VSITE Review – Questions With Verified Solutions
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Hard Signs of Vascular Injury (5)
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What is the risk of arterial injury if a hard sign is present?
z z z z z z z z z z z z zzzzzzz Right Ans - z z
1. pulsatile bleeding
z z z z
2. lack of pulses
z z z z
3. cold limb
z z z
4. expanding hematoma
z z z
5. audible bruit or palpable thrill at site of injury
z z z z z z z z z z
Indicate greater than 90% risk of arterial injury with 50% of those requiring int
z z z z z z z z z z z z z
ervention
Soft Signs of Vascular Injury (5)
z z z z z z
What is the risk of arterial injury if a soft sign is present? Right Ans -
z z z z z z z z z z z z zzzzzzz z z
1. H/o severe hemorrhage at the scene
z z z z z z z z
2. Injury near a major blood vessel
z z z z z z z
3. Nonexpanding hematoma over an artery
z z z z z z
4. Neurologic deficit originating from a nerve adjacent to a named artery
z z z z z z z z z z z z
5. Diminished or unequal pulses
z z z z z
indicates 30% risk of arterial injury - z z z z z z
zperform further investigation (ABI. If > 0.9, observe. If less, CTA)
z z z z z z z z z z
Second most commonly injured artery from blunt mechnamisms after the aorta
z z z z z z z z z z z
Most common repair
z z zzzzzzz Right Ans - Inominate arteryz z z z z
open aorto-inominate bypass
z z
Zones of the neck Right Ans - - Zone I = clavicles to cricoid cartilage
z z z zzzzzzz z z z z z z z z z z z
- Zone II = cricoid cartilage to angle of the mandible
z z z z z z z z z z z
- Zone III = angle of the mandible to base of the skull
z z z z z z z z z z z z
Zones of the retroperitoneum and their associated structures
z z z z z z z z
,Which zones should be explored in the case of hematoma? Right Ans - -
z z z z z z z z z zzzzzzz z z z
Zone I is divided into supramesocolic and inframesocolic. It extends from the ao
z z z z z z z z z z z z z
rtic hiatus to the sacral promontory. All injuries should be explored .
z z z z z z z z z z z z
-
Zone II extends from the renal hilum laterally to the pericolic gutters. All penetr
z z z z z z z z z z z z z z
ating injuries should be explored; no exploration in blunt injury
z z z z z z z z z
-
Zone III = sacral promontory inferiorly (pelvis). All penetrating injuries. Only e
z z z z z z z z z z z z
xplore expanding hematomas or those with loss of femoral pulse in blunt injurie
z z z z z z z z z z z z
s z
-
Zone IV = retrohepatic space; NO INJURIES should be explored in the absence of
z z z z z z z z z z z z z z
active extravasation
z z
Four compartments of the leg and the components of each compartment
z z z z z z z z z z zzzzzzz Righ
t Ans - 1. Anterior
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- Anterior tibial artery; deep peroneal nerve
z z z z z z
2. Lateral
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- Peroneal artery, superficial and deep peroneal nerve
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3. Superficial posterior
z z z
- no significant neuromuscular components
z z z z z
4. Deep posterior
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- posterior tibial and peroneal arteries, tibial nerve
z z z z z z z
Indications for Revascularization of the L SCA following coverage for TEVAR
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Right Ans - 1. Previous CABG with LIMA
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2. Incomplete vertebrobasilar collateralization
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3. Functioning AV access in the LUE
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4. Prior aortic intervention with coverage of lumbars and middle sacral arteries
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5. Evidence of aneurysmal changes in the aorta that may require future repair
z z z z z z z z z z z z z
6. Long segment graft >/= 20cm in length resulting in coverage of intercostals
