Vascular Surgery

Question 1

If a patient had surgery to correct an occlusion of the right external iliac artery, what type of graft could be used

Answer 1

left femoral artery to the right femoral artery

Question 2

You are performing an ultrasound on a fem-pop PTFE graft in a lower extremity and you suspect a stenosis at the distal anastomosis. How will you calculate the velocity ration in this patient

Answer 2

divide the velocity at the distal anastomosis by the velocity in the distal graft

Question 3

What vascular complication is treated with a fasciotomy

Answer 3

anterior compartment syndrome

Question 4

A patient presents for a follow up of stent placement in the SMA due to stenosis. How will you determine if the procedure was a success

Answer 4

peak velocities should be reduced compared to pre-procedure levels, but will still appear elevated when compared to normal velocities of non-stenotic arterial flow

Question 5

What intracerebral vessel is evaluated on a TCD evaluation performed during a left carotid endarterectomy

Answer 5

ipsilateral MCA

Question 6

What vessels are a common source for a type 2 endoleak

Answer 6

inferior mesenteric artery and lumbar arteries

Question 7

Hemodialysis requires native vein diameter to measure _______, native artery ________ and native vein _________ for synthetic graft

Answer 7

> 2.5mm, >2mm, >4mm

Question 8

When evaluating a patient for placement of a hemodialysis graft, what is the minimum acceptable diameter for the native artery where the graft will be connected

Answer 8

2mm

Question 9

The type of dialysis graft where the cephalic vein is anastomosed to the radial artery is called

Answer 9

brescia-cimino graft

Question 10

Velocities in a reversed vein graft are usually ______ at the _______ anastomosis because it is the smaller end of the vein

Answer 10

higher, proximal

Question 11

Arterial flow proximal to an AV fistula will be

Answer 11

low resistance

Question 12

What is a sonographic appearance of a normal renal transplant

Answer 12

decreased parenchymal resistance, RI <0.70

Question 13

Venous flow proximal to an AV fistula becomes ______ due to the inflow of arterial flow distally

Answer 13

pulsatile

Question 14

A fem-fem graft is used to treat

Answer 14

unilateral iliac stenosis

Question 15

What technique is used to monitor flow during a fem-pop bypass procedure

Answer 15

duplex ultrasound

Question 16

When evaluating a patient for placement of a AV fistula for dialysis, what is the minimum acceptable diameter for the native vein where the graft will be connected

Answer 16

2.5mm

Question 17

When continuous TCD monitoring is used to assist with a carotid endarterectomy, when is the TCD device first activated to begin monitoring the patient

Answer 17

just before the surgery starts

Question 18

If both common iliac arteries demonstrate significant stenosis, what type of treatment will most likely be used

Answer 18

kissing stents

Question 19

What describes the 2D appearance of acute renal allograft rejection on ultrasound

Answer 19

increased echogenicity and size

Question 20

Reversed vein bypass graft:
normal- PSV ______, velocity ratio ______
less than 49%- PSV _____, VR _______
50-75%- PSV _______, VR ________
>75%- PSV ________, VR ________

Answer 20

<125cm/s, <1.4
125-180cm/s, 1.5-2.4
180-300, 2.5-4
>300cm/s, >4

Question 21

If a liver transplant patient has a piggyback anastomosis, how does this affect your evaluation

Answer 21

there will be a single anastomosis site in the IVC that must be evaluated

Question 22

Volume flow calculations are used to assess hemodialysis graft performance. How is volume flow measured

Answer 22

open the sample volume from wall to wall within a normal segment of the graft and trace the waveform

Question 23

A patient presents for a 3 month follow up on his aortic endograft. The aortic sac has increased in size by 0.8cm since the last ultrasound evaluation performed 2 months ago. No endoleak was detected on ultrasound or CT evaluation. What is the most likely cause for the diameter change

Answer 23

endotension

Question 24

No leak present but there is continued expansion of the aneurysm sac greater than 5mm, sometimes referred to as type V endoleak

Answer 24

endotension

Question 25

What will decrease with acute renal allograft rejection

Answer 25

diastolic flow in the segmental arteries

Question 26

The most common site for hepatic artery stenosis in a transplant is

Answer 26

at the native hepatic artery anastomosis site located just outside the hilum of the liver

Question 27

What is the most common complication of an in situ vein graft

Answer 27

AV fistula

Question 28

A patient presents for a stat lower extremity arterial doppler evaluation following the recent placement of a fem-tib graft in the right leg. The patient complains of significant pain and weakness in the calf muscle with areas of numbness on the anterior aspect of the lower leg. What is the most likely finding on the exam

Answer 28

anterior compartment syndrome

Question 29

What native artery is commonly used for the arterial anastomosis in a renal transplant when the external iliac artery is not available

Answer 29

internal iliac artery

Question 30

A patient presents for a renal transplant evaluation. What native vessels will be evaluated during the exam

Answer 30

external iliac artery and vein

Question 31

A patient presents with a radiocephalic hemodialysis fistula in the left arm. Doppler evaluation of what vessel will be used to rule out steal syndrome

Answer 31

distal inflow artery, within 2cm below the fistula

Question 32

A patient presents for evaluation of a hemodialysis graft due to suspected stenosis. Considering the most common location of stenosis in an arterio-venous graft, where should you look first for the suspected stenosis

Answer 32

venous anastomosis and outflow vein

Question 33

How does the imaging protocol differ when evaluating a hemodialysis graft versus a hemodialysis fistula

Answer 33

a graft has two anastomotic sites and the fistula only has one

Question 34

Where is the most common location for the surgeon to place a renal allograft

Answer 34

right iliac fossa

Question 35

The saphenous vein has already been harvested from both legs for CABG surgery. What other vein could be harvested for an additional bypass graft

Answer 35

cephalic or basilic vein

Question 36

__________ is the most common endoleak and usually does not require intervention, while _______ is most dangerous and requires surgical intervention

Answer 36

type 2, type 1

Question 37

An in situ graft exam must include the evaluation of any patent branches because

Answer 37

of the potential for AV fistula formation

Question 38

A patient presents for pre-operative arterial mapping for the TRAM flap breast reconstruction procedure. What vessels should be evaluated

Answer 38

epigastric and internal mammary arteries

Question 39

You are performing a vein mapping of the cephalic vein in the right arm. The patient is supine and the head of the bed is elevated. The arm is extended and relaxed. The diameter of the vein is 1.5 to 2mm in all segments from the shoulder to the wrist. What should you do next

Answer 39

apply a tourniquet to the upper arm and remeasure the cephalic vein segments distal to the tourniquet

Question 40

When evaluating a patient with an aortic endograft, what is the minimum increase in aortic sac size that indicates a possible endoleak

Answer 40

0.5cm

Question 41

In a graft, a volume flow rate over 1200ml/min indicates

Answer 41

possible CHF