VSITE Review UPDATED ACTUAL
Questions and CORRECT Answers
Hard Signs of Vascular Injury (5)
What is the risk of arterial injury if a hard sign is present? - CORRECT 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? - CORRECT 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 - CORRECT ANSWER Inominate artery
,open aorto-inominate bypass
Zones of the neck - CORRECT 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? - CORRECT 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 - CORRECT
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 - CORRECT
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 - CORRECT 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)
Duplex criteria for renal artery stenosis - CORRECT 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 - CORRECT
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 - CORRECT 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
Questions and CORRECT Answers
Hard Signs of Vascular Injury (5)
What is the risk of arterial injury if a hard sign is present? - CORRECT 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? - CORRECT 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 - CORRECT ANSWER Inominate artery
,open aorto-inominate bypass
Zones of the neck - CORRECT 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? - CORRECT 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 - CORRECT
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 - CORRECT
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 - CORRECT 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)
Duplex criteria for renal artery stenosis - CORRECT 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 - CORRECT
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 - CORRECT 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
