VSITE EXAM QUESTIONS WITH
REVIEWED ANSWERS
Duplex criteria for renal artery stenosis - Answer- PSV > 180, RAR < 3.5 denotes
stenosis < 60%
PSV > 180, RAR > 3.5 >/= 60% stenosis
EDV > 150 denotes stenosis > 80%
Reflux criteria of superficial, deep, and perforating veins - Answer- Superficial: reflux >
0.5s
Deep (femoral and pop): > 1s
Pathologic perforator: reflux > 0.5s, diameter > 3.5mm, located underneath healed or
active venous ulcer
CEAP classification - Answer- C = clinical manifestation
0 = no s/s of venous disease
1 = telangiectasia, reticular veins
2= varicose veins
3 = edema
4 = skin changes (4a = eczema, hyperpigmentation, 4b = lipdermatosclerosis, atrophie
blanche)
5 = healed ulcer
6 = active ulcer
E = etiology
p = primary
s = secondary
n = no identification
A = anatomy
s = superficial reflux
p = perforating vein reflux
d = deep vein reflux
n = no location identified
P = pathophysiology
r = reflux
o = obstruction
r, o = reflux and obstruction
n = none identifiable
,Level 1 vs 2 = method of diagnosis
1 = handheld doppler
2 = NIVS, plethysmography
3 = invasive
ESCHAR study - Answer- Effects of Surgery and Compression on Healing and
Recurrence demonstrated significantly lower ulcer recurrence rates in patients treated
with GSV stripping and compression stockings when compared with compression
therapy alone
Addition of surgery did NOT increase the healing rate
EVRA trail - Answer- Early Venous reflux Ablation Ulcer Trial found that both the ulcer
healing rate and recurrence rate were improved with saphenous ablation
RFA vs EVLA vs high ligation and vein stripping - Answer- - Earlier ambulation and
decreased bruising in RFA vs high ligation and vein stripping
- Some evidence of less bruising with RFA than EVLA, though no definitive data
suggest earlier return to work or ambulation
- No definite earlier ambulation rate, earlier return to work shown between EVLA and
high ligation/vein stripping
What is the recurrence rate of ischemic stroke following an initial ischemic stroke? -
Answer- 2% at 7 days
4% at 1 month
12% at 1 year
30% at 5 years
What percentage of patient with a TIA will go on to experience a stroke within 5 years? -
Answer- 30%
Independent predictors of stroke following TIA - Answer- 1. age > 60
2. DM
3. presence of focal symptoms
4. TIAs lasting longer than 10 minutes
Hard Signs of Vascular Injury (5)
What is the risk of arterial injury if a hard sign is present? - Answer- 1. pulsatile bleeding
2. lack of pulses
3. cold limb
4. expanding hematoma
5. audible bruit or palpable thrill at site of injury
Indicate greater than 90% risk of arterial injury with 50% of those requiring intervention
,Soft Signs of Vascular Injury (5)
What is the risk of arterial injury if a soft sign is present? - Answer- 1. H/o severe
hemorrhage at the scene
2. Injury near a major blood vessel
3. Nonexpanding hematoma over an artery
4. Neurologic deficit originating from a nerve adjacent to a named artery
5. Diminished or unequal pulses
indicates 30% risk of arterial injury - perform further investigation (ABI. If > 0.9, observe.
If less, CTA)
Second most commonly injured artery from blunt mechnamisms after the aorta
Most common repair - Answer- Inominate artery
open aorto-inominate bypass
Zones of the neck - Answer- - Zone I = clavicles to cricoid cartilage
- Zone II = cricoid cartilage to angle of the mandible
- Zone III = angle of the mandible to base of the skull
Zones of the retroperitoneum and their associated structures
Which zones should be explored in the case of hematoma? - Answer- - Zone I is divided
into supramesocolic and inframesocolic. It extends from the aortic hiatus to the sacral
promontory. All injuries should be explored .
- Zone II extends from the renal hilum laterally to the pericolic gutters. All penetrating
injuries should be explored; no exploration in blunt injury
- Zone III = sacral promontory inferiorly (pelvis). All penetrating injuries. Only explore
expanding hematomas or those with loss of femoral pulse in blunt injuries
- Zone IV = retrohepatic space; NO INJURIES should be explored in the absence of
active extravasation
Four compartments of the leg and the components of each compartment - Answer- 1.
