Vascular Surgery

Question 0

What is stasis dermatitis (venous eczema)?

Answer 0

Itchy, erythematous, dry, scaly skin secondary to chronic venous insufficiency

Typically in gaiter region, often brown or red in colour

Question 1

What is haemosiderin deposition?

Answer 1

Venous hypertension –> venodilation –> RBC leak into the interstitium and the haemoglobin is broken down to haemosiderin

Appearance: brown pigment in patches in the skin - typically in the gaiter region

Question 2

What is lipodermatosclerosis?

Answer 2

Progressive fibrosis of the skin and subcutaneous tissue secondary to chronic venous insufficiency.

Appearance: thickened red-brown skin which is painful in the acute stage and then becomes stiff, shiny and indurated. As the fibrosis progresses this area becomes tightened and narrow, with swelling above, creating the inverted bottle shape to the legs.

Also known as: fat necrosis, chronic cellulitis, folliculitis Also

Question 3

What is atrophie blanche?

Answer 3

Skin necrosis in areas of venous insufficiency leaving grey/white scars.

May have surrounding venules and telangestasia or erythematous or brown pigmented areas nearby.

Question 4

Characteristics of Venous Ulcers

Answer 4

Warm, wet and wide

• Found in gaiter distribution
• Red base, +/- yellow fibrous tissue +/- pus
• Irregular borders

Occur in skin typical of venous insuffiency: warm, shiny, swollen skin with haemosiderin deposition

Question 5

Characteristics of Arterial Ulcers

Answer 5

Deep, dark and dry

• Occur at pressure points - heels, between toes, over bony protuberances, shoe line, anterior shin
• Base is yellow, brown, grey, black Minimal bleeding, even when probed
• Painful, especially during the night (hang leg over bed)

Leg may show signs of arterial disease: pale, shiny, hairless, reactive hyperaemia, calf wasting, nail dystrophy

Question 6

Characteristics of Neuropathic Ulcers

Answer 6

Painless, punched out, peripheral neuropathy

• On pressure points or areas of trauma, especially ball of foot
• Base is pink through to black
• Punched out appearance - very deep, edges look cut
• Calloused skin around
• Occur in diabetics primarily
• Bleed when probed

Question 7

Aneurysm

(definition)

Answer 7

an abnormal permanent dilatation of an artery, part of an artery, or the heart

• usually secondary to disease of the vessel wall (atherosclerosis or genetic connective tissue disorders)

may be saccular (like a berry) or fusiform (generally wide)

Question 8

Pseudoaneurysm

(definition)

Answer 8

a collection of blood in communication with an artery

• contained by surrounding tissue lined with thrombus
• pulsatile and expansile
• may thrombse or rupture

Question 9

Indications for Limb Amputation

Answer 9

• Acute ischaemia
  
  • irreversible ischaemia
  • severe (can’t revasc)
  • revasc failed
• Chronic ischaemia
  
  • revasc failed
  • can’t revasc - no suitable arteries
  • too sick for bypass surgery
• Foot infection (diabetes + neuropathy) ++ gangrene
• Severe trauma
• Lower extremity malignancies - skeletal or soft tissue