101

Question 1

What are the grades of blunt thoracic aortic trauma

Answer 1

1. Intimal injury - medical management
2. Mural hematoma
3. Pseudoaneurysm
4. Contained rupture

Question 2

What is CREST 2

Answer 2

A trial comparing carotid endarterectomy to best medical management and carotid stenting to best medical management, and asymptomatic patients 

Question 3

What are 4 exclusión criteria for EVAR

Answer 3

Widely accepted exclusion criteria for EVAR include:
1. proximal neck length less than 10 mm
2. proximal neck diameter greater than 32 mm
3. neck angulation greater than 60 degrees
4. external iliac diameter of less than 6mm

Question 4

Velocity criteria for severe carotid stenosis

Answer 4

PSV Greater than 230
>50% plaque
Internal:common psv ratio >4
EDV > 100

Question 5

Velocity criteria for moderate carotid stenosis 50-69%

Answer 5

ICA PSV 180-230
Plaque >50
ICA:CCA PSV Ratio 2-4
ICA EDV 40-100

Question 6

Rutherford classification for chronic ischemia

Answer 6

Stage 0 - asx
Stage 1 - mild claudication
Stage 2- moderate claudication
Stage 3 - severe claudication
Stage 4 - rest pain
Stage 5 - minor tissue loss
Stage 6 - major tissue loss

Question 7

Rutherford classification for acute limb ischemia

Answer 7

I. Intact sensory motor, Doppler signals present, cap refill intact

IIa. Loss of arterial Doppler signals. Mild sensory changes. Motor intact. Cap refill delayed. Urgent OR

IIb. Motor deficits. Worsening sensory deficits. Immediate OR

III. Paralysis and complete sensory loss. Loss of venous Doppler signals. No cap refill. Unsalvageable

Question 8

Wifi classification

Question 9

Reflux time for superficial and deep veins to be considered significant

Answer 9

Superficial greater than 0.5, deep greater than 1 second

Question 10

Exclusion for TCAR

Answer 10

1. Distance between access site (common carotid above the clavicle) and lesion less than 5cm
2. Diameter of CCA less than 6mm
3. Access and occlusion sites with significant disease
4. Visible Thrombus
5. Circumferential plaque/calcification
6. Tortuosity, small diameter ICA

Relative: neck radiation, tracheostomy

Question 11

Best-CLI Trial

Answer 11

Prospective open label trial comparing two cohorts, NEJM December 2022
Cohort 1 was patients with suitable single segment of greater saphenous vein- in this group surgery was superior to endo (major adverse limb events/death)

Cohort 2 was patients without suitable single segment saphenous. In this group surgery and endo we’re equivalent

Question 12

Adequate gsv diameter for bypass

Answer 12

3mm; 2-3 marginal

Question 13

Timing of CEA after stroke

Answer 13

48hrs - 14 days

Question 14

Popliteal artery aneurysm size threshold for repair

Question 15

Biochemical work up for carotid body tumor

Answer 15

Screen with serum metanephrines and serum dopamine if positive follow up with 24 hr urine metanephrines

(See email with Wachtel)

Question 16

Describe the Voyager trial

Answer 16

RCT of Compass dose xarelto (2.5 bid) and Asa compared to Asa alone in PAD patients with revascularization with regards to composite outcome of ALI, major amputation, MI, stroke or death from CV causes. TIMI bleeding not significantly higher but ISHT major bleeding was

Question 17

Describe the compass trial

Answer 17

In patients with stable atherosclerotic disease, three groups: asa 100mg, full strength rivaroxaban (xarelto), or low dose rovaroxaban (2.5 bid) AND asa 100mg were compared with respect to a composite outcome of cardiovascular death, MI or stroke. Combo low dose xarelto and asa had lower rates of primary outcome, higher rates of major bleeding than Asa alone. Xarelto alone had similar rates of primary outcome but higher rates of bleeding to Asa alone

Question 18

CREST Trial

Question 19

EMINENT Trial

Question 20

ZILVER PTX Trial

Question 21

BATTLE Trial

Question 22

IMPERIAL Trial

Question 23

BASIL Trial

Question 24

NASCET

Question 25

TASCA

Answer 25

aortoiliac: stenosis (not occlusion!) short (3cm) and single, unilateral or bilateral Fempop- single stenosis less than 10cm or occlusion less than 5cm