Anterior
- Anterior tibial artery; deep peroneal nerve
2. Lateral
- Peroneal artery, superficial and deep peroneal nerve
3. Superficial posterior
- no significant neuromuscular components
4. Deep posterior
- posterior tibial and peroneal arteries, tibial nerve
, Indications for Revascularization of the L SCA following coverage for TEVAR - Answer-
1. Previous CABG with LIMA
2. Incomplete vertebrobasilar collateralization
3. Functioning AV access in the LUE
4. Prior aortic intervention with coverage of lumbars and middle sacral arteries
5. Evidence of aneurysmal changes in the aorta that may require future repair
6. Long segment graft >/= 20cm in length resulting in coverage of intercostals
7. Hypogastric artery occlusion
Crawford Classification of TAAA - Answer- Type I: subclavian to renals
Type II: subclavian to bifurcation
Type III: mid thoracic (sixth intercostal) to below renals
Type IV: T12 vertebral body (around diaphragm) to bifurcation
Type V: mid thoracic (sixth intercostal space) to just above renals (visceral segment
only)
Type VI: pararenal** (not always considered a class)
Treatment of lymphatic filiariasis in the US - Answer- diethylcarbamazine
Gold standard for assessment venous malformations - Answer- MRI with gadolinium
Contraindications to sclerotherapy - Answer- - pregnancy
- late complications of diabetes
- hyperthyroidism
- relative contraindications: severe PAD, hyper coagulable state
The saphenofemoral junction is comprised of a confluence of which veins? - Answer- -
GSV
- superficial circumflex iliac veins
- superficial epigastric veins
- external pudendal veins
Indications for intervention of chronic venous disease - Answer- - failed conservative
management
- venous ulceration
- recurrent superficial venous thrombophlebitis
- variceal bleeding
Reversal agent for dabigatran - Answer- Idarucizumab (Praxbind)
Reversal agent for rivaroxaban - Answer- andexanet alfa
Reversal agent for apixaban - Answer- andexanet alfa
Factor most associated with failure of IVC filter retrieval - Answer- dwell time > 7 months
REVIEWED ANSWERS
Duplex criteria for renal artery stenosis - Answer- PSV > 180, RAR < 3.5 denotes
stenosis < 60%
PSV > 180, RAR > 3.5 >/= 60% stenosis
EDV > 150 denotes stenosis > 80%
Reflux criteria of superficial, deep, and perforating veins - Answer- Superficial: reflux >
0.5s
Deep (femoral and pop): > 1s
Pathologic perforator: reflux > 0.5s, diameter > 3.5mm, located underneath healed or
active venous ulcer
CEAP classification - Answer- C = clinical manifestation
0 = no s/s of venous disease
1 = telangiectasia, reticular veins
2= varicose veins
3 = edema
4 = skin changes (4a = eczema, hyperpigmentation, 4b = lipdermatosclerosis, atrophie
blanche)
5 = healed ulcer
6 = active ulcer
E = etiology
p = primary
s = secondary
n = no identification
A = anatomy
s = superficial reflux
p = perforating vein reflux
d = deep vein reflux
n = no location identified
P = pathophysiology
r = reflux
o = obstruction
r, o = reflux and obstruction
n = none identifiable
,Level 1 vs 2 = method of diagnosis
1 = handheld doppler
2 = NIVS, plethysmography
3 = invasive
ESCHAR study - Answer- Effects of Surgery and Compression on Healing and
Recurrence demonstrated significantly lower ulcer recurrence rates in patients treated
with GSV stripping and compression stockings when compared with compression
therapy alone
Addition of surgery did NOT increase the healing rate
EVRA trail - Answer- Early Venous reflux Ablation Ulcer Trial found that both the ulcer
healing rate and recurrence rate were improved with saphenous ablation
RFA vs EVLA vs high ligation and vein stripping - Answer- - Earlier ambulation and
decreased bruising in RFA vs high ligation and vein stripping
- Some evidence of less bruising with RFA than EVLA, though no definitive data
suggest earlier return to work or ambulation
- No definite earlier ambulation rate, earlier return to work shown between EVLA and
high ligation/vein stripping
What is the recurrence rate of ischemic stroke following an initial ischemic stroke? -
Answer- 2% at 7 days
4% at 1 month
12% at 1 year
30% at 5 years
What percentage of patient with a TIA will go on to experience a stroke within 5 years? -
Answer- 30%
Independent predictors of stroke following TIA - Answer- 1. age > 60
2. DM
3. presence of focal symptoms
4. TIAs lasting longer than 10 minutes
Hard Signs of Vascular Injury (5)
What is the risk of arterial injury if a hard sign is present? - Answer- 1. pulsatile bleeding
2. lack of pulses
3. cold limb
4. expanding hematoma
5. audible bruit or palpable thrill at site of injury
Indicate greater than 90% risk of arterial injury with 50% of those requiring intervention
,Soft Signs of Vascular Injury (5)
What is the risk of arterial injury if a soft sign is present? - Answer- 1. H/o severe
hemorrhage at the scene
2. Injury near a major blood vessel
3. Nonexpanding hematoma over an artery
4. Neurologic deficit originating from a nerve adjacent to a named artery
5. Diminished or unequal pulses
indicates 30% risk of arterial injury - perform further investigation (ABI. If > 0.9, observe.
