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Vascular Surgery In-Training Examination
(VSITE) | Latest Verified Questions and Detailed
Answers
OVERVIEW DESCRIPTION:
This comprehensive set of multiple-choice questions is designed for the Vascular Surgery In-
Training Examination (VSITE®). The questions span the entire breadth of vascular surgery,
including cerebrovascular disease, aortic aneurysms, peripheral arterial occlusive disease, venous
and lymphatic disorders, vascular trauma, and applied science. Each question is followed by a
precise, expert rationale that explains the correct answer, making this collection an ideal tool for
self-assessment, targeted study, and rapid review of key vascular surgery concepts.
QUESTION 1
A 68-year-old male with a history of hypertension and smoking presents with
transient episodes of left eye monocular vision loss, described as a "curtain coming
down." A carotid duplex ultrasound reveals a 75% stenosis of the right internal carotid
artery. What is the most appropriate next step in management?
A) Initiate dual antiplatelet therapy with aspirin and clopidogrel
B) Perform a carotid endarterectomy (CEA) within two weeks
C) Perform a carotid artery stent (CAS) with embolic protection
D) Order a CT angiogram to confirm the degree of stenosis
CORRECT ANSWER: ✓ B
EXPERT RATIONALE: The patient is symptomatic with a >70% carotid stenosis. Based on
NASCET criteria, CEA is indicated and should be performed as soon as possible, ideally
within two weeks of the index event, to maximize stroke prevention.
QUESTION 2
A 72-year-old man undergoes an endovascular aneurysm repair (EVAR) for a 6.0 cm
infrarenal abdominal aortic aneurysm. His one-year surveillance CT scan shows a type
II endoleak with a 7 mm increase in sac diameter. What is the most appropriate
management?
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A) Continued surveillance with CT in 6 months
B) Embolization of the feeding lumbar or inferior mesenteric artery
C) Conversion to open surgical repair
D) Observation only, as type II endoleaks are benign
CORRECT ANSWER: ✓ B
EXPERT RATIONALE: While many type II endoleaks are benign, sac expansion of >5 mm
is an indication for intervention. Translumbar or transarterial embolization of the nidus
and feeding vessels is the standard treatment.
QUESTION 3
A 60-year-old diabetic male presents with rest pain and a non-healing ulcer on his
right great toe. His ankle-brachial index (ABI) is 0.3. Which of the following is the best
initial diagnostic test to guide revascularization?
A) Magnetic resonance angiography (MRA)
B) Duplex ultrasound of the lower extremity arteries
C) Contrast angiography
D) Toe-brachial index (TBI) with pulse volume recordings (PVR)
CORRECT ANSWER: ✓ C
EXPERT RATIONALE: For a patient with chronic limb-threatening ischemia (CLTI) in
whom revascularization is planned, contrast angiography is the gold standard to
provide a detailed roadmap of the arterial tree from the aorta to the foot, necessary for
planning either open bypass or endovascular intervention.
QUESTION 4
A 55-year-old female presents with unilateral left leg swelling and pain. A duplex
ultrasound confirms an acute deep vein thrombosis (DVT) involving the common
femoral and external iliac veins. She has no contraindications to anticoagulation. What
is the most compelling reason to consider catheter-directed thrombolysis (CDT) over
anticoagulation alone?
A) To reduce the risk of pulmonary embolism
B) To prevent the development of phlegmasia cerulea dolens
,3|Page
C) To reduce the incidence of post-thrombotic syndrome
D) To provide faster symptomatic relief of pain and swelling
CORRECT ANSWER: ✓ C
EXPERT RATIONALE: While CDT provides faster symptom relief, its primary benefit
over anticoagulation alone in proximal iliofemoral DVT is the preservation of valve
function and reduction in the long-term incidence and severity of post-thrombotic
syndrome.
QUESTION 5
A patient presents with acute onset of severe, tearing chest pain radiating to the back,
a blood pressure differential between the right and left arms, and a widened
mediastinum on chest X-ray. What is the single most important initial step in
management?
A) Obtain a stat transesophageal echocardiogram (TEE)
B) Initiate intravenous beta-blocker therapy
C) Perform an immediate CT angiogram of the chest and abdomen
D) Prepare the patient for emergent operative exploration
CORRECT ANSWER: ✓ B
EXPERT RATIONALE: In suspected acute aortic dissection, the immediate priority is to
reduce the force of left ventricular ejection (dP/dt) with intravenous beta-blockers
(e.g., esmolol, labetalol) to prevent propagation of the dissection before definitive
diagnostic imaging.