Question 26

TASC B

Answer 26

Aortoiliac: -short infrarenal stenosis -unilateral common iliac occlusion -external iliac stenosis: multiple or greater than 3cm but less than 10 and not extending into CFA -external iliac occlusion: unilateral, not involving CFA or internal Fempop: - multiple lesions all less than 5cm - single stenosis or occlusions less than 15, not involving infrageniculate pop - heavily calcified occlusion less than 5cm - single popliteal stenosis

Question 27

4 compartments of lower leg

Answer 27

Deep and superficial posterior Anterior Lateral

Question 28

Indications for concomitant carotid/CABG

Answer 28

—symptomatic carotid stenosis —bilateral 80-99% stenosis —unilateral 70-99% stenosis with contralateral occlusion

Question 29

CEAP classes

Answer 29

Class 1: telangiectasias/reticular veins Class 2: varicose veins Class 3: Edema Class 4: venous stasis skin changes Class 5: healed ulcer Class 6: active ulcer

Question 30

Name and describe all the collateral pathways in the visceral circulation

Answer 30

Arc of buhler- variant direct connection between celiac and sma Arc of riolan- anastomosis between middle colic and left colic (first branch of IMA) Marginal artery of Drummond GDA- pancreatico duodenal arcades - inferior pancreatioduodenal artery - SMA Internal iliac - middle hemorrhoidal - superior hemorrhoidal - ima

Question 31

Crawford classification for thoracoabdominal aneurysms

Answer 31

Extent 1: Distal to LSCA, proximal to renals (isolated DTA) Extent 2: Distal to LSCA, and including some or all of the abdominal aorta Extent 3: Distal to 6th intercostal space, some or all of the abdominal aorta Extent 4: Distal to diaphragm, all of the abdominal aorta (Extent 5: distal to 6th intercostal space, proximal to renals; like a focal distal extent 1)

Question 32

Arc of Buhler

Answer 32

Variant embryologic remnant direct connection between celiac and sma

Question 33

Arc of riolan

Answer 33

Connection between middle colic (SMA) and left colic (IMA)

Question 34

Extent I TAAA

Answer 34

From LSCA to renals

Question 35

Extent II

Answer 35

LSCA to iliac Bifurcation

Question 36

Extent III

Answer 36

Extent 3: Distal to 6th intercostal space, some or all of the abdominal aorta

Question 37

Extent IV

Answer 37

Distal to diaphragm, all of the abdominal aorta

Question 38

COBEST Trial

Question 39

Lateral superior most branch of CFA

Answer 39

Superficial circumflex iliac artery

Question 40

Medial superior most branch of CFA

Answer 40

Superficial epigastric artery

Question 41

Arterial branches of the arm

Answer 41

Axillary artery becomes brachial at lateral border or teres major Brachial gives off a deep brachial branch Brachial bifurcation Ulnar gives off common interosseous -anterior and posterior divisions

Question 42

Name and origin of 3rd major forearm artery

Answer 42

Common interosseous artery, comes off ulnar and then has anterior and posterior divisions

Question 43

PPI

Answer 43

Profunda - popliteal index

Question 44

Describe appearance of acute thrombus in a vein on B mode imaging

Answer 44

Anechoic to hypo-echoic. Enlarged vein Incompressible. On color flow, absence of flow

Question 45

Chronic DVT appearance

Answer 45

Increased echogenicity Decreased size Wall thickening Fibrosis and synechia

Question 46

Size threshold for descending thoracic aneurysm

Question 47

Size threshold for iliac artery aneurysm

Question 48

Size threshold for splenic artery aneurysm

Question 49

Size threshold for renal artery aneurysm

Question 50

Resistive Indices

Answer 50

PSV - EDV / PSV

Question 51

Markers of chronically ischemic unsalvageable kidney

Answer 51

-Size less than 8cm - resistive indices 0.8 or greater

Question 52

Vascular Causes of Horner’s syndrome?

Answer 52

1) FMD 2) carotid artery dissection [ 3) vertebral artery transposition surgery]

Question 53

What respiratory maneuver worsens MALS

Answer 53

End Expiration Exacerbation during End Expiration

Question 54

Giacomini vein

Answer 54

Posterior thigh tributary/ trunk projection off the SSV, present in 56-86% of limbs and may increase the effective length of SSV for use as a bypass conduit

Question 55

Peroneus magnus

Question 56

Where do most lower extremity venous thrombi originate

Answer 56

The soleal sinuses