Post-Test Questions

Article One (281–291)

1. A 37-year-old woman with medical history of severe hypertension and migraines presents with leg weakness. When she walks about 300 m her left leg gets tired. If she keeps walking, she has cramping in her left calf. Once she stops walking, pain and fatigue are relieved with less than 5 minutes rest. She is a nonsmoker. On physical exam, she has a right carotid bruit and bilateral femoral bruits. Pedal pulses are palpable. She has had an ABI study with exercise that showed an ABI that was 0.9 bilaterally at baseline but decreased to 0.6 on the left when she walked for 5 minutes on the treadmill. She also underwent carotid and renal artery duplex ultrasound studies which showed elevated peak systolic velocities in the right distal internal carotid and both right and left renal arteries distally. She is set up for a lower extremity angiogram. What is the likely diagnosis for her leg symptoms?

   • Popliteal artery entrapment syndrome

   • Aortoiliac atherosclerotic disease

   • Fibromuscular dysplasia

   • Buerger disease

2. Which disorder presents with the Ishikawa sign?

   • Cystic adventitial disease

   • Fibromuscular dysplasia

   • Popliteal artery entrapment syndrome

   • Buerger disease

   • Vasculitis

3. Among thrombophilic disorders noted below, which are associated with arterial thrombosis?

   • Isolated factor V Leiden heterozygous mutation

   • Isolated heterozygous prothrombin gene mutation

   • Positive lupus anticoagulation

   • None of the above

   Article Two (292–299)

4. Which of the following descriptions represents the limb requiring the most urgent intervention?

   • White limb, hair loss, ulceration

   • White limb, perishing cold, reduced sensation

   • White limb, reduced power, tender compartments

   • White limb, pulseless, reduced sensation

5. What is the approximate 5-year risk of major limb amputation in a patient presenting with intermittent claudication?

   • 1.5–3.5%

   • 3.5–5.5%

   • 5–10%

   • 10–20%

6. Which of the following describes a correct ABPI measurement/calculation?

   • Patient at rest, brachial pressures assessed with stethoscope, pedal pressures assessed with Doppler, highest pedal pressure for each limb divided by highest brachial pressure

   • Patient at rest, brachial pressures assessed with Doppler, pedal pressures assessed with Doppler, highest pedal pressure for each limb divided by highest brachial pressure

   • Patient at rest, brachial pressure assessed with Doppler, pedal pressures assessed with Doppler, average pedal pressure for each limb divided by highest brachial pressure

   • Patient at rest, brachial pressures assessed with Doppler, pedal pressures assessed with Doppler, highest pedal pressure for each limb divided by ipsilateral brachial pressure

   Article Three (300–306)

7. All of the following advancements have improved the outcomes following endovascular treatment of critical limb ischemia EXCEPT:

   • Development of subintimal angioplasty

   • Development of steerable hydrophilic wires

   • Development of larger and stiff er stent technology

   • Drug-eluting balloons and stents

   • None of the above

8. The following is TRUE regarding randomized controlled trials (RCTs) comparing endovascular and surgical treatments for critical limb ischemia:

   • Only 5–10% of suitable patients are actually enrolled in such clinical trials

   • No RCTs currently exist directly comparing surgery and endovascular treatments

   • In RCTs to date, surgery has been proven to have superior long-term results for femoropopliteal disease

   • In RCTs to date, endovascular techniques have been shown to be superior to surgery in the treatment of tibial vessel disease

   • None of the above

9. According to the Trans-Atlantic Inters-Society Consensus II recommendations:

   • TASC C lesions in the aorta are best treated with surgery

   • TASC A–C lesions of the femoropopliteal segments are more durably treated with endovascular techniques

   • TASC A lesions should all be treated with endovascular techniques on presentation

   • Recommendations are based on lesion morphology

   • All of the above

   Article Four (307–312)

10. Which statement regarding diabetic foot patients with peripheral arterial disease is INCORRECT?

    • There is functional impairment of the microcirculation in the diabetic foot

    • There may be a need for revascularization to promote ulcer healing

    • The presentation of neuroischemic foot does not diff er from the classical picture presented by the ischemic patient, with a natural progression through claudication, rest pain, ulceration, and gangrene

    • Revascularization could aid the healing of postoperative wounds if the infected necrotic foot has undergone surgical debridement.

