Nesvs 2013 Annual Meeting Self-assessment Exam

The given answer states that when using the device, 97% of primary cases and 89% of revisions were free of type I leaks at one month. This suggests that the device is highly effective in preventing type I leaks, both in initial surgeries and in revisions. The high success rate indicates that the device is reliable and can be trusted for use in these cases.

The concurrent venogram during first rib resection for idiopathic venous thoracic outlet syndrome provides information that frequently changes the procedural plan. This means that during the procedure, the venogram helps to gather real-time information about the patient's condition and allows the medical team to make necessary adjustments to the surgical plan based on this information. This ensures that the procedure is tailored to the specific needs of the patient and increases the chances of a successful outcome.

During the index admission, the mortality rate for endovascular treatment of acute mesenteric ischemia is approximately 20%. This means that out of all the patients who undergo endovascular treatment for this condition, around 20% of them will die during their hospital stay. This suggests that although endovascular treatment can be effective in managing acute mesenteric ischemia, it still carries a significant risk of mortality.

The best post procedural management for patients undergoing endovascular treatment for chronic mesenteric ischemia would be to have follow up duplex at 3, 6 and 12 months. This is because duplex ultrasound is a non-invasive and cost-effective imaging modality that can assess blood flow and detect any restenosis or complications after the procedure. Regular follow up at these intervals allows for timely detection and management of any issues, ensuring optimal patient outcomes.

In recent years, patients undergoing thoracic aortic dissection repair have seen an increase in the use of TEVAR (Thoracic Endovascular Aortic Repair). This procedure now comprises a majority of the repairs. However, it has been observed that patients undergoing TEVAR have higher comorbidity burdens compared to those undergoing open repair. This suggests that patients who are deemed suitable for TEVAR may have more underlying health conditions or complications, which necessitate the use of a less invasive procedure.

Supervised exercise dictated by a vascular specialist is a clinically and cost-effective initial management approach for classic unilateral arterial calf claudication. This approach involves a structured exercise program that is supervised by a vascular specialist. It is considered effective because exercise helps improve blood flow to the affected area and can increase the distance that the patient can walk before experiencing symptoms. Additionally, it is cost-effective because it does not involve invasive procedures or the use of expensive medical devices.

Using the smallest possible sheath during percutaneous intervention is important for several reasons. Firstly, it reduces the risk of complications such as bleeding and hematoma formation at the access site. Secondly, it allows for better patient comfort and faster recovery post-procedure. Additionally, using a smaller sheath can minimize the risk of vascular injury and improve procedural success rates. Therefore, it is recommended to utilize the smallest possible sheath during percutaneous intervention.

The data collected in the study indicated that using ultrasound guidance routinely during procedures was effective in decreasing complications at the access site after the procedure.

Type I endoleaks developing post-operatively can sometimes resolve spontaneously, meaning that they can heal on their own without any intervention. However, it is important to note that this does not happen in all cases. The study mentioned in the presentation found that 24% of the time, these endoleaks resolved spontaneously. This means that in about a quarter of the cases, the endoleaks healed without any further treatment. It is also worth mentioning that the other options provided in the question are incorrect.

The factors that were not identified as independent predictors of worsening the patients postoperative renal dysfunction include moderate CKD class, suprarenal clamp time, and operative time. However, female gender was also not identified as an independent predictor of worsening postoperative renal dysfunction.

The patient's presentation is consistent with aortic dissection with cardiac tamponade. The stabbing chest pain radiating to the left shoulder, distant heart sounds, and pulsus paradoxus (an abnormal drop in blood pressure during inspiration) are all indicative of cardiac tamponade, which occurs when fluid accumulates in the pericardial sac and compresses the heart. The ECG findings of low voltage and ST wave changes can be seen in aortic dissection, and the widening of the mediastinum on the CXR is a classic finding in this condition. Therefore, aortic dissection with cardiac tamponade is the most likely diagnosis.

The left renal artery being perfused by the false lumen would be an indication to use a TEVAR to treat the patient. In a type B aortic dissection, the false lumen can cause complications such as organ malperfusion. If the left renal artery is being perfused by the false lumen, it means that the blood flow to the kidney is compromised. Using a TEVAR can help redirect blood flow and restore perfusion to the left renal artery, preventing further complications. Therefore, this would not be a reason to not use a TEVAR in this patient.

