Nesvs 2013 Annual Meeting Self-assessment Exam

Thromboembolic complications

Perioperative stroke

Blood transfusions

Length of stay

Aorto-subclavian bypass

Carotid-subclavian bypass

Femoro-subclavian bypass

Cilastozol treatment

10%

20%

30%

40%

Antiplatelet therapy with aspirin

Follow up duplex at 3, 6 and 12 months

Clinical follow up only

Routine follow up CT angiogram at 6 months

TEVAR now comprises a majority of thoracic aortic dissection repairs

Patients undergoing TEVAR have higher comorbidity burdens compared to patients undergoing open repair

Patients undergoing open repair have significantly inferior 3-year mortality rates compared to TEVAR

Men undergoing TEVAR have inferior 3-year mortality rates compared to women

Aortic dissection with cardiac tamponade

HTN crisis

Massive pulmonary thromboembolism

Myocardial infarct with congestive failure

Rupture of papillary muscle

False lumen of the stented segment rarely thromboses

The stented segment true lumen diameter remained stable over time

The stented segment false lumen diameter remained stable over time

The non-stented segment false lumen diameter remained stable over time

Impending rupture

Left renal artery perfused by the false lumen

Malperfusion of the intestines

Refractory hypertension

Type I with distal leak (Type Ib)

Type II emanating from a lumbar branch with an expanding aneurysm sac

Type II from a patent IMA with a gradually decreasing aneurysm sac size

Type II of a left common iliac aneurysm with an expanding aneurysm sac E) Type III from component separation with an expanding aneurysm sac

Lifelong surveillance is required

All type II endoleaks require investigation and repair

All type I endoleaks require investigation and repair

MR angiography is adequate for all patients after endovascular aneurysm repair

Pre-operative data

Inpatient stay

Intraoperative data

Postoperative data

Aorto-iliac reconstruction

Age of 74

Post-operative renal dysfunction

Moderate CKD disease at baseline

Patients with low psoas muscle area are more likely to have abdominal aortic aneurysm than arterial occlusive disease

Frailty as defined by low psoas muscle area is more severe with increased degree of arterial occlusive disease

Patients with abdominal aortic aneurysm are less frail than patients with arterial occlusive disease based on psoas muscle area

Low psoas muscle area in patients with arterial occlusive disease is predictive of coronary morbidity and mortality

Local wound care

Purely endovascular intervention

Purely open surgical revascularization

Primary major amputation

Local wound care

Hybrid revascularization approaches

Open autogenous surgical revascularization

Primary major amputation

1%

2%

3%

5%

Expeditiously during same hospital admission

At 4 weeks following MRI if no hemorrhage is detected

After 6 week of anticoagulation with coumadin

After 4 weeks of treatment with aspirin and clopidigrel

Consistent recommendations for interventions for symptomatic carotid stenosis with variable cost of therapy

Substantial variation in recommendations for revascularization for patients with both asymptomatic and symptomatic carotid stenosis

Widely variable costs for revascularization of asymptomatic, but not symptomatic, patients with carotid occlusive disease

Low costs despite variable interpretation criteria for carotid duplex examinations of symptomatic and asymptomatic patients

Recommend endarterectomy based on the patient’s report from the other institution

Repeat the study in your institution’s vascular lab to confirm the degree of stenosis

Not proceed with surgery because asymptomatic disease should be treated medically

Obtain an MRI to look for evidence of prior silent left hemispheric events

Moderate CKD class

Suprarenal clamp time

Female gender

Operative time

Use epidural anesthesia

Have a cardiology evaluation pre-operative

Start statin medication

Do the case in the fixed angio room

Carotid stenting was always associated with less adverse complications in all subgroups

The presence or absence of symptoms was less important than degree of stenosis in predicting adverse events

Carotid stenting and carotid endarterectomy always had similar outcomes

If patients were both high risk medically and symptomatic, those treated with CEA had fewer major adverse events post procedure

No treatment

Observation and Plavix

Stenting

CEA

White patients are more likely to initiate dialysis with an arteriovenous fistula than either black or Hispanic patients

Black patients are more likely to initiate dialysis with a tunneled catheter than white or Hispanic patients

Hispanic patients have similar rates of arteriovenous grafts as black patients, but more frequently than white patients

White patients, but not black and Hispanic patients, meet the threshold for arteriovenous fistulas set by the Fistula First Breakthrough