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7. Hypogastric artery occlusion
z z z
Crawford Classification of TAAA Right Ans - Type I: subclavian to renals
z z z zzzzzzz z z z z z z z z
Type II: subclavian to bifurcation
z z z z z
Type III: mid thoracic (sixth intercostal) to below renals
z z z z z z z z z
Type IV: T12 vertebral body (around diaphragm) to bifurcation
z z z z z z z z z
Type V: mid thoracic (sixth intercostal space) to just above renals (visceral seg
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ment only) z z
,Type VI: pararenal** (not always considered a class)
z z z z z z z
Duplex criteria for renal artery stenosis Right Ans -
z z z z z zzzzzzz z z
PSV > 180, RAR < 3.5 denotes stenosis < 60%
z z z z z z z z z z
PSV > 180, RAR > 3.5 >/= 60% stenosis
z z z z z z z z z
EDV > 150 denotes stenosis > 80%
z z z z z z
Reflux criteria of superficial, deep, and perforating veins Right Ans -
z z z z z z z zzzzzzz z z
Superficial: reflux > 0.5s
z z z z
Deep (femoral and pop): > 1sz z z z z
Pathologic perforator: reflux > 0.5s, diameter > 3.5mm, located underneath heal
z z z z z z z z z z
ed or active venous ulcer
z z z z
CEAP classification Right Ans - C = clinical manifestation
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0 = no s/s of venous disease
z z z z z z z
1 = telangiectasia, reticular veins
z z z z z
2= varicose veins
z z z
3 = edema
z z z
4 = skin changes (4a = eczema, hyperpigmentation, 4b = lipdermatosclerosis, at
z z z z z z z z z z z
rophie blanche) z
5 = healed ulcer
z z z z
6 = active ulcer
z z z z
E = etiology
z z z
p = primary
z z z
s = secondary
z z z
n = no identification
z z z z
A = anatomy
z z z
s = superficial reflux
z z z z
p = perforating vein reflux
z z z z z
d = deep vein reflux
z z z z z
n = no location identified
z z z z z
P = pathophysiology
z z z
r = reflux
z z z
o = obstruction
z z z
r, o = reflux and obstruction
z z z z z z
n = none identifiable
z z z z
, Level 1 vs 2 = method of diagnosis
z z z z z z z z
1 = handheld doppler
z z z z
2 = NIVS, plethysmography
z z z z
3 = invasive
z z
ESCHAR study Right Ans - z zzzzzzz z z
zEffects of Surgery and Compression on Healing and Recurrence demonstrated s
z z z z z z z z z z
ignificantly lower ulcer recurrence rates in patients treated with GSV stripping
z z z z z z z z z z z
and compression stockings when compared with compression therapy alone
z z z z z z z z z
Addition of surgery did NOT increase the healing rate
z z z z z z z z
EVRA trail Right Ans - z zzzzzzz z z
Early Venous reflux Ablation Ulcer Trial found that both the ulcer healing rate a
z z z z z z z z z z z z z z
nd recurrence rate were improved with saphenous ablation
z z z z z z z
RFA vs EVLA vs high ligation and vein stripping Right Ans - -
z z z z z z z z zzzzzzz z z z
Earlier ambulation and decreased bruising in RFA vs high ligation and vein stri
z z z z z z z z z z z z z
pping z
-
Some evidence of less bruising with RFA than EVLA, though no definitive data s
z z z z z z z z z z z z z z
uggest earlier return to work or ambulation
z z z z z z z
-
No definite earlier ambulation rate, earlier return to work shown between EVL
z z z z z z z z z z z z
A and high ligation/vein stripping
z z z z
Treatment of lymphatic filiariasis in the US z z z z z z zzzzzzz Right Ans - diethylcarbamazine
z z z
Gold standard for assessment venous malformations
z z z z z Right Ans -
zzzzzzz z z
MRI with gadolinium
z z z
Contraindications to sclerotherapy Right Ans - - pregnancy z z zzzzzzz z z z z z
- late complications of diabetes
z z z z z
- hyperthyroidism
z z
- relative contraindications: severe PAD, hyper coagulable state
z z z z z z z
The saphenofemoral junction is comprised of a confluence of which veins?
z z z z z z z z z z Ri
zzzzzzz
ght Ans - - GSV z z z z z
z z z z z z z
Hard Signs of Vascular Injury (5)
z z z z z
What is the risk of arterial injury if a hard sign is present?
