Peripheral Vascular Surgery MCQs: Questions for MCh/DrNB/ MRCS Exam Preparation (Part 1)

Brachial plexus injuries, vascular injuries, pleural effusion, winged scapula, and infection are complications that may arise secondary to first rib removal.

Raynaud’s Phenomenon

• Raynaud’s phenomenon is characterized by episodic digital ischemia on exposure to cold or emotional stress
• Manifested by the sequential development of digital blanching, cyanosis and rubor (redness) of fingers or toes
• BCR: Blanching, Cyanosis and Rubor (redness)

• Raynaud’s phenomenon is divided into:
− Primary or idiopathic (Raynaud’s disease)
− Secondary (associated with other diseases)

Associations
• Raynaud’s phenomenon occurs frequently in patients who also have migraine or variants angina. These
associations suggest a common predisposing cause for vasospasm.
• Occupational groups that use vibrating tools are more predisposed.
• Sclerodactyly (thickening and tightening of digital subcutaneous tissue) may develop in few patients.

• Surgery indicated when size of AAA >5.5 cm (Not the 6 cm).
• After rupture, mortality rate of emergent operation is 45-50%.
• Most serious gastrointestinal complication is ischemia of the left colon and rectum. Post-operative hypotension and
hemodynamic instability are contributory factors.
• Occasionally, microembolization can occur, resulting in small patchy areas of ischemia, usually on the plantar aspect of           the foot, referred to as trash foot.

Aortic Dissection:

• Aortic dissection is caused by a circumferential or, less frequently, transverse tear of the intima.
• MC site: Right lateral wall of the ascending aorta.
• Another common site: Descending thoracic aorta (just below the ligamentum arteriosum).
• Peak incidence: 6th and 7th decades.
• MenQ are more commonly affected.

• Aneurysm: permanent and irreversible localized dilatation of blood vessel with at least 50% increase in diameter
• Ectasia: dilatation <50% of normal diameter
• AAA (abdominal aortic aneurysm) is diagnosed if diameter >3 cm in males or >2.6 cm in females.                                              • Width of aneurysm is most important predicting factor of rupture.
• Juan Parodi introduced endovascular aortic aneurysm repair (EVAR).