Vascular Surgery Flashcards
T/F: patients with PAD do not die from vascular disease, but other pre-existing conditions.
True.
The MOST common cause of vascular disease is:
Coronary artery disease
T/F: intermittent claudication is a life threatening problem.
False.
T/F: Only 5% of patients with intermittent claudication will go on to develop critical ischemia.
True.
A patient has been diagnosed with PAD. Treatment of the conditions should involve:
Smoking cessation and control of diabetes or HTN.
Exercise therapy as tolerated.
Appropriate surveillance of the disease.
Medications used to treat symptoms of PAD include:
Cilostazol or Pentoxyflyine.
Intervention (either endovascular or open vascular surgery) are treatments for PAD that are used for:
patients with limb threatening ischemia and those with severe, compromising claudication.
The recommended test for work-up of a patient with vascular symptoms is:
(1) ABI
(2) Stress ABI
(3) Duplex US
(4) CTA/MRA
(5) Angiogram
(1) ABI
The de facto “cutoff” ABI for claudication and rest pain is:
0.4
The de facto “cutoff” for rest pain and tissue loss is:
0.2
A patient presents with vascular disease and you do an ABI. The patient has an ABI of 1.7. This may be due to:
diabetes
Renal failure
Occlusive, calcified arteries.
A normal toe-brachial index value is:
> 0.7
A toe-brachial index consistent with rest pain is:
< 0.2
A patient presents with vascular disease. The patient has an ABI of 1.8 and a history of diabetes and atherosclerosis. You decide to do a toe-brachial index to get more accurate results. The toe-brachial index value that is consistent with rest pain is:
< 0.2.
The major disadvantage of PVR is that it is:
detection of collateral vessels is low.
Which of the following regarding duplex US is TRUE?
(1) It evaluates anatomy
(2) It cannot evaluate the percentage of stenosis.
(3) A duplex cannot determine whether the severity of occlusive warrants surgical intervention.
(1) Duplex US can evaluate anatomy.
T/F: Duplex is useful for patients with bypass surgery since there is narrowing of the entrance and exit.
True.
The gold standard for diagnosis of PAD is:
(1) conventional angiogram
(2) MRA
(3) CTA
(1) The gold standard for diagnosis of PAD is conventional angiogram.
The imaging study that can overestimate stenosis:
(1) conventional angiogram
(2) MRA
(3) CTA
(2) MRA can overestimate stneosis.
CTA is a diagnostic study that is used for:
rule out neoplasm, AVM or aneurysms.
Which of the following regarding vascular workup is TRUE?
(1) Invasive vascular lab is the first line evaluation in non-acute patients.
(2) They are a sufficient study to plan intervention.
(3) Segmental limb pressures often are combined with doppler waveform analysis.
(3) Segmental limb pressures often are combined with doppler.
Surgical management of vascular disease is indicated for:
(1) Unacceptable lifestyle limitations (failure of medical management)
(2) No pain on rest.
(3) Healing wounds
(4) absence of gangrene.
(1) Unacceptable lifestyle limitations (failure of medical management).
The BEST treatment option of chronic lower extremity PAD is:
(1) Risk factor modification
(2) Exercise
(3) Pharmacotherapy
(4) Revascularization
(5) amputation
(1) Risk factor modification
A patient with a diagnosis of PAD MOST likely:
(1) Only has localized atherosclerosis.
(2) Chronic PAD usually does not need risk factor intervention.
(3) Claudication is a lifestyle-limiting problem.
(3) Claudication is a lifestyle-limiting problem.
A patient presents with severe decrements in limb perfusion. However, they do not present with clinical symptoms of CLI. Surgical treatment for this patient is:
contraindicated.
Which of the following patients is indicated for primary amputation?
(1) No necrosis of the weight-bearing portions of the foot.
(2) Incorrectible flexion contracture.
(3) Pain on exertion (but no pain on rest) that is non-refractory.
(4) Long life expectancy.
(2) Incorrectible flexion contracture.
A patient presents with critical limb ischemia. The patient has combined inflow and outflow disease. The type of lesions that should be addressed FIRST is:
inflow lesions.
An aorto-bifemoral bypass is recommended for patients with:
symptomatic, hemodynamically significant aorto-bi-iliac disease requiring intervention.
Bypasses to the above-knee popliteal artery should be constructed with:
autogenous saphenous vein.
Bypasses to the below-knee popliteal artery should be constructed with:
autogenous veins when possible.
Prosthetic material can be used for vascular surgery when:
(1) As first line treatment.
(2) When no autogenous vein from ipsilateral or contralateral leg or arm is possible.
(2) When no autogenous vein from ipsilateral or contralateral leg or arm is available.
The hallmark clinical symptoms and physical examination signs of acute limb ischemia:
pain, paralysis paresthesia pulselessness pallor
A patient with acute arterial embolism is MOST likely to present with:
(1) Gradual onset and worsening of symptoms.
(2) There is an unknown embolic source.
(3) There is antecedent claudication or other manifestations of obstructive arterial disease.
(4) The presence of normal arterial pulses and a doppler systolic blood pressures in the contralateral limb.
A patient with acute arterial embolism is MOST likely to present with (4) the presence of normal arterial pulses and a doppler systolic blood pressures in the contralateral limb.
Emergent surgical evaluation that includes identifying the anatomic level of occlusion is reserved for:
(1) Patients with ALI and a salvageable extemity.
(2) Patients with ALI and a non-viable extremity.
Emergent surgical evaluation that includes identifying the anatomic level of occlusion is reserved for (!) Patients with ALI and a salvageable extremity.