z z z z z z z z z z z z zzzzzzz Right Ans - z z
1. pulsatile bleeding
z z z z
2. lack of pulses
z z z z
3. cold limb
z z z
4. expanding hematoma
z z z
5. audible bruit or palpable thrill at site of injury
z z z z z z z z z z
Indicate greater than 90% risk of arterial injury with 50% of those requiring int
z z z z z z z z z z z z z
ervention
Soft Signs of Vascular Injury (5)
z z z z z z
What is the risk of arterial injury if a soft sign is present? Right Ans -
z z z z z z z z z z z z zzzzzzz z z
1. H/o severe hemorrhage at the scene
z z z z z z z z
2. Injury near a major blood vessel
z z z z z z z
3. Nonexpanding hematoma over an artery
z z z z z z
4. Neurologic deficit originating from a nerve adjacent to a named artery
z z z z z z z z z z z z
5. Diminished or unequal pulses
z z z z z
indicates 30% risk of arterial injury - z z z z z z
zperform further investigation (ABI. If > 0.9, observe. If less, CTA)
z z z z z z z z z z
Second most commonly injured artery from blunt mechnamisms after the aorta
z z z z z z z z z z z
Most common repair
z z zzzzzzz Right Ans - Inominate arteryz z z z z
open aorto-inominate bypass
z z
Zones of the neck Right Ans - - Zone I = clavicles to cricoid cartilage
z z z zzzzzzz z z z z z z z z z z z
- Zone II = cricoid cartilage to angle of the mandible
z z z z z z z z z z z
- Zone III = angle of the mandible to base of the skull
z z z z z z z z z z z z
Zones of the retroperitoneum and their associated structures
z z z z z z z z
,Which zones should be explored in the case of hematoma? Right Ans - -
z z z z z z z z z zzzzzzz z z z
Zone I is divided into supramesocolic and inframesocolic. It extends from the ao
z z z z z z z z z z z z z
rtic hiatus to the sacral promontory. All injuries should be explored .
z z z z z z z z z z z z
-
Zone II extends from the renal hilum laterally to the pericolic gutters. All penetr
z z z z z z z z z z z z z z
ating injuries should be explored; no exploration in blunt injury
z z z z z z z z z
-
Zone III = sacral promontory inferiorly (pelvis). All penetrating injuries. Only e
z z z z z z z z z z z z
xplore expanding hematomas or those with loss of femoral pulse in blunt injurie
z z z z z z z z z z z z
s z
-
Zone IV = retrohepatic space; NO INJURIES should be explored in the absence of
z z z z z z z z z z z z z z
active extravasation
z z
Four compartments of the leg and the components of each compartment
z z z z z z z z z z zzzzzzz Righ
t Ans - 1. Anterior
z z z z z
- Anterior tibial artery; deep peroneal nerve
z z z z z z
2. Lateral
z z
- Peroneal artery, superficial and deep peroneal nerve
z z z z z z z z
3. Superficial posterior
z z z
- no significant neuromuscular components
z z z z z
4. Deep posterior
z z z
- posterior tibial and peroneal arteries, tibial nerve
z z z z z z z
Indications for Revascularization of the L SCA following coverage for TEVAR
z z z z z z z z z z zzzzzzz
Right Ans - 1. Previous CABG with LIMA
z z z z z z z z
2. Incomplete vertebrobasilar collateralization
z z z z
3. Functioning AV access in the LUE
z z z z z z z
4. Prior aortic intervention with coverage of lumbars and middle sacral arteries
z z z z z z z z z z z z
5. Evidence of aneurysmal changes in the aorta that may require future repair
z z z z z z z z z z z z z
6. Long segment graft >/= 20cm in length resulting in coverage of intercostals
z z z z z z z z z z z z z
7. Hypogastric artery occlusion
z z z
Crawford Classification of TAAA Right Ans - Type I: subclavian to renals
z z z zzzzzzz z z z z z z z z
