyperkalemia (which can cause cardiac arrhythmias), and edema (which can cause compartment syndrome).

Question 10

What does ABPI stand for? What values indicate what conditions?

Answer 10

Ankle brachial pressure index
>1.2- abnormal vessel hardening
1-1.2- Normal
0.9-1- acceptable
0.8-0.9- Some arterial disease
0.5-0.8- Moderate arterial disease
<0.5- Severe arterial disease

Question 11

What is the difference between a true and a false aneurysm?

Answer 11

A true aneurysm is formed of all 3 layers of the artery, a false aneurysm has blood escaping through the intima and media and causing bulging through the externa.

Question 12

What are the two types of true aneurysm?

Answer 12

o A true aneurysm can be sacular where the aneurysm bulging in one aspect of the wall, fusiform is where the whole artery is dilated.

Question 13

What is CEAP

Answer 13

o C
 C0= NO DISEASE
 C1= SMALL/ INTRADERMAL
 C2= TRIBUTARY VV
 C3= OEDEMA
 C4= SKIN CHANGES INCLUDING PIGMENTATION, ECZEMA, LDS
 C5= HEALED ULCER
 C6= ACTIVE ULCER
o E= aetiology (congenital, primary, secondary)
o A= anatomy (deep, superficial or perforator)
o P= pathophysiology (reflux or obstruction)