Placement of a tunneled catheter at the initiation of hemodialysis

Use of an arteriovenous graft since autologous fistulas perform poorly in Hispanics

Bridging an arteriovenous graft with a tunneled catheter

Early creation of an autologous arteriovenous fistula

Insulin

Thioglitazone

Sulfonylureas

Biguanides

Non-diabetic patient with TASC A lesion

Diabetic patient with TASC D lesion and one vessel runoff

Non-diabetic patient with popliteal aneurysm

Diabetic patient with TASC C lesion and peroneal runoff with tissue loss

Primary patency

Secondary patency

Primary assisted patency

Limb salvage

Aspirin and clopidigrel

A statin agent

Antiplatelet agent, statin and ACE inhibitor

Antiplatelet agent and ACE inhibitor

Provision of information that frequently changes the procedural plan

Increasing post-operative bleeding complications

Abrogating the need for any post-procedure anticoagulation

Excluding requirement for provocative positions during imaging

Never be performed, deferring instead to a dedicated study after 3 months of anticoagulation

Be performed with the arm in the neutral and hyper-abduction positions

Be completed with CO2 only

Delineate vena cava anatomy in view of the high rate of associated anomolies

Biologic mechanisms of restenosis after percutaneous transluminal angioplasty include acute vessel recoil, negative wall remodeling, and intimal hyperplasia

“Edge restenosis” after vascular brachytherapy (higher-than-expected restenosis rates at the edges of the treated vessel) is due to geographic miss of the lesion, barotrauma secondary to balloon inflation, dose falloff at the edge of the treated vessel, and source movement during the treatment

A vascular brachytherapy protocol using high-energy gamma sources must take into account the logistics of patient transportation to the department of radiation oncology, including increase in overall catheterization time, anticoagulation, and patient monitoring by trained personnel

Gamma-emitting sources for vascular brachytherapy have decreased depth penetration compared with beta-emitting sources

High-energy radio-therapy

Protamine coated stents

High-dose rate brachytherapy

Magnetic resonsance nano-particle infusion

Eph-B4 and ephrin-B2 and osteopontin expression were all significantly decreased in organ culture

Treatment of vein rings with Ephrin-B2/Fc led to a decrease in neointimal hyperplasia compared to controls

Activation of Eph-B4 with exogenous Ephrin-B2/Fc increased neointimal hyperplasia in human saphenous veins

Cultured endothelial cells demonstrated a significant down regulation of Eph-B4 phosphorylation when treated with Ephrin-B2/Fc

Supervised exercise dictated by primary care provider

Supervised exercise dictated by vascular specialist

Non-supervised exercise

Primary stenting

Supervised exercise dictated by a vascular specialist

Axillo-bifemoral bypass

Neo-aorto iliac system (NAIS) procedure

Primary stenting

Randomized controlled trials

Cohort single center studies

Retrospective cohort studies

Case control studies

Male gender

Age > 80

Smoking

Tissue loss

Symptomatic CAD and vasopressin use

Non-home discharge and procedure time

ICU stay and procedure time

Patient age and ICU stay

Undertake more clinical research from clinical databases

Make meta-analyses more clear and transparent

Have systemic reviews and meta-analyses written by independent statisticians

Answer option 4

Body Mass Index is the most important predictor of post-procedure hematoma formation

Use of small sheaths was protective of post-procedure hematoma

Use of ultrasound created more hematomas post-procedure

Pathology treated was important to predicting post-procedure hematoma

U/S should always be avoided

Smallest possible sheath should be utilized

Pt should be instructed to lose 20 lbs and return for therapy

Start Plavix

Routine use of ultra-sound guidance was helpful in reducing post-procedure access site complications

Vascular closure devices have caused more cardiac complications in PVI patients

Higher Body Mass Index was associated with lower access site complications

Older patients on Coumadin had the LOWEST complication rates of all groups studied

Routine use of U/S is important

Vascular closure devices should be avoided

Pts should be advised to lose weight and return for a procedure on another date

Start Plavix

24% of the time resolve spontaneously

All resulted in rupture of aneurysm sac

Always necessitate repair with onyx

Never resolved spontaneously

Only one device was necessary on all patients

In using this device 97% of primary cases and 89% of revisions were free of type I leaks at one month

Suggested use is only on proximal necks of 4cm or greater length

Similar to sea anchors, two should be used during high winds