Vascular Surgery Practice Questions

Q: The ideal synthetic material used for femoropopliteal bypass when autologous vein is unavailable is:

ePTFE. ***ePTFE (Expanded Polytetrafluoroethylene)*** - **ePTFE** is the preferred synthetic graft for femoropopliteal bypass when autologous vein is unavailable - Offers good **biocompatibility** and relative resistance to **thrombosis** - Provides superior patency rates in above-knee femoropopliteal bypasses compared to other synthetic materials (5-year patency ~50-60%) - The expanded structure allows tissue ingrowth and better integration *Dacron (Polyethylene terephthalate)* - Generally used for **larger diameter vessels** (e.g., aortoiliac grafts) - Has **inferior patency rates** in smaller diameter femoropopliteal position compared to ePTFE - More prone to kinking and associated with higher rates of intimal hyperplasia in peripheral circulation *Saphenous vein* - The autologous saphenous vein is the **gold standard** for femoropopliteal bypass with superior long-term patency (5-year patency ~70-80%) - However, this question specifically asks for synthetic material when vein is unavailable or unsuitable - Not always available or of adequate quality in all patients *PTFE (non-expanded)* - **Non-expanded PTFE** lacks the porous structure of ePTFE - Not used for vascular grafts due to absence of tissue ingrowth capability - The **expanded** form is specifically engineered for vascular applications

Q: Falsely elevated ankle brachial index is used for evaluation of?

Calcified vessels. A falsely elevated **ankle-brachial index (ABI)**, often >1.3, indicates that the **ankle arteries are non-compressible** due to calcification [1]. This calcification is common in conditions like **diabetes** and **end-stage renal disease**, where the vessels become stiff and resist compression, leading to inaccurate pressure readings [1].

Q: What is the most probable cause of this condition?

Chronic lymphedema. ***Chronic lymphedema*** - This condition is characterized by chronic accumulation of **interstitial fluid** and **proteins** due to impaired lymphatic drainage. - Causes persistent, non-pitting edema that often starts distally and progresses proximally, leading to characteristic limb enlargement. *Chronic aerial blockage* - This term is not a recognized medical condition and does not describe a mechanism for chronic edema. - The human body does not have a system of "aerial" structures that could cause chronic blockage leading to edema. *Chronic venous insufficiency* - While chronic venous insufficiency causes edema, it is typically characterized by **pitting edema**, skin discoloration (hyperpigmentation), and sometimes ulceration due to impaired venous return. - Unlike lymphedema, it does not primarily involve the lymphatic system and the edema is usually less firm and often improves with elevation. *Chronic venous blockage* - This term is less precise than chronic venous insufficiency and generally refers to conditions like **deep vein thrombosis (DVT)**, which can cause acute or subacute edema. - Chronic venous blockage (e.g., post-thrombotic syndrome) can lead to chronic edema, but it is typically associated with prominent venous signs and symptoms, and the edema can still be different from the specific characteristics of lymphedema.

Q: Primary vascular access of choice in chronic kidney disease is:

Radio-cephalic fistula. ***Radio-cephalic fistula*** - The **radio-cephalic fistula** is the preferred primary vascular access in **chronic kidney disease** patients because it has the longest patency rates and lowest complication rates. - It is often created at the **wrist** and involves an anastomosis between the **radial artery** and the **cephalic vein**. *PTFE graft* - **PTFE grafts** are typically used when autologous veins are unsuitable for fistula creation due to poor quality or prior failures. - They tend to have **lower patency rates** and **higher infection rates** compared to native fistulas. *Brachio-cephalic fistula* - A **brachio-cephalic fistula** is usually considered a secondary option when a radio-cephalic fistula is not feasible. - It is created in the **upper arm** and generally has a **shorter lifespan** and potentially more complications than a wrist fistula. *Permcath* - A **Permcath** (tunneled central venous catheter) is a temporary or short-term access option, often used for immediate dialysis needs or when no other vascular access is possible. - It carries a **high risk of infection** and central venous stenosis, making it unsuitable for long-term primary vascular access.

Q: In acute limb ischemia, which finding indicates irreversible damage?

Paralysis. ***Paralysis*** - **Paralysis** (loss of motor function) in acute limb ischemia signifies severe and prolonged ischemia leading to **nerve and muscle infarction**, indicating irreversible damage to the limb. - This symptom represents **Stage III ischemia** (Rutherford Classification), typically requiring amputation. *Pulselessness* - **Pulselessness** is a cardinal sign of acute limb ischemia, indicating a lack of blood flow, but it does not alone confirm irreversible damage. - While critical, blood flow can often be restored, and viability saved if treated promptly before nerve and muscle death occurs. *Pain* - **Pain** is one of the earliest and most common symptoms of acute limb ischemia, resulting from tissue hypoxia. - Though an indicator of significant ischemia, pain itself does not signify irreversible damage and is often present in reversible stages. *Pallor* - **Pallor** (whiteness) of the limb is due to reduced arterial blood flow and is a characteristic sign of acute limb ischemia. - Like pulselessness and pain, pallor is an early sign of ischemia and does not solely indicate irreversible tissue damage.

Q: Which of the following is the most common cause of acute mesenteric ischemia?

