ABSITE Vascular questions and answers with solutions 2025

Describe the risk factors associated with atherosclerosis: -
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ANSWER Smoking, diabetes, hyperlipidemia, obesity, HTN, sedentary lifestyle
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Arterial ulcers vs venous ulcers - ANSWER Arterial ulcers—
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painful and usually occur on toes or foot
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Venous ulcers—commonly broad-based, shallow at medial malleolus
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Claudication— - O



ANSWER cramping ischemic muscle pain with exertion that occurs distal to arterial stenosis, ass
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ociated with 1% risk of limb loss and 5% mortality.
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Rest pain— -O O



ANSWER due to ischemia, arises without exertion and classically wakes patients from sleep (oft
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en over distal metatarsals). The pain may resolve with standing or placing foot over side of bed (
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dependent position, gravity). >50% patients eventually require amputation.
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Dry gangrene— - ANSWER necrotic "mummified" tissue without signs of infection—
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not a surgical emergency
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Wet gangrene— - ANSWER necrotic tissue indicative of active infectious process—
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requires aggressive debridement or amputation to avoid sepsis
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How are ankle brachial index/digital brachial index (ABIs/DBIs) and segmental pressures measur
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ed? Pulse volume recordings (PVRs)? What is their significance? -
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ANSWER Normal ABI at rest: 1.0 to 1.2, mild arterial insufficiency: 0.7 to 0.9, claudication: 0.5 to
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0.7, rest pain and ultimately tissue necrosis: <0.4 (falsely elevated ABIs may be seen in diabetic
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patients or those with chronic renal disease due to extensive vascular calcification).
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,PVRs analyze the waveforms at sequential sites along patient's leg—
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triphasic or biphasic waveforms, indicates more perfusion than monophasic.
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What is the half-life of heparin? Intraoperative therapeutic dosing? How is it reversed? -
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OANSWER Half- O



life is 60 to 90 minutes. Intraoperative dosing is 70 to 100 units/kg (activating clotting time of 25
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0 to 350 seconds if measured). Protamine sulfate: 1 mg/100 units of heparin.
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What are the 5- O O O



year patencies of common and external iliac percutaneous transluminal angioplasty (PTA) witho
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ut stenting? - ANSWER Common iliac: 70% to 80%
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External iliac: 50% to 60% O O O O




What are the classic signs/symptoms of acute arterial occlusion? In what order do they present?
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- ANSWER The "6 P's" include: Paresthesias, Pain, Pallor, Poikilothermia, Pulselessness, Paralysis
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What percentage of emboli originate in the heart? First and second most common causes? -
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ANSWER 80% of peripheral emboli are due to cardiac etiology (First—
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atrial fibrillation, Second—acute MI)
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At what anatomic sites do atherosclerotic lesions most commonly occlude? -
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ANSWER Atherosclerosis forms at branch points such as carotid bifurcation, bends, and tethere
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d segments such as superficial femoral artery as it passes through Hunter canal Emboli lodge at
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arterial bifurcation—that is, femoral bifurcation, brachial bifurcation
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How can a peripheral venous embolus cause occlusion in the peripheral arterial circulation? -
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OANSWER A "paradoxical embolus" occurs when a peripheral venous thromboembolus crosses in
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to the peripheral arterial circulation through a patent foramen ovale in the heart.
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What is the risk of limb loss associated with acute thromboembolic disease? What is the associa
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ted mortality? - ANSWER Risk of limb loss: 8% to 22%
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, Thromboembolic perioperative mortality: 10% to 17% O O O O O




Name some of the indications to operate for peripheral arterial occlusive disease: -
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OANSWER Tissue necrosis, rest pain, infection, debilitating claudication refractory to nonoperativ
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e management (Pentoxifylline, Aspirin, Cessation of smoking, Exercise—
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PACE pneumonic) NOTE—
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claudication is not an indication for surgery; it is best treated with supervised exercise training.
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What is 5-year patency rate of Fem-Pop vein grafts versus prosthetic grafts - ANSWER 5-
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year patency of an above-the-
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knee vein graft is 75% (no difference between in situ or reverse); prosthetic is 40% to 50%.
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5-year patency of a below-the-knee vein graft is 65%, prosthetic is 30%.
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What do early (<30 day), intermediate, and late (>2 year) bypass graft failures generally represe
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nt? - ANSWER Early—Use of small, poor-
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quality vein; anastomosis to inadequate outflow artery or technical error (kink/twist of graft; inc
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omplete lysis of valves) at the time of surgery Intermediate—
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Intimal hyperplasia at anastomotic sites or valve sites within the graft Late—
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Progression of atherosclerotic disease within the inflow or outflow vessels
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Name the 4 calf compartments in order of compartment syndrome probability: -
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ANSWER Anterior, lateral, deep posterior, superficial posterior compartment
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What is the first sign of compartment syndrome? How long after revascularization is greatest ris
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k? - O



ANSWER Numbness of great toe webbing is an early sign of compartment syndrome due to dee
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p peroneal nerve compression (anterior). Greatest risk occurs 4 to 6 hours after revascularizatio
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n along with release of intracellular ions/proteins/enzymes from damaged sarcolemma.
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What is the most common iatrogenic injury during anterior compartment fasciotomy? -
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ANSWER Injury to the lateral peroneal nerve in the superior aspect of the incision
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