The answer suggests that patients who are both high risk medically and symptomatic have fewer major adverse events after undergoing carotid endarterectomy (CEA) compared to carotid stenting. This implies that CEA is more beneficial in this specific subgroup of patients. The statement contradicts the previous statements that carotid stenting was always associated with less adverse complications and that the presence or absence of symptoms was less important than the degree of stenosis in predicting adverse events.

Post-operative renal dysfunction would best predict decreased long term survival in a 74-year-old patient pre-op for an open AA repair. Renal dysfunction after surgery can lead to complications such as kidney failure, electrolyte imbalances, and fluid overload, which can negatively impact the overall health and survival of the patient in the long term. Age, aorto-iliac reconstruction, and moderate CKD disease at baseline may also have an impact on survival, but post-operative renal dysfunction is likely to have the greatest impact.

Patients presenting with stable acute stroke with significant ipsilateral carotid stenosis should undergo carotid endarterectomy (CEA) expeditiously during the same hospital admission. This means that the procedure should be done promptly, without delay, while the patient is still in the hospital. This is because CEA is an effective surgical treatment for carotid stenosis, and early intervention can help prevent further complications and improve outcomes for the patient. Delaying the procedure may increase the risk of recurrent stroke or other adverse events.

The best therapy for an 85-year-old with left amaurosis fujax and a left-sided 80% stenosis would be carotid endarterectomy (CEA). This surgical procedure involves removing the plaque buildup in the carotid artery to restore blood flow and prevent further complications such as stroke. It is considered the gold standard treatment for symptomatic patients with significant carotid stenosis. No treatment or observation with Plavix may not be sufficient to address the underlying issue, and stenting may not be recommended due to the patient's age and the severity of the stenosis.

The correct answer suggests that patients with abdominal aortic aneurysm have a higher psoas muscle area, indicating that they are less frail compared to patients with arterial occlusive disease. This implies that the presence of abdominal aortic aneurysm may be a protective factor against frailty, as indicated by the measurement of psoas muscle area.

The treatment of vein rings with Ephrin-B2/Fc resulted in a decrease in neointimal hyperplasia compared to the control group. This suggests that Ephrin-B2/Fc has a inhibitory effect on the development of neointimal hyperplasia.

The data from the US Renal Database System shows that white patients are more likely to start dialysis with an arteriovenous fistula compared to black or Hispanic patients. This suggests that there may be disparities in access to and utilization of arteriovenous fistulas among different racial and ethnic groups. It is important to address these disparities and ensure equal access to optimal dialysis initiation methods for all patients.

Primary stenting is the least cost-effective option for patients with ilio-femoral occlusive disease and claudication, according to contemporary cost-effectiveness analysis. This means that compared to the other options listed (supervised exercise dictated by primary care provider, supervised exercise dictated by vascular specialist, and non-supervised exercise), primary stenting is not as cost-effective in terms of the outcomes it provides relative to its cost.

The answer suggests that if carotid duplex criteria from 10 different vascular laboratories are applied, there will be substantial variation in recommendations for revascularization for patients with both asymptomatic and symptomatic carotid stenosis. This means that different laboratories would have different opinions on whether or not a patient should undergo revascularization, leading to inconsistent recommendations.

Thioglitazone is a medication commonly used to treat type 2 diabetes. It belongs to a class of drugs called thiazolidinediones, which work by increasing the body's sensitivity to insulin. This improved insulin sensitivity can help regulate blood sugar levels and reduce the risk of complications associated with diabetes, such as vascular problems. In the context of the question, it suggests that diabetic patients who are on thioglitazone as part of their medical regimen have better outcomes in terms of primary patency (the ability of a blood vessel to remain open) following stenting of the superficial femoral artery.

The correct answer is "Non-diabetic patient with TASC A lesion." This patient has the best outcome with superficial artery stenting because TASC A lesions are characterized by single, short, and less complex stenosis or occlusion. These lesions have a lower risk of complications and are more amenable to endovascular treatment. Additionally, being non-diabetic further improves the prognosis as diabetes is a risk factor for poor outcomes in peripheral artery disease. Therefore, this patient has the best chance of successful treatment and a favorable outcome with superficial artery stenting.

Randomized controlled trials are considered the highest level of evidence by the Oxford Centre for Evidence-based Medicine. This is because these trials involve randomly assigning participants to different groups, with one group receiving the intervention being studied and the other group receiving a control or placebo. This randomization helps to minimize bias and ensures that any observed differences between the groups can be attributed to the intervention being studied. Randomized controlled trials are considered to provide the most reliable evidence for determining the effectiveness of an intervention.

