Vascular Surgery

Topics in this chapter

• Abdominal Aortic Aneurysm Repair
• Acute Limb Ischemia Management
• Peripheral Arterial Disease
• Venous Thromboembolism and Insufficiency
• Dialysis Vascular Access
• Vascular Imaging and Complications

Practice questions

1. Question 1Q-776DAE

   A 68-year-old male presents with severe pain in his left lower limb while walking a distance of about 50 meters, which forces him to stop and rest. The pain resolves within minutes of resting. On examination, the left lower limb is cool with absent pedal pulses. Which of the following is the most appropriate initial investigation to establish the anatomical diagnosis and plan revascularization?

   1. A.Duplex ultrasonography
   2. B.Catheter digital subtraction angiography (DSA)
   3. C.Contrast-enhanced computed tomography angiography (CTA)
   4. D.Magnetic resonance angiography (MRA)
   See the answer and solution
2. Question 2Q-5855F4

   A 72-year-old heavy smoker presents with an asymptomatic pulsatile abdominal mass detected during a routine physical examination. An abdominal ultrasound confirms an infrarenal abdominal aortic aneurysm (AAA) measuring 5.8 cm in maximum diameter. What is the standard management for this patient?

   1. A.Strict blood pressure control and ultrasound surveillance every 6 months
   2. B.Immediate open surgical repair or endovascular aneurysm repair (EVAR)
   3. C.Prescription of antiplatelet agents and statins with lifestyle modification only
   4. D.Therapeutic anticoagulation with low-molecular-weight heparin
   See the answer and solution
3. Question 3Q-09958E

   A 55-year-old male undergoes open surgical repair of a large infrarenal abdominal aortic aneurysm. Six hours postoperatively, he develops severe, unremitting abdominal pain out of proportion to physical findings, accompanied by bloody diarrhea and metabolic acidosis. Which of the following vessels is most likely compromised during the procedure?

   1. A.Celiac trunk
   2. B.Superior mesenteric artery
   3. C.Inferior mesenteric artery
   4. D.Internal iliac artery
   See the answer and solution
4. Question 4Q-969632

   A 45-year-old male presents with acute onset of severe right lower limb pain, pallor, pulselessness, poikilothermia, paresthesia, and paralysis of 3 hours duration. He has a known history of chronic atrial fibrillation. What is the most definitive initial step in management, assuming the limb is viable?

   1. A.Immediate therapeutic anticoagulation with intravenous heparin and surgical revascularization (embolectomy)
   2. B.Systemic thrombolytic therapy with streptokinase as the sole treatment
   3. C.Conservative management with bed rest and vasodilators
   4. D.Primary above-knee amputation
   See the answer and solution
5. Question 5Q-19677D

   A 60-year-old male with chronic renal failure on hemodialysis presents for evaluation of vascular access. He is planned for the creation of a radiocephalic arteriovenous fistula (AVF) in his non-dominant left arm. Which of the following is considered the most critical preoperative assessment?

   1. A.Allen test to evaluate the palmar arch collateral circulation
   2. B.Duplex ultrasound mapping of the radial artery diameter and cephalic vein caliber
   3. C.Magnetic resonance angiography of the upper extremity arterial tree
   4. D.Coagulation profile to rule out hypercoagulable states
   See the answer and solution