QUESTION 6
Which of the following intestinal arcades is the most important collateral pathway
connecting the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA)
in chronic mesenteric ischemia?
A) Arcade of Riolan (meandering mesenteric artery)
B) Marginal artery of Drummond
C) Gastroepiploic arcade
D) Pancreaticoduodenal arcades
, 4|Page
CORRECT ANSWER: ✓ A
EXPERT RATIONALE: The arcade of Riolan, or meandering mesenteric artery, is a
central collateral between the left branch of the middle colic artery (SMA) and the left
colic artery (IMA). Its presence indicates significant occlusive disease in one of these
main vessels.
QUESTION 7
A 78-year-old female is admitted to the ICU after a ruptured EVAR. She becomes
hypotensive and her hemoglobin drops by 2 g/dL. A contrast-enhanced CT scan shows
a large retroperitoneal hematoma but no active extravasation. What is the most
appropriate next step?
A) Emergent return to the operating room for open conversion
B) Administer blood products and repeat the CT scan in 6 hours
C) Observe in the ICU with strict blood pressure control
D) Perform a diagnostic peritoneal lavage
CORRECT ANSWER: ✓ A
EXPERT RATIONALE: A patient who is hemodynamically unstable after aortic surgery
with a dropping hemoglobin and a significant hematoma has a surgical bleed until
proven otherwise. The absence of active contrast extravasation does not rule out a
venous or intermittent arterial bleed, necessitating emergent re-exploration.
QUESTION 8
A renal transplant recipient with a failing arteriovenous graft (AVG) in the arm
undergoes a fistulogram. It reveals a 60% stenosis at the graft-vein anastomosis. What
is the appropriate next step in management?
A) Surgical patch angioplasty of the venous anastomosis
B) Percutaneous transluminal angioplasty (PTA) of the lesion
C) Immediate surgical revision with a jump graft
D) Increase the target blood pressure for dialysis
CORRECT ANSWER: ✓ B
Vascular Surgery In-Training Examination
(VSITE) | Latest Verified Questions and Detailed
Answers
OVERVIEW DESCRIPTION:
This comprehensive set of multiple-choice questions is designed for the Vascular Surgery In-
Training Examination (VSITE®). The questions span the entire breadth of vascular surgery,
including cerebrovascular disease, aortic aneurysms, peripheral arterial occlusive disease, venous
and lymphatic disorders, vascular trauma, and applied science. Each question is followed by a
precise, expert rationale that explains the correct answer, making this collection an ideal tool for
self-assessment, targeted study, and rapid review of key vascular surgery concepts.
QUESTION 1
A 68-year-old male with a history of hypertension and smoking presents with
transient episodes of left eye monocular vision loss, described as a "curtain coming
down." A carotid duplex ultrasound reveals a 75% stenosis of the right internal carotid
artery. What is the most appropriate next step in management?
A) Initiate dual antiplatelet therapy with aspirin and clopidogrel
B) Perform a carotid endarterectomy (CEA) within two weeks
C) Perform a carotid artery stent (CAS) with embolic protection
D) Order a CT angiogram to confirm the degree of stenosis
CORRECT ANSWER: ✓ B
EXPERT RATIONALE: The patient is symptomatic with a >70% carotid stenosis. Based on
NASCET criteria, CEA is indicated and should be performed as soon as possible, ideally
within two weeks of the index event, to maximize stroke prevention.
QUESTION 2
A 72-year-old man undergoes an endovascular aneurysm repair (EVAR) for a 6.0 cm
infrarenal abdominal aortic aneurysm. His one-year surveillance CT scan shows a type
II endoleak with a 7 mm increase in sac diameter. What is the most appropriate
management?
,2|Page
A) Continued surveillance with CT in 6 months
B) Embolization of the feeding lumbar or inferior mesenteric artery
C) Conversion to open surgical repair
D) Observation only, as type II endoleaks are benign
CORRECT ANSWER: ✓ B
EXPERT RATIONALE: While many type II endoleaks are benign, sac expansion of >5 mm
is an indication for intervention. Translumbar or transarterial embolization of the nidus
and feeding vessels is the standard treatment.
