Rapid Acquisition Of Key Concepts- Cardiothoracic And Vascular Surgery

Apr 8, 2024

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Rutherford’s Classification of Acute Limb Ischaemia

Comparison between Buerger’s Disease and Atherosclerosis:

Differentiation between different types of pain (other causes of pain)

Modified Well criteria for the prediction of deep venous thrombosis (DVT)

Modified Well criteria for the prediction of Pulmonary Embolism

Summary of the Arterial Supply and the Venous Drainage

Masaoka Staging System for Thymoma

Thymoma staging

Rapid Acquisition Of Key Concepts- Cardiothoracic And Vascular Surgery

Rutherford’s Classification of Acute Limb Ischaemia

Rutherford’s Classification of Acute Limb Ischaemia
Grade	Category	Sensory loss	Motor deficit	Doppler signals		Prognosis
Arterial	Venous
I	Viable	None	None	Audible	Audible	No immediate threat
IIA	Marginally threatened	None or minimal (toes)	None	Inaudible	Audible	Salvageable if promptly treated
IIB	Immediately threatened	More than toes	Mild/moderate	Inaudible	Inaudible	Salvageable with immediate revascularisation
III	Irreversible	Profound or insensate	Paralysed	Inaudible	Inaudible	Limb irreversibly damaged, major tissue toss, amputation

Comparison between Buerger’s Disease and Atherosclerosis:

Buerger’s Disease	Atherosclerosis
Age/ Cause	<40 years (3rd or 4th decades of life). Thrombus formation	>50 years Plaque formation
Gender	More common in male	Males and females are equally affected
Predisposition	Smoking (Main factor)	Combination of multiple risk factors - Hypertension, diabetes, hyperlipidemia, smoking, etc.
Site	Lower limbs are more commonly involved than upper limbs.	Predominantly involves only the lower limbs.
Involvement	Arteries, veins as well as nerves Commonly associated with migratory Superficial Thrombophlebitis and Raynaud’s Phenomenon	Mainly involves arteries. Can also lead to Raynaud’s syndrome
Vessel size	Small to Medium	Medium to Large
Progression	Distal to proximal	Proximal to distal
In Buerger’s disease there can be segmental involvement with presence of skip lesion

Differentiation between different types of pain (other causes of pain)

Vasculogenic (Reproducible)	Neurogenic (d/t nerve root compression)	Chronic Compartment Syndrome	Osteoarthritis	Venous Claudication
Onset	Walking	Variable onset	Heavy /major exercise	1st step (in some patients) After exercise (in others) In advanced OA - pain can occur at rest itself.	Walking
Nature	Cramps	Sharp lancinating pain	Tight bursting pain	Dull aching	Tight bursting
Location	Most commonly calf	Radiates to leg	Calf	Buttocks, hip, knee	Entire lower limb - more commonly in thigh
Relief	Stop walking. Relief in <5 mins	Sit/ lie down. Relief takes more than 5 mins	Very slow	Sit down. Takes longer time - more than 5 mins	Slow and comes by elevation of the limb
Effect of body position	No change	Change in body position	Elevation of limb	Takes off weight of his legs	Elevation

Modified Well criteria for the prediction of deep venous thrombosis (DVT)

Modified Wells criteria for predicting deep vein thrombosis (DVT)
Variable	Score
Lower limb trauma or surgery or immobilization in a plaster cast	1
Bedridden for >3 days or surgery in last 4 weeks	1
Tenderness along the line or femoral or popliteal veins	1
Entire limb swollen	1
Calf >3 cm larger circumference than other side 10 cm below tibial tuberosity	1
Pitting oedema	1
Dilated collateral superficial veins (not varicose veins)	1
Previous DVT	1
Malignancy (including treatment up to 6 months ago)	1
Intravenous drug abuse	3
Alternative diagnosis more likely than DVT	–2
Low probability (5%) of DVT (score –2 to 0); moderate probability (17%) of DVT (score 1 or 2); high probability (17-53%) of DVT (score >2)

Modified Well criteria for the prediction of Pulmonary Embolism

Modified Wells criteria for predicting pulmonary embolism (PE)
Variable	Score
Clinical signs and symptoms of DVT (minimum of leg swelling and pain on palpation of deep veins	3
Alternative diagnosis less likely than PE	3
Heart rate >100 bpm	1.5
Immobilisation >3 days or surgery within past 4 weeks	1.5
Previous DVT or PE	1.5
Haemoptysis	1
Malignancy (treatment or palliation within past 6 months)	1
A score of <4 means PE is unlikely (12.4%); >4 is suggestive of PE (37.1%)

Also Read: Knowing Venous Diseases and How to Treat Them

Summary of the Arterial Supply and the Venous Drainage

Groove	Artery	Accompanied by the vein
Anterior Interventricular groove Left Atrioventricular/ Left Coronary sulcus. Posterior Interventricular groove Right Atrioventricular/ Right Coronary sulcus	Left Anterior Descending (LAD) Circumflex Artery Posterior Descending Artery (PAD) Right Coronary Artery (RCA)	Great Cardiac Vein Great Cardiac Vein Middle Cardiac Vein Small Cardiac Vein

Masaoka Staging System for Thymoma

Stage I	Encapsulated tumor with no gross or microscopic evidence of capsular invasion
Stage II	Gross capsular invasion or invasion into the mediastinal fat or pleura or microscopic capsular invasion
Stage III	Gross invasion into the pericardium, great vessels, or lung
Stage IV A	Pleural or pericardial dissemination
Stage IV B	Lymphogenous or hematogenous metastasis

Thymoma staging

Thymoma staging
T Descriptors Category	Definition (involvement of)
T1 T2 T3 T4	Encapsulated or unencapsulated, with or without extension into mediastinal fat Extension into mediastinal pleura Pericardium Lung, brachiocephalic vein, superior vena cava, chest wall, phrenic nerve, hilar (extra-pericardial) pulmonary vessels Aorta, arch vessels, main pulmonary artery, myocardium, trachea or esophagus
N and M Descriptors Category	Definition (Involvement of)
N0 N1 N2 M0 M1 A B	No nodal involvement Anterior (perithymic) nodes Deep intrathoracic or cervical nodes On metastatic pleural, pericardial or distant sites Separate pleural or pericardial nodule(s) Pulmonary intraparenchymal nodule or distant organ metastasis
Stage Grouping STAGE	T	N	M
I	T1	No	M0
II	T2	No	M0
IIIa	T3	No	M0
IIIb	T4	No	M0
IVa	T any	N1	M0
IVa	T any	No.1	M1a
Ivb	T any	N2	M0, 1a
Ivb	T any	N any	M1b

Also Read: High Yield Cardiothoracic and Vascular Surgery Questions

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