Embolism. ***Embolism*** - **Embolic occlusion** (typically from the heart, e.g., atrial fibrillation) accounts for a significant majority of acute mesenteric ischemia cases. - This typically leads to sudden onset of severe abdominal pain with minimal physical findings initially. *Thrombosis* - **Arterial thrombosis** of the mesenteric vessels is another cause but is less frequent than embolism in acute settings. - It often occurs in the context of pre-existing **atherosclerotic disease** and can present with a more gradual onset of symptoms. *NOMI* - **Nonocclusive Mesenteric Ischemia (NOMI)** is caused by severe vasoconstriction and hypoperfusion, not a physical blockage. - It is often seen in critically ill patients with conditions like **shock**, sepsis, or heart failure. *Venous thrombosis* - **Mesenteric venous thrombosis** is a less common cause of acute mesenteric ischemia compared to arterial causes. - It is often associated with hypercoagulable states and can present with more insidious abdominal pain and bowel wall edema.

Q: Which of the following is a true statement about varicose veins?

Caused by venous valve incompetence. ### Caused by venous valve incompetence - **Varicose veins** result from dysfunctional **venous valves**, leading to **venous reflux** and pooling of blood [1][2]. - This **valvular incompetence** increases pressure in the veins, causing them to dilate, become tortuous, and visible under the skin [2]. ### Do not cause skin changes - This statement is incorrect; chronic **venous insufficiency** due to varicose veins often leads to various **skin changes** [1]. - These can include **stasis dermatitis**, skin discoloration (hyperpigmentation), thickening, and eventually **venous ulcers** [1][2]. ### More common in men - This statement is incorrect; **varicose veins** are generally more common in **women**, particularly those who have been pregnant. - Hormonal factors, pregnancy, and occupations involving prolonged standing contribute to the higher prevalence in women. ### Lead to arterial ulcers - This statement is incorrect; **varicose veins** primarily cause **venous ulcers**, not arterial ulcers [1]. - **Arterial ulcers** are caused by inadequate arterial blood flow, while **venous ulcers** result from chronic venous hypertension and insufficiency [1].

Q: Which of the following is not true regarding the surgical treatment of varicose veins?

Sclerotherapy is curative. ***Sclerotherapy is curative*** - **Sclerotherapy** is a procedure where a solution is injected into varicose veins to cause them to scar and collapse, but it is typically not considered **curative** on its own, especially for larger or recurrent veins. - While effective for smaller veins and spider veins, its role is often **palliative** or adjunctive, and it may require multiple sessions or be combined with other treatments to achieve long-term success. - Modern guidelines prefer endovenous ablation techniques (radiofrequency or laser) for definitive treatment of great saphenous vein incompetence. *High ligation is commonly performed* - **High ligation**, involving the surgical tie-off of the sapheno-femoral junction (SFJ), is a common component of surgical treatment for **varicose veins** to prevent reflux from the deep venous system into the superficial system. - It aims to eliminate a primary source of **venous hypertension** in the superficial veins and is often combined with stripping of the great saphenous vein. *Compression stockings are recommended after surgery* - **Compression stockings** are routinely recommended after surgical treatment of varicose veins to minimize **postoperative swelling**, reduce pain, and improve venous return. - They also play a role in preventing complications such as **thrombosis** and promoting better long-term outcomes by maintaining vein compression during healing. *Phlebectomy is used* - **Ambulatory phlebectomy** is a surgical technique used to remove varicose veins through small incisions, particularly for superficial, tortuous veins that are not easily treated by other methods. - It is often performed in conjunction with **high ligation** and stripping or as a standalone procedure for localized varicose segments.

Question 1

The ideal synthetic material used for femoropopliteal bypass when autologous vein is unavailable is:

Accepted Answer

ePTFE

Answer

Dacron

Answer

Xenograft

Answer

Saphenous vein

Answer

PTFE (non-expanded)

Answer

Cryopreserved vein graft

Answer

Polyethylene terephthalate (PET)

Answer

Allograft

Question 2

A patient is on follow-up for recurrent abdominal pain. USG reveals an aortic aneurysm of 40 mm. What should be the next immediate step?

Accepted Answer

Establish surveillance protocol with repeat imaging in 6-12 months.

Answer

Initiate medical management with beta-blockers.

Answer

Perform surgical intervention immediately.

Answer

Start antihypertensive therapy immediately.

Question 3

Falsely elevated ankle brachial index is used for evaluation of?

Accepted Answer

Calcified vessels

Answer

Deep vein thrombosis

Answer

Acute limb ischemia

Answer

Chronic venous insufficiency

Question 4

What is the most probable cause of this condition?

Accepted Answer

Chronic lymphedema

Answer

Chronic aerial blockage

Answer

Chronic venous insufficiency

Answer

Chronic venous blockage

Question 5

Primary vascular access of choice in chronic kidney disease is:

Accepted Answer

Radio-cephalic fistula

Answer

PTFE graft

Answer

Brachio-cephalic fistula

Answer

Permcath

Question 6

In acute limb ischemia, which finding indicates irreversible damage?

Accepted Answer

Paralysis

Answer

Pulselessness

Answer

Pain

Answer

Pallor

Question 7

Which of the following is the most common cause of acute mesenteric ischemia?

Accepted Answer

Embolism

Answer

Thrombosis

Answer

NOMI

Answer

Venous thrombosis

Question 8

Which of the following is a true statement about varicose veins?

Accepted Answer

Caused by venous valve incompetence

Answer

Do not cause skin changes

Answer

More common in men

Answer

Lead to arterial ulcers

Question 9

Which of the following is not true regarding the surgical treatment of varicose veins?

Accepted Answer

Sclerotherapy is curative

Answer

High ligation is commonly performed

Answer

Compression stockings are recommended after surgery

Answer

Phlebectomy is used

Question 10

A 70-year-old woman presents with chronic venous insufficiency and varicose veins. Which is the most appropriate first-line interventional approach for treating her condition?

Accepted Answer

Endovenous laser therapy

Answer

Saphenous vein stripping

Answer

Radiofrequency ablation

Answer

Surgical intervention is not required.

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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