Type II: subclavian to bifurcation
z z z z z
Type III: mid thoracic (sixth intercostal) to below renals
z z z z z z z z z
Type IV: T12 vertebral body (around diaphragm) to bifurcation
z z z z z z z z z
Type V: mid thoracic (sixth intercostal space) to just above renals (visceral seg
z z z z z z z z z z z z
ment only) z z
,Type VI: pararenal** (not always considered a class)
z z z z z z z
Duplex criteria for renal artery stenosis Right Ans -
z z z z z zzzzzzz z z
PSV > 180, RAR < 3.5 denotes stenosis < 60%
z z z z z z z z z z
PSV > 180, RAR > 3.5 >/= 60% stenosis
z z z z z z z z z
EDV > 150 denotes stenosis > 80%
z z z z z z
Reflux criteria of superficial, deep, and perforating veins Right Ans -
z z z z z z z zzzzzzz z z
Superficial: reflux > 0.5s
z z z z
Deep (femoral and pop): > 1sz z z z z
Pathologic perforator: reflux > 0.5s, diameter > 3.5mm, located underneath heal
z z z z z z z z z z
ed or active venous ulcer
z z z z
CEAP classification Right Ans - C = clinical manifestation
z zzzzzzz z z z z z z z
0 = no s/s of venous disease
z z z z z z z
1 = telangiectasia, reticular veins
z z z z z
2= varicose veins
z z z
3 = edema
z z z
4 = skin changes (4a = eczema, hyperpigmentation, 4b = lipdermatosclerosis, at
z z z z z z z z z z z
rophie blanche) z
5 = healed ulcer
z z z z
6 = active ulcer
z z z z
E = etiology
z z z
p = primary
z z z
s = secondary
z z z
n = no identification
z z z z
A = anatomy
z z z
s = superficial reflux
z z z z
p = perforating vein reflux
z z z z z
d = deep vein reflux
z z z z z
n = no location identified
z z z z z
P = pathophysiology
z z z
r = reflux
z z z
o = obstruction
z z z
r, o = reflux and obstruction
z z z z z z
n = none identifiable
z z z z
, Level 1 vs 2 = method of diagnosis
z z z z z z z z
1 = handheld doppler
z z z z
2 = NIVS, plethysmography
z z z z
3 = invasive
z z
ESCHAR study Right Ans - z zzzzzzz z z
zEffects of Surgery and Compression on Healing and Recurrence demonstrated s
z z z z z z z z z z
ignificantly lower ulcer recurrence rates in patients treated with GSV stripping
z z z z z z z z z z z
and compression stockings when compared with compression therapy alone
z z z z z z z z z
Addition of surgery did NOT increase the healing rate
z z z z z z z z
EVRA trail Right Ans - z zzzzzzz z z
Early Venous reflux Ablation Ulcer Trial found that both the ulcer healing rate a
z z z z z z z z z z z z z z
nd recurrence rate were improved with saphenous ablation
z z z z z z z
RFA vs EVLA vs high ligation and vein stripping Right Ans - -
z z z z z z z z zzzzzzz z z z
Earlier ambulation and decreased bruising in RFA vs high ligation and vein stri
z z z z z z z z z z z z z
pping z
-
Some evidence of less bruising with RFA than EVLA, though no definitive data s
z z z z z z z z z z z z z z
uggest earlier return to work or ambulation
z z z z z z z
-
No definite earlier ambulation rate, earlier return to work shown between EVL
z z z z z z z z z z z z
A and high ligation/vein stripping
z z z z
Treatment of lymphatic filiariasis in the US z z z z z z zzzzzzz Right Ans - diethylcarbamazine
z z z
Gold standard for assessment venous malformations
z z z z z Right Ans -
zzzzzzz z z
MRI with gadolinium
z z z
Contraindications to sclerotherapy Right Ans - - pregnancy z z zzzzzzz z z z z z
- late complications of diabetes
z z z z z
- hyperthyroidism
z z
- relative contraindications: severe PAD, hyper coagulable state
z z z z z z z
The saphenofemoral junction is comprised of a confluence of which veins?
z z z z z z z z z z Ri
zzzzzzz
ght Ans - - GSV z z z z z
