Vascular Surgery Practice Questions

Q: All statements are true about Paget-Schroetter syndrome except?

Associated with jugular-subclavian venous thrombosis. **Explanation:** **Paget-Schroetter Syndrome (PSS)**, also known as **"Effort Thrombosis,"** is a specific type of primary upper extremity deep vein thrombosis (UEDVT). **Why Option B is the Correct Answer (The False Statement):** While PSS involves the **subclavian and axillary veins**, it is specifically characterized by thrombosis at the level of the **costoclavicular space** (between the first rib and the clavicle). It is **not** typically associated with jugular vein involvement. The term "jugular-subclavian venous thrombosis" is more characteristic of secondary causes, such as central venous catheterization or malignancy (Trousseau’s syndrome), rather than the mechanical "effort-induced" etiology of PSS. **Analysis of Other Options:** * **Option A:** PSS is indeed the vascular manifestation of **Venous Thoracic Outlet Syndrome (vTOS)**, where the vein is compressed by anatomical structures (first rib, clavicle, or scalene muscles). * **Option C:** It typically occurs in young, healthy athletes (e.g., swimmers, pitchers, weightlifters) following **vigorous or repetitive overhead activities** that lead to microtrauma of the vessel wall. * **Option D:** Repetitive compression results in **intimal damage** to the subclavian vein, triggering the coagulation cascade and subsequent thrombus formation. **NEET-PG High-Yield Pearls:** * **Clinical Presentation:** Sudden onset of "blue-arm" (cyanosis), swelling, and prominent collateral veins over the shoulder (Urschel’s sign). * **Diagnosis:** Duplex Ultrasound is the initial investigation; **Catheter-directed Venography** is the gold standard. * **Treatment Triad:** 1. Catheter-directed thrombolysis, 2. Anticoagulation, and 3. **Surgical decompression** (First rib resection) to prevent recurrence.

Q: Which instrument is used for aerial embolectomy?

Aerial embolectomy. ### Explanation The correct answer is **Aerial Embolectomy**. The question refers to the **Fogarty Embolectomy Catheter**, which is the gold-standard instrument used for removing fresh arterial thrombi or emboli (aerial/arterial embolectomy). **Why it is correct:** The Fogarty catheter is a thin, flexible hollow tube with an inflatable balloon at its tip. During an embolectomy, the catheter is passed through an arteriotomy, distal to the clot. Once past the obstruction, the balloon is inflated and the catheter is withdrawn, effectively "dragging" the embolus out of the vessel. This procedure is crucial in managing acute limb ischemia. **Why the other options are incorrect:** * **Bladder catheterization:** This is typically performed using a **Foley catheter** (self-retaining) or a **Nélaton catheter** (straight). While they also use balloons, their design and material are not suited for the high-pressure environment of the arterial system. * **Control of upper GI bleeding:** This usually involves the **Sengstaken-Blakemore tube** or **Minnesota tube**, which are multi-lumen tubes with large gastric and esophageal balloons used specifically for esophageal variceal tamponade. * **Insertion of a central line:** This is performed using a **Triple Lumen Catheter** or a **PICC line**, typically via the Seldinger technique. These do not utilize the balloon-extraction mechanism characteristic of an embolectomy. **High-Yield Clinical Pearls for NEET-PG:** * **Inventor:** Thomas J. Fogarty (1961). * **Fluid used for inflation:** Always use **Normal Saline** (never air) to inflate the balloon to ensure controlled pressure and prevent air embolism in case of balloon rupture. * **Size:** Measured in **French (F)**; common sizes range from 2F to 7F. * **Complications:** Intimal injury, arterial dissection, or vessel rupture if the balloon is over-inflated.

Q: Which of the following statements is NOT true regarding Buerger's disease?

Cigarette cessation is the definitive treatment.. **Explanation:** Buerger’s disease, also known as **Thromboangiitis Obliterans (TAO)**, is a non-atherosclerotic, segmental, inflammatory disease that most commonly affects small and medium-sized arteries and veins of the extremities. **Why Option C is the correct answer (The "Not True" statement):** While smoking cessation is the **most critical step** and the only way to halt the progression of the disease, it is technically not a "definitive treatment" in the surgical sense. Once critical limb ischemia or gangrene has set in, smoking cessation alone cannot reverse the established vascular damage or tissue loss. There is no definitive "cure" or surgical gold standard; management is supportive and focused on prevention. **Analysis of Incorrect Options:** * **Option A:** True. Buerger’s disease characteristically involves the distal arteries of the **lower extremities** (e.g., tibial and dorsalis pedis) and the upper extremities. * **Option B:** True. **Migratory superficial thrombophlebitis** is a hallmark clinical feature, occurring in approximately 40-50% of patients. * **Option C:** True. The disease typically affects **young male smokers**, usually presenting before the age of 40-45, with many cases starting **below 30 years of age**. **NEET-PG High-Yield Pearls:** * **Angiographic Finding:** Classic **"Corkscrew collaterals"** (Martorell’s sign) are seen due to the occlusion of distal vessels. * **Pathology:** Unlike atherosclerosis, the **Internal Elastic Lamina is preserved**. A highly characteristic feature is the "microabscess" within the thrombus. * **Allen’s Test:** Often positive, indicating involvement of the radial or ulnar arteries. * **Treatment:** Absolute cessation of tobacco (including smokeless tobacco and nicotine replacements) is mandatory. Sympathectomy may be used for pain relief, but revascularization is rarely possible due to the distal nature of the disease.

