Lower Extremity

Question 1

arterial anatomy of the leg?

Answer 1

external iliac > femoral > deep femoral, superficial circumflex iliac, SFA –> popliteal artery –> posterior tibial, peroneal, anterior tibial –> dorsalis pedis

Question 2

infrapopliteal muscles medial to lateral

Answer 2

posterior tibial (medial)
peroneal artery (tibioperoneal trunk to AT)
anterior tibial (lateral)

Question 3

Leriche syndrome

Answer 3

chronic occlusive atherosclerotic disease of the distal abdominal aorta

-impotence, buttock claudication, absent femoral pulses, cold lower extremities

Question 4

TASC II

Answer 4

The 2006 second TransAtlantic Inter-Society Consensus; recommendations for treatment of aortoiliac and infrainguinal occlusive disease classify lesions as Types A through D (most severe).

Question 5

TASC II Type A

Answer 5

noncalcified concentric iliac stenosis <3cm in length

Treatment: percutaneous transluminal PTA

Question 6

TASC II Type B/C

Answer 6

lesion 3-10 cm in length

surgery or PTA

Question 7

TASC II Type D

Answer 7

stenoses >10 cm

Question 8

indications for stenting

Answer 8

stenting is indicated if there is >30% residual stenosis or >10 mm Hg systolic pressure gradient at rest

Question 9

iliac artery aneurysm definition

Answer 9

> 1.5 cm; repair when > 3 cm

Question 10

causes of internal iliac aneurysms

Answer 10

older men; associated with AAA

associated with atherosclerosis, connective tissue disease

Question 11

persisent sciatic artery

Answer 11

fetal sciatic artery supplies majority of the leg; arises from the internal iliac artery –> popliteal;

Question 12

active pelvic bleeding, next steps?

Answer 12

• angiography, then ortho
• nonselective pelvic arteriogram –> selective bilateral internal iliac arteriograms

avoid superselective embolization in the setting of life threatening hemorrhage

Question 13

indications for uterine artery embolization

Answer 13

fibroids, postpartum hemorrhage

frequently used polyvinyl chloride

Question 14

complications of uterine artery embolization

Answer 14

abscess, endometritis, ovarian necrosis, premature menopause, infertility

Question 15

risk factors for peripheral vascular disease

Answer 15

CAD, smoking, DM, HTN, HLD, lack of exercise, family history

Question 16

treatment for cladication

Answer 16

risk factor control, exersie, aspirin, cilostazol (platelet aggregation inhibitor with vasodilator action)

Question 17

common places for atherosclerotic stenoses

Answer 17

common iliac artery, SFA, popliteal, TP trunk, origins of tibial arteries

Question 18

Rutherford classification for chronic limb ischemia

Answer 18

Category 0 is asymptomatic, category 1 is mild claudication,
categories 2–3 are moderate to severe ischemia
category 4 is ischemic rest pain
categories 5–6 are minor or major tissue loss, respectively.

Question 19

ABI

Answer 19

ankle brachial index

SBP in the ankles compared to the arms

<0.9 is abnormal
0.5-0.9 is intermittent claudication
<0.4 is rest pain

Question 20

normal waveforms

Answer 20

normal triphasic
biphasic (moderate stenosis)
flat waveform (severe stenosis/occlusion)

Question 21

femoropopliteal lesions by TASC-II

Answer 21

Type A: Single stenosis ≤10 cm: Endovascular treatment is the treatment of choice.
Type B: Multiple lesions (stenosis or occlusion), each <5 cm; single lesion <15 cm: Endovascular
treatment is preferred, depending on patient’s comorbidities and preference.
Type C: Multiple stenoses or occlusions >15 cm: Surgery is preferred, depending on patient’s comorbidities and preference.
Type D: Chronic total occlusion: Surgery is treatment of choice.

Question 22

acute limb ischemia symptoms

Answer 22

pain, pallor, poikilothermia (coldness), pulselessness, paresthesia

Question 23

common embolic source for acute thromboembolic disease

Answer 23

left atrial thrombus from Afib

workup: echocardiography

Question 24

meniscus sign in IR

Answer 24

abrupt cutoff of ffected vessel from atherosclerotic disease

Question 25

treatment for acute thromboembolic disease

Answer 25

embolectomy, surgical bypass graft, endovascular thrombolysis

Question 26

administration of tPA

Answer 26

hydrophilic wire to cross lesion

multi-sidehole infusion catheter across thrombus with 0.5 mg/h for 48-72 hrs

monitor hct and fibrinogen iin the ICU. stop if fibrinogen <100, slow if<150.

Question 27

definition of popliteal aneurysm; treatment

Answer 27

8mm
treat when symptomatic or >2cm

endovascular stent graft/surgical bypass

Question 28

symptomatic popliteal aneurysm

Answer 28

distal ischemia due to embolism; rupture rare

Question 29

Buerger disease

Answer 29

medium and small occlusive vasculitis of lower extremities and hands ; seen in smokers (middle aged men with claudication)

Question 30

Buerger disease angiography findings

Answer 30

corkscree collaterals in vasa vasorum

segmental stenoses of medium and small arteries in the leg; CFA, SFA, popliteal artery usually spared

Question 31

popliteal entrapment syndrome

Answer 31

compression of popliteal artery y calf muscle/fibrous band (aberrant medial head gastrocnemius)

cause of exercise induced claudication

Question 32

treatment of popliteal entrapment syndrome

Answer 32

surgical release of offending muscle

Question 33

cystic adventitial disease

Answer 33

distal claudication due to mucoid cyst in adventitia by popliteal artery causing luminal compression; middle aged men

Question 34

cystic adventitial disease diagnosis

Answer 34

MRI; T2 hyperintensity of cystic component

Question 35

treatment cystic adventitial disease

Answer 35

surgical resection/bypass