QUESTION 3
A 60-year-old diabetic male presents with rest pain and a non-healing ulcer on his
right great toe. His ankle-brachial index (ABI) is 0.3. Which of the following is the best
initial diagnostic test to guide revascularization?
A) Magnetic resonance angiography (MRA)
B) Duplex ultrasound of the lower extremity arteries
C) Contrast angiography
D) Toe-brachial index (TBI) with pulse volume recordings (PVR)
CORRECT ANSWER: ✓ C
EXPERT RATIONALE: For a patient with chronic limb-threatening ischemia (CLTI) in
whom revascularization is planned, contrast angiography is the gold standard to
provide a detailed roadmap of the arterial tree from the aorta to the foot, necessary for
planning either open bypass or endovascular intervention.
QUESTION 4
A 55-year-old female presents with unilateral left leg swelling and pain. A duplex
ultrasound confirms an acute deep vein thrombosis (DVT) involving the common
femoral and external iliac veins. She has no contraindications to anticoagulation. What
is the most compelling reason to consider catheter-directed thrombolysis (CDT) over
anticoagulation alone?
A) To reduce the risk of pulmonary embolism
B) To prevent the development of phlegmasia cerulea dolens
,3|Page
C) To reduce the incidence of post-thrombotic syndrome
D) To provide faster symptomatic relief of pain and swelling
CORRECT ANSWER: ✓ C
EXPERT RATIONALE: While CDT provides faster symptom relief, its primary benefit
over anticoagulation alone in proximal iliofemoral DVT is the preservation of valve
function and reduction in the long-term incidence and severity of post-thrombotic
syndrome.
QUESTION 5
A patient presents with acute onset of severe, tearing chest pain radiating to the back,
a blood pressure differential between the right and left arms, and a widened
mediastinum on chest X-ray. What is the single most important initial step in
management?
A) Obtain a stat transesophageal echocardiogram (TEE)
B) Initiate intravenous beta-blocker therapy
C) Perform an immediate CT angiogram of the chest and abdomen
D) Prepare the patient for emergent operative exploration
CORRECT ANSWER: ✓ B
EXPERT RATIONALE: In suspected acute aortic dissection, the immediate priority is to
reduce the force of left ventricular ejection (dP/dt) with intravenous beta-blockers
(e.g., esmolol, labetalol) to prevent propagation of the dissection before definitive
diagnostic imaging.
QUESTION 6
Which of the following intestinal arcades is the most important collateral pathway
connecting the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA)
in chronic mesenteric ischemia?
A) Arcade of Riolan (meandering mesenteric artery)
B) Marginal artery of Drummond
C) Gastroepiploic arcade
D) Pancreaticoduodenal arcades
, 4|Page
CORRECT ANSWER: ✓ A
EXPERT RATIONALE: The arcade of Riolan, or meandering mesenteric artery, is a
central collateral between the left branch of the middle colic artery (SMA) and the left
colic artery (IMA). Its presence indicates significant occlusive disease in one of these
main vessels.
QUESTION 7
A 78-year-old female is admitted to the ICU after a ruptured EVAR. She becomes
hypotensive and her hemoglobin drops by 2 g/dL. A contrast-enhanced CT scan shows
a large retroperitoneal hematoma but no active extravasation. What is the most
appropriate next step?
A) Emergent return to the operating room for open conversion
B) Administer blood products and repeat the CT scan in 6 hours
C) Observe in the ICU with strict blood pressure control
D) Perform a diagnostic peritoneal lavage
CORRECT ANSWER: ✓ A
EXPERT RATIONALE: A patient who is hemodynamically unstable after aortic surgery
with a dropping hemoglobin and a significant hematoma has a surgical bleed until
proven otherwise. The absence of active contrast extravasation does not rule out a
venous or intermittent arterial bleed, necessitating emergent re-exploration.
QUESTION 8
A renal transplant recipient with a failing arteriovenous graft (AVG) in the arm
undergoes a fistulogram. It reveals a 60% stenosis at the graft-vein anastomosis. What
is the appropriate next step in management?
A) Surgical patch angioplasty of the venous anastomosis
B) Percutaneous transluminal angioplasty (PTA) of the lesion
C) Immediate surgical revision with a jump graft
D) Increase the target blood pressure for dialysis
CORRECT ANSWER: ✓ B
