VASCULAR SURGERY STATIONS 11 - 16

c. Give four hard signs of vascular trauma (4) Station 11 a Leflleftt subclavian artery b Axillary artery aneurysm c) Hard signs: Bruit Absent distal pulses Cold, pale limb. Active pulsating bleed Palpable thrill. Expanding haematoma A 23 years old male patient presented with a supraclavicular mass. He had a history of a left supraclavicular stab two months prior. a. Looking at the angiogram above, name the artery as indicated in arrow (b) (1) b. Looking at the angiogram above, what is the pathology indicated by arrow (a) (2) c. Give four hard signs of vascular trauma (4)

Station 12 75 years old lady with known hypertension, diabetes, hyperlipidaemia and chronic smoker. With a long history of upper limb claudication. Clinically both upper limbs had no palpable pulses a. In aortic arch disease what is a significant blood pressure difference between two limbs(2) b. Where is the likely source of the emboli (2) c. In a younger patient what other three causes of this pathology besides atherosclerosis must you think of (6) >20mmHg Heart (atrial fibrillation) Proximal thrombus c) – Takayashu’s arteritis - Buerger’s disease - Subclavian artery aneurysm with thrombosis.

STATION 13 AAA Size Males: >5.5cm female: >5cm - saccular aneurysm 2x normal aorta - Growth >1cm per annum - symptomatic c) EVAR

Station 14 Occlusion of internal carotid artery Atherosclerotic thrombus occluding artery, emboli from carotid to R hemisphere: in middle and anterior cerebral artery Endarterectomy PTA: Percutaneous transluminal angioplasty with stenting. d) Duplex doppler

a. Please name the artery as indicated by arrow “a” (1) STATION 15 a b Abdominal aorta Common femoral PVD; ileofemoral occlusion PTA and stenting bypass surgery:- aorto bi-iliac - aorto bi-femoraL A 60 year old male patient presented with left lower limb 20 metres claudication distance. He had no palpable left lower limb. a. Please name the artery as indicated by arrow “a” (1) b. Please name the artery as indicated by arrow “b” (1) c. What is the diagnosis? (1) d. Give two surgical options available for this patient (2)

Station 16 Acute Limb Ischaemia due to Thromboembolism or acute thrombosis. Unfractionated heparin: 100 IU/kg stat, thrombolysis, Embolectomy ARDS Myocardial stunning Compartment Syndrome. Above is a picture of a 35 years old female who presented with a 24 hour history of iliofemoral deep vein thrombosis treatment with anticoagulation only, now with an obviously gangrenous foot a. What is the diagnosis? (2) b. How could the luminal patency been immediately achieved (3) c. Give three systemic complications of revascularizing this dead limb (3)

a. What are the two causes of acute arterial occlusion (2) QUESTION 1 a. Give four common risk factors for atherosclerosis (2) b. How do you define critical limb ischaemia (6) c. why is ABI not always reliable in diabetic patient (2)   QUESTION 2 a. Give four soft signs of vascular trauma (4) b. Give three indications for vascular imaging in lower limb trauma (3) c. Give three possible causes for early vascular repair thrombosis (3) QUESTION 3 a. What are the two causes of acute arterial occlusion (2) b. Give three signs of a dead limb (6) c. What is the treatment of Rutherford three limb (acute arterial occlusion) (2) Q1 Hypercholesterolaemia Smoking Hypertension Diabetes Chronic limb ischaemia with rest pain +- ulceration or gangrene and an ankle BP of less than 50 mmHg. Their vessels are calcified and thus give a less acurate reading of what the true blood pressure is. Q2 Peripheral nerve deficit. Hx of haemorrhage. Reduced, palpable pulses. Injury close to major vessels. Pulselessness Poikilothermia Paralysis Poor inflow – pre-existing proximal occlusion. Poor conduit – Failed anastomosis at surgery. Poor outflow – Distal pre-existing thrombosis. Q3 Acute thrombotic occlusion of stenotic arterial segment. Thromboembolism No venous flow on doppler. Loss of sensation. Loss of motor function c) Amputation, the level of which will be determined by the level at which the limb is still viable.

STATION 12 Axillary a Pseudoaneurysm Brachiocephalic a - rupture - thrombus/ emboli - pressure symptoms

STATION 15 A 50 years old male presented with a one week history of a left lower limb swelling. He has had hip surgery one month earlier. a.. Looking at the picture above what is the diagnosis? (2) b. How would you confirm the diagnosis (1) c. Give two acute complications of this condition (2) d . How would you achieve immediate luminal patency? (2) DVT most likely iliofemoral Color Duplex Doppler Pulmonary Embolis Phlegmasia cerulea dolens D) Thrombectomy, thrombolysis