Vascular

Question 1

Where are abdominal aortic aneurysms most commonly located?

Answer 1

Between the renal and inferior and mesenteric arteries

The Infrarenal aorta

Question 2

What is the investigation for AAA?

Answer 2

Abdominal ultrasound is the initial investigation of choice for both screening and follow up

Question 3

What is the imaging modality of choice for preoperative evaluation in AAA?

Answer 3

CT Angiography

Question 4

When should patients be offered repair for AAA?

Answer 4

AAA>5.5cm in size or rapid expansion

Question 5

What is the follow up for AAA 3-4.4cm in diameter?

Answer 5

Yearly repeat ultrasound

Question 6

What is the follow up for AAA 4.5-5.4cm in diameter?

Answer 6

Repeat ultrasound every 3 months is offered

Question 7

What is the follow up for AAA more than 5.5cm in diameter?

Answer 7

Surgical intervention is recommended

Question 8

What is acute limb ischaemia?

Answer 8

It is a severe, symptomatic hypoperfusion of a limb that has been occuring for less than 2 weeks.

Although the definition states two weeks it is considered a surgical emergency and demands urgent intervention, ideally within 4-6 hours

Question 9

What can acute limb ischaemia be caused by?

Answer 9

• Thrombosis (40%) - This often results from the rupture of atherosclerotic plaques.
• Embolism (40%) - These are most commonly observed in patients with atrial fibrillation.
• Vasospasm - Such as observed in Raynaud’s phenomenon.

External vascular compromise:
- Trauma
- Compartment syndrome

Question 10

What are the symptoms of Acute Limb Ischaemia?

Answer 10

• Pulseless
• Painful
• Pale
• Paralysis
• Paraesthesia
• Perishingly cold

Question 11

What is the management of ALI where thrombosis is the cause?

Answer 11

• Angiography for incomplete ischaemia
• Urgent bypass surgery for complete ischaemia

Question 12

What is the management of ALI where embolism is the cause?

Answer 12

Immediate Embolectomy

Question 13

What is Buerger’s disease?

Answer 13

A non-atherosclerotic vasculitis characterized by the occlusion of small and medium-sized arteries

Question 14

What factors may contribute to Buerger’s disease diagnosis?

Answer 14

• Young male smokers of Mediterranean and Middle Eastern origin

Question 15

What are the clinical features of Buerger’s disease?

Answer 15

• Typically presents as an acutely ischaemic limb without a background of peripheral claudication
• Raynauds
• Ulcers or non-healing wounds on the fingers and toes, often associated with gangrene
• Superficial migratory thrombophlebitis

Question 16

What is the management of Buerger’s disease?

Answer 16

• Stop Smoking
• Vasoactive medications
  *Nifedipine: A CCB promotes vasodilation
  *Iloprost: Synthetic prostacyclin analog that also promotes vasodilation and inhibits platelet aggregation
  *Prostaglandin E1

Question 17

What is the first-line treatment for superficial thrombophlebitis?

Answer 17

NSAIDS
Naproxen

Question 18

What are varicose veins?

Answer 18

They are tortuous dilated superficial veins

Question 19

What are the direct complications of varicose veins?

Answer 19

Bleeding
Thrombophlebitis

Question 20

What are indirect complications of varicose veins?

Answer 20

They occurs as a result of venous hypertension
- Oedema
- Venous Ulceration
- Pigmentation changes
- Lipodermatosclerosis
- Varicose Eczema

Question 21

What is the pathophysiology of primary varicose veins?

Answer 21

Weak vein walls –> Dilated veins –> Valve cusps cant meet –> Valve incompetence

Question 22

What is the pathophysiology of secondary varicose veins?

Answer 22

Pelvic or abdominal masses –> Venous return obstructed