The primary indications for infrainguinal bypass are:
severe claudication and CLI.
A patient presents with severe claudication and critical limb ischemia. Before considering surgery, a pre-operative assessment should note that:
70% of mortality in infra-inguinal bypass surgery is due to CAD.
The most often employed imaging study for infra-inguinal bypass is:
angiography.
The MOST commonly used inflow vessel for infra-inguinal bypass is:
CFA, but the SFA, profunda, popliteal or proximal tibial vessels can also be used.
A patient is undergoing an infra-inguinal bypass surgery. You decide to use the CFA as a bypass vein. The vein should be:
> 3 mm.
The standard infra-inguinal bypass procedure is:
A femoral to saphenous bypass from the common femoral to above or below the popliteal.
Detach the saphenous veins and the common femoral vein and being it over to the profunda to the common femoral artery.
A patient with a vascular procedure has graft failure 15 days after the procedure. The graft failure is MOST likely due to:
(1) Technical error
(2) intimal hyperplasia
(3) progression of atherosclerosis.
(1) Technical error.
A patient with a vascular procedure has graft failure 1 year after the procedure. The graft failure is MOST likely due to:
(1) Technical error
(2) intimal hyperplasia
(3) progression of atherosclerosis.
(2) intimal hyperplasia.
A patient with a vascular procedure has a graft failure 3 years after the procedure. The graft failure is MOST likely due to:
(1) Technical error
(2) intimal hyperplasia
(3) progression of atherosclerosis.
(3) progression of atherosclerosis.
Factors that affect patency
Poor runoff and renal failure.
Which of the following regarding aortobiliac/aortobifemoral bypass is TRUE?
(1) It has an excellent long-term patency rate.
(2) It does not require general anesthesia.
(3) It has a 10% mortality rate.
(1) It has an excellent long-term patency rate.
The bypass that has the BEST patency rate after 5 years is:
(1) femorofmoeral bypass
(2) axillofemoral bypass
(3) Aortoiliac, aortofemoral or aortobifemoral bypass.
(3) aortoiliac, aortofemoral or aortobifemoral bypass.
Which of the following regarding profundoplasty is TRUE?
(1) The profunda is the main arterial blood supply to the thigh.
(2) Non-contrast angiogram is the “gold standard” for patient selection and correlates with the operative results.
(1) The profunda is the main arterial blood supply to the thigh.
When operating on the profunda:
(1) The profunda does not respond well to endovascular stent treatment.
(2) The profunda has minimal branches.
(1) The profunda does not respond well to endovascular stent treatment.
T/F: unless contraindicated, all patients undergoing revascularization for CLI should be placed on anti-platelet therapy indefinitely.
True.
Patients who have undergone placement of aortobifemoral bypass grafts should be followed up with:
(1) Periodic evaluations that record any return or progression of ischemic symptoms.
(2) the presence of femoral pulses
(3) ABIs
Patients with a prior history of CLI or who have undergone successful treatment for CLI should be evaluated at least:
BIANNUALLY.
A patient with claudication undergoes vascular testing. There is no significant pressure gradient across a stenosis. The patient takes vasodilators. In this patient, endovascular intervention is:
contraindicated in these patients.
Primary stent placement is recommended in the:
(1) Femoral artery
(2) popliteal artery
(3) tibial artery
(4) none of these.
(4) None of these.
T/F: endovascular intervention is not indicated as prophylactic therapy in an asymptomatic patient with lower extremity PAD.
True.
T/F: patients with an ALI and a non-viable extremity should not undergo an evaluation to define vascular anatomy or efforts to attempt revascularization.
True.
Which of the following regarding endovascular treatment is TRUE?
(1) Smaller caliber segments have better expected long-term patency.
(2) The longer the lesion, the lower the long term patency.
(3) Stenotic lesions do not have better patency rates than occluded lesions.
(4) Success rates for multi-level lesions are twice as high as focal lesions.
(2) The longer the lesion, the LOWER the long term patency.
Stents and stent grafts are indicated for:
Prevent recoil of the arterial wall.
Repair complications resulting from angioplasty.
When placing a stent, it is important to consider that:
It has a limited role at regions of high mobility and may therefore fracture.
When compared to iliac disease, PTA of the femoral-popliteal segment has patency rates that are:
PTA of the femoral popliteal segment has lower patency rates than iliac disease.
The best predictors for outcome of vascular surgery are:
(1) Clinical stage
(2) Lesion morphology/length
(3) run-off status.
All of these.
T/F: the higher up the endovascular procedure, the better the patency.
True.
Which of the following regarding aortoiliac angioplasty is TRUE?
(1) IT has a high procedural success rate (90%).
(2) IT has excellent long term patency (> 70% at 5 years).
All of these.
Which of the following is considered a factor associated with poor outcomes in endovascular surgery?
(1) short segment oclusion.
(2) Singular focal stenoses
(3) eccentric calcification
(4) good runoff
(3) Eccentric calcification is associated with poor outcome in endovascular srugery.
An artherectomy involves debulking a plaque. THis involves:
cutting, pulverizing and shaving of a plaque, followed by removal and excision.
Blue toe syndrome is a symptom of:
arterial-arterial embolization.
IF a patient has an infection AND requires revascularization, the condition that should be treated FIRST is:
Treat the infection first.
Peripheral diagnostic catheterization is indicated for:
(1) Atherosclerosis of arteries of extremities with gangrene.
(2) Atherosclerosis of arteries of extremities with rest pain.
(3) Pain in the leg.
All of these.