The best medical management for patients undergoing endovascular treatment of infrainguinal occlusive disease likely includes an antiplatelet agent, a statin agent, and an ACE inhibitor. This combination of medications helps to prevent platelet aggregation, reduce cholesterol levels, and improve vascular function. Antiplatelet agents, such as aspirin and clopidogrel, help to prevent blood clot formation. Statin agents help to lower cholesterol levels and reduce the risk of atherosclerosis. ACE inhibitors help to improve vascular function and reduce blood pressure. Therefore, the combination of these three medications provides a comprehensive approach to managing this condition.

The correct answer is non-home discharge and procedure time. This means that patients who were not discharged to their homes after endovascular AAA repair and had longer procedure times had a greater increase in length of stay. This suggests that patients who required more extensive procedures or had complications that prevented them from being discharged home had longer hospital stays.

The data from the study suggests that using small sheaths was protective of post-procedure hematoma formation. This means that when smaller sheaths were used during the procedure, there was a lower likelihood of developing hematoma afterwards. This finding implies that the size of the sheath used plays a significant role in preventing hematoma formation, indicating that using smaller sheaths may be a beneficial practice in reducing post-procedure complications.

The correct answer is Routine use of U/S is important. This is because the patient is 62 years old, obese, and has diabetes. These factors put the patient at a higher risk for vascular complications during a procedure. The routine use of ultrasound (U/S) can help in identifying any abnormalities or potential complications before and during the procedure, allowing for appropriate management and minimizing risks.

The correct answer is to perform the intraoperative venogram with the arm in the neutral and hyper-abduction positions. This is because these positions allow for better visualization and assessment of the subclavian vein and any potential residual stenosis or thrombosis. By performing the venogram in these positions, the surgeon can ensure that the procedure has been successful in relieving the venous thoracic outlet syndrome and subclavian vein thrombosis. The other options are not relevant to the intraoperative venogram procedure or the specific case presented.

Carotid-subclavian bypass would be the best management option for an 82-year-old woman with COPD and disabling right arm claudication from proximal subclavian artery occlusion. This procedure involves creating a bypass graft to restore blood flow from the carotid artery to the subclavian artery, bypassing the occluded segment. This would alleviate the symptoms of arm claudication and improve blood flow to the arm. Aorto-subclavian bypass may be considered in certain cases, but carotid-subclavian bypass is generally preferred due to its lower morbidity and mortality rates. Femoro-subclavian bypass may not be suitable in this case as it involves bypassing the subclavian artery from the femoral artery, which is a more invasive procedure. Cilostazol treatment alone may not be sufficient to address the underlying occlusion.

Based on the information provided, the correct answer is to repeat the study in your institution's vascular lab to confirm the degree of stenosis. This is because the patient's previous duplex study from another institution may not be accurate or reliable. By repeating the study in your own lab, you can ensure the accuracy of the results before making any decisions regarding carotid endarterectomy.

High-dose rate brachytherapy is a valid approach to enhance the durability of endovascularly treated femoral occlusive lesions. Brachytherapy involves the use of high-dose radiation delivered directly to the site of the lesion, which can help prevent restenosis and improve long-term outcomes. This approach is particularly effective in selected circumstances, such as in a 72-year-old male with specific risk factors or characteristics that make him a suitable candidate for this treatment. The other options, including high-energy radiotherapy, protamine coated stents, and magnetic resonance nanoparticle infusion, are not currently recognized as valid approaches for enhancing the durability of endovascularly treated femoral occlusive lesions.

The most appropriate type of endoleak for transcaval embolization is Type II emanating from a lumbar branch with an expanding aneurysm sac. This type of endoleak occurs when blood flows into the aneurysm sac through a lumbar artery. Transcaval embolization is a minimally invasive procedure that involves blocking the flow of blood through the lumbar artery to prevent further expansion of the aneurysm sac. This treatment is effective for Type II endoleaks because it targets the specific source of the blood flow and helps to reduce the risk of rupture or complications.