Q: Obstruction at the bifurcation of the aorta leads to which of the following?

Gangrene of the foot. ### Explanation **Concept:** Obstruction at the bifurcation of the aorta is most commonly associated with **Leriche Syndrome** (Aortoiliac Occlusive Disease). This condition is characterized by a triad of: 1. **Intermittent claudication** of the buttocks and thighs. 2. **Erectile dysfunction** (impotence) due to decreased blood flow to the internal iliac arteries. 3. **Absent or diminished femoral pulses.** **Why Gangrene of the Foot is the Correct Answer:** Chronic, high-grade obstruction at the aortic bifurcation leads to **Critical Limb Ischemia (CLI)**. When collateral circulation fails to compensate for the lack of distal perfusion, it results in rest pain, non-healing ulcers, and eventually **gangrene of the foot**. While other symptoms occur, gangrene is a definitive clinical consequence of the severe, end-stage ischemia caused by such a proximal obstruction. **Analysis of Incorrect Options:** * **A & D (Rubor and Pallor):** These are signs of peripheral vascular disease (Buerger’s test), but they are transient postural changes rather than the definitive "end-result" of a major bifurcation obstruction. * **B (Retrograde Ejaculation):** This is typically a complication of **aortic surgery** (due to damage to the superior hypogastric plexus) or diabetes, rather than the obstructive process itself. The obstruction causes *impotence* (failure of erection), not retrograde ejaculation. **High-Yield Clinical Pearls for NEET-PG:** * **Leriche Syndrome Triad:** Claudication + Impotence + Absent Femoral Pulses. * **Most common site of atherosclerotic occlusion:** Superficial Femoral Artery (within the Adductor/Hunter’s canal). * **Investigation of Choice:** Digital Subtraction Angiography (DSA) is the gold standard, but CT Angiography is the initial diagnostic modality. * **Management:** Aortobifemoral bypass is the classic surgical treatment for extensive aortoiliac disease.

Q: The Hunterian Ligature operation is performed for what condition?

Aneurysm. **Explanation:** The **Hunterian Ligature** (proximal ligation) is a classic surgical technique historically used for the treatment of **aneurysms**, specifically popliteal aneurysms. **1. Why Aneurysm is correct:** Introduced by John Hunter in 1785, the procedure involves ligating the artery (the superficial femoral artery in the adductor/Hunter’s canal) at a site **proximal** to the aneurysm. The physiological principle is to reduce the high-pressure pulsatile flow into the aneurysmal sac without completely cutting off circulation. This encourages gradual thrombosis of the aneurysm while allowing collateral circulation to maintain limb viability, thereby preventing the high risk of gangrene associated with ligation immediately above the sac (Anel’s ligation). **2. Why other options are incorrect:** * **Varicose veins:** These are treated with Trendelenburg ligation (juxtafemoral ligation) or stripping, not Hunterian ligation. * **Arteriovenous fistulas:** These require excision or repair of the communication (e.g., Nicoladoni-Branham sign assessment), as proximal ligation alone can worsen ischemia via "steal phenomenon." * **Acute arterial ischemia:** This is an emergency requiring embolectomy (Fogarty catheter) or thrombolysis; ligation would worsen the ischemia. **3. High-Yield Clinical Pearls for NEET-PG:** * **Hunter’s Canal (Adductor Canal):** Located in the middle third of the thigh; contains the femoral artery, femoral vein, and saphenous nerve. * **Evolution of Aneurysm Surgery:** * *Antyllus:* Proximal and distal ligation with evacuation. * *Anel’s:* Ligation immediately proximal to the sac. * *Hunter’s:* Ligation well proximal to the sac (in healthy tissue). * *Matas (Endoaneurysmorrhaphy):* Internal repair of the sac. * **Modern Standard:** Today, aneurysms are typically managed with **interposition grafts** or **endovascular stenting (EVAR)**.

Q: Management of subclavian artery injury due to inadvertent central catheter insertion include all of the following except?

