ABSITE Vascular Surgery Exam With Complete
Solutions
Bottom Line: Management of suppurative thrombophlebitis starts with administration of
IV antibiotics of the proper coverage for the most likely organism.
The most reasonable first line approach is with antibiotics which would cover
staphylococci and Enterobacteriaceae which are the most common cause of peripheral
vein suppurative thrombophlebitis. IV vancomycin and ceftriaxone can be administered
for 7 days
Acute Mesenteric Ischemia
The most common cause is from embolic disease from the heart, which can be seen in
atrial fibrillation or after a myocardial infarction. Embolic events will usually lodge in the
SMA past the takeoff of the middle colic artery. Acute mesenteric ischemia is a surgical
emergency and is treated with an embolectomy.
Acute neurological deficit immediately following a carotid endarterectomy requires
emergent evaluation because of the possibility of a potentially correctable thrombus or
embolus. If no technical abnormality is identified, one should rule out cerebral
hemorrhage before obtaining a CT angiogram to confirm embolic etiology and guide
management.
High-output cardiac failure secondary to arteriovenous (AV) fistula
Arteriovenous fistula is associated with high-output cardiac failure because of
diminished total systemic vascular resistance, increased venous return, and cardiac
output. It may precipitate or worsen heart failure, particularly in patients with
pre-existing cardiovascular diseases. Medical management should first be instituted,
followed by attempts at diminishing the AV access flow rate with banding followed by
ligation if unsuccessful.
Varicose vein treatment
, Although simple varicose veins can be conservatively treated by compression
stockings, in the presence of a saphenous vein reflux abolition of the saphenous vein
may decrease the need for further treatment of small varicose veins.
TX: small saphenous vein radioablation
Common sites for embolic events
The brain and lower extremities are the most common sites for embolic events. In the
lower extremity, embolic events most commonly occur in the common femoral and
popliteal arteries. Less common sites of embolic events in the upper extremity include
the origin of the profunda brachialis and the brachial artery bifurcation.
Paraplegia as complication of AAA repair
Bottom Line: Paraplegia is a rare, devastating complication after AAA repair. Adequate
maintenance of prograde pelvic perfusion through the internal iliac arteries may
minimize this complication.
The potential mechanisms for this devastating complication include embolization,
thrombosis of the spinal artery, and disruption of the spinal blood supply. Paraplegia
after aneurysm repair is irreversible. Paraplegia may be minimized by maintaining
adequate prograde pelvic perfusion through the internal iliac arteries.
divesivmuncausl
Absolute contraindications to thrombolytic treatment
active internal bleeding
recent (within 2 months) cerebrovascular accident, trauma, or intracranial or
intraspinal surgery
known intracranial neoplasm
severe uncontrollable hypertension
uncontrollable clotting disorders
previous severe allergic reactions to the thrombolytic agent
Solutions
Bottom Line: Management of suppurative thrombophlebitis starts with administration of
IV antibiotics of the proper coverage for the most likely organism.
The most reasonable first line approach is with antibiotics which would cover
staphylococci and Enterobacteriaceae which are the most common cause of peripheral
vein suppurative thrombophlebitis. IV vancomycin and ceftriaxone can be administered
for 7 days
Acute Mesenteric Ischemia
The most common cause is from embolic disease from the heart, which can be seen in
atrial fibrillation or after a myocardial infarction. Embolic events will usually lodge in the
SMA past the takeoff of the middle colic artery. Acute mesenteric ischemia is a surgical
emergency and is treated with an embolectomy.
Acute neurological deficit immediately following a carotid endarterectomy requires
emergent evaluation because of the possibility of a potentially correctable thrombus or
embolus. If no technical abnormality is identified, one should rule out cerebral
hemorrhage before obtaining a CT angiogram to confirm embolic etiology and guide
management.
High-output cardiac failure secondary to arteriovenous (AV) fistula
Arteriovenous fistula is associated with high-output cardiac failure because of
diminished total systemic vascular resistance, increased venous return, and cardiac
output. It may precipitate or worsen heart failure, particularly in patients with
pre-existing cardiovascular diseases. Medical management should first be instituted,
followed by attempts at diminishing the AV access flow rate with banding followed by
ligation if unsuccessful.
Varicose vein treatment
, Although simple varicose veins can be conservatively treated by compression
stockings, in the presence of a saphenous vein reflux abolition of the saphenous vein
may decrease the need for further treatment of small varicose veins.
TX: small saphenous vein radioablation
Common sites for embolic events
The brain and lower extremities are the most common sites for embolic events. In the
lower extremity, embolic events most commonly occur in the common femoral and
popliteal arteries. Less common sites of embolic events in the upper extremity include
the origin of the profunda brachialis and the brachial artery bifurcation.
Paraplegia as complication of AAA repair
Bottom Line: Paraplegia is a rare, devastating complication after AAA repair. Adequate
maintenance of prograde pelvic perfusion through the internal iliac arteries may
minimize this complication.
The potential mechanisms for this devastating complication include embolization,
thrombosis of the spinal artery, and disruption of the spinal blood supply. Paraplegia
after aneurysm repair is irreversible. Paraplegia may be minimized by maintaining
adequate prograde pelvic perfusion through the internal iliac arteries.
divesivmuncausl
Absolute contraindications to thrombolytic treatment
active internal bleeding
recent (within 2 months) cerebrovascular accident, trauma, or intracranial or
intraspinal surgery
known intracranial neoplasm
severe uncontrollable hypertension
uncontrollable clotting disorders
previous severe allergic reactions to the thrombolytic agent