11. Regarding endovascular revascularization of diabetic foot, which of the following statements is correct?

    • All patients require either a CT or MR angiogram before intervention

    • It cannot be performed safely on a day-case basis.

    • All patients on metformin should stop the medication after the procedure

    • Angioplasty and bypass are regarded not as competing treatments but as complementary, and hybrid procedures are increasingly carried out

12. Which of the following statements regarding a multidisciplinary coordinated care of diabetic foot is INCORRECT?

    • The multidisciplinary approach has proved to be a successful way of reducing amputations and improving outcomes

    • Team members include podiatrist, nurse, orthotist, microbiologist, diabetologist, interventional radiologist, and surgeon, including vascular surgeon, orthopaedic surgeon, and plastic surgeon

    • The work of the multidisciplinary care team is solely in a focused diabetic foot clinic

    • Through a multidisciplinary approach, it is possible to organize a “fast-track” service comprising clinical assessment, investigations, and urgent treatment

    Article Five (313–319)

13. All of the following techniques may prove helpful specifi cally for patients with foot vessel occlusive disease EXCEPT:

    • Retrograde percutaneous puncture

    • Balloon angioplasty by oversizing the balloon by 0.5 to 1.0 mm

    • Predilatation before defi nitive dilatation to facilitate balloon catheter placement.

    • Pedal plantar loop technique

    • All of the above techniques are helpful

14. Regarding revascularization of below the knee and below the ankle vessels, which of the following is TRUE?

    • Wound-related artery interventions are based on the concept of angiosomes

    • Complete revascularization strategy focuses on having one in-line vessel supply the distal calf and foot as possible, regardless of distribution

    • In the largest study to date, Peregrin et al demonstrated a limb-salvage rate of 40% following distal angioplasty

    • Stenting should be used early for possible angioplasty failures

    • None of the above

15. True or false? Radiation exposure to the operator during a distal revascularization procedure is generally less than an iliac intervention due to the decrease in patient body size.

    • True

    • False

    Article Six (320–329)

16. Benefi ts of the multidisciplinary team (MDT) approach include all of the following EXCEPT:

    • The ability to bill for services rendered during the MDT meeting

    • Teaching clinicians of the benefi ts of diff erent imaging modalities

    • Teaching the radiologist about the problems facing clinicians with PAD patients

    • To have all parties better understand the relationship between imaging fi ndings and clinical presentation

    • All of the above

17. Regarding the imaging of vascular stents:

    • The lumen may be obscured through a combination of susceptibility artifact and RF shielding of the stent interior

    • Nitinol stents are particularly prone to such artifacts

    • The role for CTA is more limited than MRA due to beam hardening artifact

    • Duplex ultrasound is not helpful in this population due to artifacts

    • None of the above

18. Regarding blooming artifact on CTA arising from dense calcifi cations:

    • In order to decrease the artifact, do not use iodinated contrast

    • Subtraction techniques are usually not helpful due to misregistration in the majority of cases

    • To minimize the artifact, the diagnosis should be made from reconstructed coronal/sagittal images rather than source images

    • To minimize the artifact, set the window level at 1,000 HU and the width at 200 HU.