The explanation for the correct answer, which is "Postoperative data," is that the concordance of variables between the two vascular surgery databases, VQI and NSQIP, is least in the postoperative data. This means that there is a greater discrepancy or difference in the variables reported in the postoperative data between the two databases compared to other categories such as pre-operative data, inpatient stay, and intraoperative data. This could be due to various factors such as differences in data collection methods, reporting practices, or data abstraction techniques used in the two databases.

The correct answer is "Early creation of an autologous arteriovenous fistula." This is the recommended option because autologous arteriovenous fistulas are the preferred method of vascular access for hemodialysis. They have better long-term outcomes and lower rates of complications compared to tunneled catheters or arteriovenous grafts. The patient being Hispanic does not impact the choice of vascular access.

The given question is asking for the factor that was not greater for trans-thoracic versus extra thoracic aortic branch reconstructions. The options provided are thromboembolic complications, perioperative stroke, blood transfusions, and length of stay. The correct answer is perioperative stroke. This means that perioperative stroke was not greater for trans-thoracic versus extra thoracic aortic branch reconstructions compared to the other factors mentioned.

The statement that gamma-emitting sources for vascular brachytherapy have decreased depth penetration compared with beta-emitting sources is not correct.

In patients with end-stage renal disease and peripheral vascular disease with tissue loss, primary major amputation is associated with the highest costs and the worst clinical outcomes. This means that choosing primary major amputation as a treatment option for these patients is likely to result in higher healthcare expenses and poorer overall patient outcomes compared to other options such as local wound care, purely endovascular intervention, or purely open surgical revascularization.

Primary major amputation is associated with the highest costs and the worst clinical outcomes for a patient with peripheral vascular disease, IDDM, and end-stage renal disease with minor forefoot tissue loss. This is because amputation is a major surgical procedure that involves removing a limb or a significant part of it, which can lead to significant complications and a prolonged recovery period. Additionally, amputation can have a significant impact on the patient's quality of life and functional abilities, resulting in higher healthcare costs and poorer clinical outcomes compared to other treatment options such as local wound care or revascularization approaches.

The correct answer is "All type II endoleaks require investigation and repair." This statement is incorrect because not all type II endoleaks require investigation and repair. Type II endoleaks occur when blood flows into the aneurysm sac through branch vessels. In some cases, these endoleaks may resolve on their own without intervention. Therefore, not all type II endoleaks require investigation and repair, making this statement false.

The use of an ACE inhibitor for patients undergoing endovascular treatment of lower extremity disease improved limb salvage. This means that the ACE inhibitor helped in preserving the affected limb and preventing amputation. It is likely that the ACE inhibitor had a positive effect on blood flow and circulation, reducing the risk of complications and improving the overall outcome for patients undergoing this treatment.

The correct answer is to make meta-analyses more clear and transparent. This is because with the decrease in randomized controlled trials in vascular surgery, meta-analyses and systematic reviews have become more important in advancing knowledge and informing healthcare decision making. By making these analyses more clear and transparent, it ensures that the findings and conclusions are easily understood and can be critically evaluated by healthcare professionals. This promotes transparency and helps to improve the quality and reliability of the research in the field of vascular surgery.

Late remodeling of the aorta refers to the changes that occur in the aorta after a stent graft is placed to treat aortic dissection. In this case, the correct answer suggests that the false lumen diameter of the non-stented segment remains stable over time. This means that the area of the aorta that was not treated with the stent graft does not expand or increase in size. This is a positive finding because it indicates that the stent graft is effectively diverting blood flow away from the false lumen and preventing further expansion of the aorta.

The correct answer is 1%. This means that out of all the patients undergoing early carotid endarterectomy (CEA) for acute stroke, only 1% experienced a perioperative stroke. This suggests that the incidence of perioperative stroke in this group is relatively low.

Smoking is not an independent predictor for amputation-free survival of critical limb ischemia patients who undergo peripheral vascular intervention. This means that smoking does not have a significant impact on the likelihood of these patients surviving without needing amputation. Other factors, such as male gender, age over 80, and tissue loss, may have a stronger influence on amputation-free survival.

Starting statin medication can help minimize the post-operative stay for the 84-year-old patient undergoing EVAR (endovascular aneurysm repair). Statins are commonly prescribed to lower cholesterol levels and reduce the risk of cardiovascular events. By starting statin medication pre-operatively, it can potentially improve the patient's overall cardiovascular health, reduce complications, and facilitate a faster recovery, ultimately leading to a shorter hospital stay. This option is more likely to have an impact on the patient's post-operative stay compared to the other options listed.