Vascular Surgery

Question 1

Classification and surveillance of AAA

Answer 1

Aneurysm is above 3 cm. Small is 3-4.4, 4.5-5.4 is medium, large is above 5.5

One US offered to men at age 65, yearly if above 3, monthly if above 4.5

Question 2

Indications for elective AAA repair

Answer 2

More than 5.5, growing at more than 1 cm a year or if it is symptomatic

Open or EVAR done. EVAR has better short term outcomes, but more likely to need surgery again. If fit and well may consider open

Question 3

Symptoms of AAA

Answer 3

Abdo, back or loin pain
Pulsatile central abdominal mass

Question 4

What is the classic triad of AAA

What is permissive hypotension

Answer 4

Flank or back pain, hypotension and a Pulsatile mass

Keeping BP kinds low (less than 100 systolic) in order to stop bleedigm

Question 5

What Ix is done for triple A

Answer 5

US first line
CTA if patient is stable and surgery considered

Question 6

How can critical limb ischaemia be defined

6ps
Pain
Pallor
Pulslessness
Parasthesia
Perishingly cold
Paralysis

Ischaemic pain at rest for greater than 2 weeks
Presence of ischaemic lesions or gangrene
ABPI of less than 0.5

Question 7

Hx of peripheral artery disease

Answer 7

Intermittent claudication (can be described as burinin) on exertion
Pain when in bed which requires patient to hand leg off bed

Change or loss of sensation limbs

Question 8

Ix for chronic limb ischaemia

Answer 8

ABPI
>1.2 could indicate calcified vessels due to DM
0.9-1.2 is normal
0.6-0.9 is mild
0.5-0.6 is moderate
0.4-0.3 is severe

Less than 0.3 indicated critical limb ischaemia

Duplex US scan

CT angiography

Question 9

Medical managment of PAD

Answer 9

Lifestyle - weight loss and smoking
Statin therapy
Anti platelet therapy

Question 10

Surgical management of CLI

Answer 10

Endivascular angioplasty with our without stenting
Endartectomy
Bypass surgery

Question 11

Causes of acute limb ischaemia

Answer 11

Thrombus in situ
Embolus
Trauma

Question 12

Ix for acute limb ischaemia

Answer 12

Same as critical
Bloods, with lactate, group and save and cross match

Question 13

Mx of acute limb ischaemia

Answer 13

Urgent vascular repair within 6 hours

Emebelctomy if ambolus
Thrmobolysis
Angioplasty and stenting
Bypass surgery

Question 14

What is used to classify acute limb ischaemia

Answer 14

Rutherford

1 is viable, no signs on evaluation
2a is marginally threatened, small sensory loss of toes and inaudible arterial Doppler
2h is immediately threatened. Lots of sensory loss, mild to moderate motor deficit, and inaudible arterial and venous Doppler

Rutherford 3 is fucked

Question 15

How is the mx of Rutherford of 1 and 2 a different from 2b

Answer 15

1 and 2a can be managed with a heparin bolus and infusion, 2b needs surgery