    • None of the above

    Article Seven (330–337)

19. Does nicotine replacement therapy increase the risk of cardiovascular events during the cessation period?

    • Yes

    • No

20. Does preoperative clopidogrel increase the risk of perioperative bleeding complications?

    • Yes

    • No

21. What is the antihypertensive medicine of choice in patients with PAD?

    • Thiazide diuretics

    • Calcium channel blockers

    • Angiotensin-converting enzyme inhibitors

    • Angiotensin II receptor antagonists

    • Beta-adrenoceptor antagonists

22. What novel therapies can be used to induce angiogenesis in limb ischemia?

    • Growth hormones

    • Gene therapy

    • Stem cell therapy

    • All of the above

    • None of the above

    Article Eight (338–344)

23. Regarding stenting for iliac occlusive disease:

    • Covered stents have proven benefi t over bare metal stents in terms of long-term primary patency

    • Stents should be used primarily for all iliac occlusive disease patients with rest pain

    • TASC C and D lesions may be better treated with primary stenting rather than angioplasty

    • Surgery should be reserved for the elderly due to the lower complication rate

    • None of the above

24. True or false? One benefi t of registries is that they provide a constantly evolving real-world picture of practice patterns.

    • True

    • False

25. Advantages of the British Iliac Angioplasty and Stenting (BIAS) registry include all of the following EXCEPT:

    • Mortality rates are reported

    • Individual practitioners can request personal outcome data

    • Summary reports are publicized every few years

    • A minor limitation is that only individuals, and not specifi c centers, may request outcome data for themselves

    • All of the above are true

    Article Nine (345–352)

26. According to the most recent TASC guidelines, an endovascular-fi rst strategy is recommended for lesions categorized as:

    • A and B only

    • B and C only

    • A, B and C

    • A, B, C and D

27. Which of the following is the most important contributor factor for low patency rates following stent placement in the femoropopliteal axis?

    • Elastic recoil of the treated segment

    • Intimal dissection

    • Development of neointimal hyperplasia

    • None of the above

28. Which statement is TRUE regarding endovascular recanalization of the femoropopliteal segment?

    • Femoropopliteal lesions should always be stented

    • The use of plain balloons is favored over drug-coated balloons for the treatment of femoropopliteal lesions

    • The use of drug-coated balloons is favored over plain balloons for the treatment of femoropopliteal lesions

    • None of the above statements is true

    Article Ten (353–360)

29. Which statement regarding the common femoral artery is INCORRECT?

    • The bifurcation of the common femoral artery is located in all cases below the inferior margin of the femoral head

    • The groin crease is located below the common femoral artery bifurcation in a signifi cant number of patients

    • Femoral access beyond the boundaries of the common femoral artery is correlated with postprocedural bleeding

    • Vascular closure devices are intended for use in the common femoral artery

30. Regarding access, which of the following statements is CORRECT?

    • Fluoroscopic guidance reduces the likelihood of an ideal access

    • The use of fl uoroscopy does not have an infl uence on the incidence of pseudoaneurysm formation

    • Ultrasound guidance allows for faster access, and less risk of inadvertent venipunctures

    • The point of maximum pulsation correlates always with the midpoint of the common femoral artery

31. Which of the following statements regarding vascular closure devices is INCORRECT?

    • Vascular closure devices may lead to more severe complications (infection, etc.)

    • Vascular closure devices can lead to periarterial fi brosis

    • Vascular closure devices can be used safely in a diseased common femoral artery

    • The use of vascular closure devices will reduce time to ambulation

    Article Eleven (361–369)

32. All of the following steps should be taken to prevent complications EXCEPT:

    • Discussion of diffi cult patients at an appropriate multidisciplinary team meeting

    • A review (rounds) of the upcoming days procedures to review special needs for any given case

    • Discussion of the entire treatment plan with the IR team before intervention

    • Obtaining informed consent except in cases where patients are unconsentable

    • All of the above

33. Following a complication, all of the following should occur EXCEPT:

    • Discussion with the patient or family should occur only after discussion with the hospital risk offi cer in the case of a death

    • A team debriefi ng should be held of all the team members

    • Systematic problems should be identifi ed, and a plan put in place to address such problems

    • Apologize to the patient and/or family if appropriate

    • All of the above

34. All of the following are fundamental principles of complication management EXCEPT:

    • Preparedness

    • Alertness

    • Assessment

    • Response

    • All are fundamental principles