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VSITE Review Questions with Answers (100%
Correct Answers)
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
,2
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
,3
- 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)
, 4
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
VSITE Review Questions with Answers (100%
Correct Answers)
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
,2
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
,3
- 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)
, 4
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