If less, CTA)
Second most commonly injured artery from blunt mechnamisms after the aorta
Most common repair - Answer- Inominate artery
open aorto-inominate bypass
Zones of the neck - Answer- - Zone I = clavicles to cricoid cartilage
- Zone II = cricoid cartilage to angle of the mandible
- Zone III = angle of the mandible to base of the skull
Zones of the retroperitoneum and their associated structures
Which zones should be explored in the case of hematoma? - Answer- - Zone I is divided
into supramesocolic and inframesocolic. It extends from the aortic hiatus to the sacral
promontory. All injuries should be explored .
- Zone II extends from the renal hilum laterally to the pericolic gutters. All penetrating
injuries should be explored; no exploration in blunt injury
- Zone III = sacral promontory inferiorly (pelvis). All penetrating injuries. Only explore
expanding hematomas or those with loss of femoral pulse in blunt injuries
- Zone IV = retrohepatic space; NO INJURIES should be explored in the absence of
active extravasation
Four compartments of the leg and the components of each compartment - Answer- 1.
Anterior
- Anterior tibial artery; deep peroneal nerve
2. Lateral
- Peroneal artery, superficial and deep peroneal nerve
3. Superficial posterior
- no significant neuromuscular components
4. Deep posterior
- posterior tibial and peroneal arteries, tibial nerve
, Indications for Revascularization of the L SCA following coverage for TEVAR - Answer-
1. Previous CABG with LIMA
2. Incomplete vertebrobasilar collateralization
3. Functioning AV access in the LUE
4. Prior aortic intervention with coverage of lumbars and middle sacral arteries
5. Evidence of aneurysmal changes in the aorta that may require future repair
6. Long segment graft >/= 20cm in length resulting in coverage of intercostals
7. Hypogastric artery occlusion
Crawford Classification of TAAA - Answer- Type I: subclavian to renals
Type II: subclavian to bifurcation
Type III: mid thoracic (sixth intercostal) to below renals
Type IV: T12 vertebral body (around diaphragm) to bifurcation
Type V: mid thoracic (sixth intercostal space) to just above renals (visceral segment
only)
Type VI: pararenal** (not always considered a class)
Treatment of lymphatic filiariasis in the US - Answer- diethylcarbamazine
Gold standard for assessment venous malformations - Answer- MRI with gadolinium
Contraindications to sclerotherapy - Answer- - pregnancy
- late complications of diabetes
- hyperthyroidism
- relative contraindications: severe PAD, hyper coagulable state
The saphenofemoral junction is comprised of a confluence of which veins? - Answer- -
GSV
- superficial circumflex iliac veins
- superficial epigastric veins
- external pudendal veins
Indications for intervention of chronic venous disease - Answer- - failed conservative
management
- venous ulceration
- recurrent superficial venous thrombophlebitis
- variceal bleeding
Reversal agent for dabigatran - Answer- Idarucizumab (Praxbind)
Reversal agent for rivaroxaban - Answer- andexanet alfa
Reversal agent for apixaban - Answer- andexanet alfa
Factor most associated with failure of IVC filter retrieval - Answer- dwell time > 7 months