Mechanical Compression. **Explanation:** The management of inadvertent subclavian artery cannulation (the "Hoarseness of the Subclavian" or "Big Bore" injury) has shifted away from traditional methods due to the anatomical constraints of the vessel. **Why Mechanical Compression is the Correct Answer (The "Except"):** Unlike the femoral or radial arteries, the **subclavian artery is a non-compressible vessel**. It lies posterior to the clavicle and subclavius muscle, making external manual compression ineffective for achieving hemostasis. Attempting compression often leads to delayed recognition of internal bleeding, resulting in massive hemothorax, tension hemothorax, or compressive mediastinal hematomas. Therefore, "pull and press" is contraindicated for large-bore injuries in this location. **Analysis of Other Options:** * **Closure Devices (A):** Percutaneous suture-mediated or collagen-plug closure devices (e.g., ProGlide) are increasingly used to seal the arteriotomy site upon catheter removal. * **Covering Stent (C):** Endovascular management using a covered stent (stent-graft) is a preferred minimally invasive approach to exclude the injury site while maintaining distal flow. * **Tract Embolization (D):** This involves using prothrombotic agents or coils to seal the tract as the catheter is withdrawn, preventing track-related bleeding. **Clinical Pearls for NEET-PG:** * **Zone of Injury:** Subclavian injuries are difficult to manage surgically because they often require clavicular resection or thoracotomy for proximal control. * **The "Rule of Thumb":** If a large-bore catheter (≥7 French) is inadvertently placed in a non-compressible artery, **do not remove it** until a definitive repair plan (Endovascular or Surgical) is in place. * **Gold Standard:** Endovascular repair is now preferred over open surgery for stable patients due to lower morbidity.

Q: What is the most common cause of superficial thrombophlebitis?

Intravenous catheters/infusion. **Explanation:** Superficial thrombophlebitis (STP) is the inflammation of a superficial vein associated with a blood clot. **1. Why Option A is Correct:** In modern clinical practice, **intravenous (IV) catheterization and infusions** are the most common causes of superficial thrombophlebitis. This occurs due to mechanical irritation of the vein wall by the cannula or chemical irritation from the infused medications/fluids (iatrogenic trauma). It most frequently affects the cephalic or basilic veins of the upper limbs. **2. Analysis of Incorrect Options:** * **Option B (DVT):** While STP and DVT share similar risk factors (Virchow’s triad), DVT is a complication or a concurrent finding rather than the primary *cause* of STP. * **Option C (Varicose Veins):** This is the most common **spontaneous** cause of STP in the lower limbs. However, globally and across all hospital settings, IV-induced phlebitis remains more frequent. * **Option D (Trauma):** While physical trauma can lead to vein injury and thrombosis, it is less frequent than the controlled "micro-trauma" caused by millions of IV cannulations performed daily. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mondor’s Disease:** A specific type of superficial thrombophlebitis involving the lateral thoracic or epigastric veins; it presents as a "cord-like" structure on the chest wall. * **Trousseau’s Sign (Migratory Thrombophlebitis):** Recurrent STP at different sites, strongly associated with internal malignancies, most commonly **Carcinoma of the Pancreas**. * **Management:** Most cases are self-limiting. Treatment includes NSAIDs, warm compresses, and elevation. If STP occurs at the saphenofemoral junction, anticoagulation is required to prevent progression to DVT.

Question 1

All statements are true about Paget-Schroetter syndrome except?

Accepted Answer

Associated with jugular-subclavian venous thrombosis

Answer

Also known as venous thoracic outlet syndrome

Answer

History of performing prolonged activities

Answer

Results in damage to the subclavian vein

Question 2

Which instrument is used for aerial embolectomy?

Accepted Answer

Aerial embolectomy

Answer

Bladder catheterization

Answer

Control of upper gastrointestinal bleeding

Answer

Insertion of a central line

Question 3

Which of the following venous abnormalities is indicated for surgery?

Accepted Answer

Deep vein incompetence with DVT

Answer

Deep vein incompetence without DVT

Answer

Varicosity > 3 mm in diameter

Answer

Varicosity < 3 mm in diameter

Question 4

Lumbar sympathectomy can be recommended in all of the following conditions except?

Accepted Answer

Erectile dysfunction

Answer

Hyperhydrosis

Answer

Causalgia

Answer

Buerger's disease

Question 5

Which of the following statements is NOT true regarding Buerger's disease?

Accepted Answer

Cigarette cessation is the definitive treatment.

Answer

It is common in the lower extremities.

Answer

Superficial thrombophlebitis is common.

Answer

It usually affects individuals below 30 years of age.

Question 6

Obstruction at the bifurcation of the aorta leads to which of the following?

Accepted Answer

Gangrene of the foot

Answer

Rubor on putting the leg in a dependent position

Answer

Retrograde ejaculation

Answer

Pallor of the lower limb

Question 7

The Hunterian Ligature operation is performed for what condition?

Accepted Answer

Aneurysm

Answer

Varicose veins

Answer

Arteriovenous fistulas

Answer

Acute arterial ischemia

Question 8

Sclerotherapy is contraindicated in all of the following conditions EXCEPT:

Accepted Answer

Recurrent varices

Answer

Deep vein thrombosis

Answer

Saphenofemoral incompetence

Answer

Huge varicosities

Question 9

Management of subclavian artery injury due to inadvertent central catheter insertion include all of the following except?

Accepted Answer

Mechanical Compression

Answer

Closure device

Answer

Covering stent

Answer

Tract embolization

Question 10

What is the most common cause of superficial thrombophlebitis?

Accepted Answer

Intravenous catheters/infusion

Answer

Deep vein thrombosis (DVT)

Answer

Varicose veins

Answer

Trauma

Vascular Surgery — MCQs

Vascular Surgery — MCQs

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