The Vein Forum: Comprehensive Venous Management For The Practicing Clinician
The American College of Surgeons has assigned a maximum of 14 AMA PRA Category 1 Credits™ to the course. Self-assessment credit has been assigned for the entire course. The post-test must be completed by September 18, 2014. A minimum performance level of 75% must be attained in order to earn the self-assessment credit. Multiple attempts are permitted within the 10-day span. Please note that a physician cannot earn the entire self-assessment credit if he/she has not attended the entire course. CME ScaleSeptember 5Morning Sessions: 3. 5 credit hoursAfternoon Sessions: 3. 5 credit hoursSeptember 6Morning Sessions: 4 credit hoursAfternoon Sessions: 3 credit hours
- 1.Write text here
- 2.Relevant Venous AnatomyThe intersaphenous vein connects the:
- A.
Anterior accessory and great saphenous veins.
- B.
Perforator and great saphenous veins.
- C.
Great saphenous and small saphenous veins.
- D.
Small saphenous and superficial femoral veins.
- 3.Clinical Presentation and PathophysiologyAccording to the SVS/AVF 2011 clinical practice guidelines regarding perforators which is correct?
- A.
All perforators should be ablated
- B.
Only C5 and C6 should have perforator surgery once the superficial reflux has been corrected
- C.
Perforator diameter of less than 3.5 mm with reflux should be ablated
- D.
Symptomatic C2 and C3 patients with perforator insufficiency should have ablation in conjunction with superficial saphenous ablation
- 4.Venous Ablation RFA/EVLTLaser light is:
- A.
Scattered, dissipated, absorbed
- B.
Reflected, diminished, intensified
- C.
Attenuated, scattered, reflected
- D.
Absorbed, reflected, scattered
- 5.Venous Non-Thermal AblationWhich of the following is a characteristic on US evaluation of iliofemoral vein obstruction?
- A.
Phasic flow in the common femoral vein
- B.
Chronic changes in the common femoral vein
- C.
Pulsatility in the common femoral vein
- D.
Continous non-phasic flow in the common femoral vein
- 6.Venous Ablation Sclerotherapy/USGFSA 39 year old female patient has reticular veins (3-4 mm veins), and requires a sclerotherapic agent to ablate her veins. Which of the following agents is most appropriate to achieve effective vein closure, but with minimal side effects (the “minimum effective concentration”)?
- A.
3.0% Sodium Tetradecyl Sulfate (STS) liquid
- B.
0.5% Polidocanol (PD) liquid
- C.
Foam sclerotherapy
- D.
1.0% Polidocanol (PD)
- 7.IVC FiltersA 56 year old female requires an IVC filter due to a failure of anticoagulation for an iliofemoral DVT. When obtaining consent you can explain that The PREPIC study:
- A.
Randomized patients with DVT +/- PE to receive or not receive an IVC filter in addition to anticoagulation and the follow up was 18 years.
- B.
At 8 years patients with IVC filters had a significant decrease in pulmonary embolism
- C.
At 18 years there was an increase in survival in patients receiving IVC filters
- D.
At 8 years patients with an IVC filter had significantly less recurrent deep vein thrombosis
- 8.IFDVT/Outflow ObstructionA 64 year old female presents with left leg edema and her CEAP classification is C5. When teaching the medical student, you explain the etiology may include an Iliofemoral venous obstruction and:
- A.
Rarely contributes to the development of chronic venous insufficiency
- B.
Is only caused by venous thrombosis
- C.
May be diagnosed using venography or IVUS
- D.
Can often by treated by stenting and data supports this approach.
- 9.Pelvic Venous CongestionWhich of the following statements is CORRECT about Pelvic Venous Congestion Syndrome?
- A.
In the presence of LEFT ovarian vein reflux, varicose veins always appear on the LEFT labial and leg region
- B.
If pelvic venous congestion is associated with severe obstruction of the left renal vein or iliac veins, then this obstruction should be treated prior to pelvic venous embolization when possible
- C.
Pelvic Venous Congestion Syndrome is a disorder common in post menopausal women
- D.
If internal iliac vein reflux is detected, coils should always be used along with catheter directed sclerotherapy
- 10.Vascular MalformationsA 14 year old boy has always had a “birthmark” on his left thigh. As a child, prominent veins were noticed, but over the past year, a larger network of distended tortuous veins over thigh has become more evident. He reports that his leg tires easily and it feels heavy after activities. Which of the following would be the most useful initial diagnostic study?
- A.
Angiogram
- B.
Venogram
- C.
CT scan
- D.
MRI
- E.
Duplex ultrasound
- 11.DVT and Post-Thrombotic SyndromeAccording to the Clinical Practice Guidelines from the American Venous Forum and Society of Vascular Surgery: A strategy for early thrombus removal is suggested for which patient?
- A.
45 year old with femoropopliteal DVT less than 14 days in duration.
- B.
55 year old with iliofemoral DVT of less than 14 days in duration.
- C.
55 year old with femoropopliteal DVT of less than 21 days in duration.
- D.
45 year old with iliofemoral DVT of less than 21 days in duration.
- 12.Compression and Wound AdjuvantsA 48 year old male with a history of chronic venous insufficiency has been treated for over a year for a recalcitrant venous leg ulcer. Compression with high strength bandaging has resulted in some improvement in the wound but not complete healing. Reflux duplex studies reveal a normal deep venous system and an incompetent great saphenous vein throughout its length. Which of the following is most likely to result in an increased likelihood of healing of the ulcer in the next 6 months?
- A.
Continued high strength compression bandaging
- B.
High ligation and stripping of the great saphenous vein
- C.
Endovenous laser ablation of the great saphenous vein
- D.
Application of Apligraf to the wound and continued high strength compression bandaging.
- 13.Indication for Treating DVT and RecurrenceRecurrent Deep Vein Thrombosis (DVT) is most likely to occur in patients:
- A.
On chronic therapeutic anticoagulation
- B.
After a provoked acute DVT that resolves on anticoagulation
- C.
After thrombolysis for acute DVT while on therapeutic rivaroxaban (xarelto)
- D.
With diffuse chronic scar in the iliac and common femoral veins.
- 14.How to Use AnticoagulantsBased on current evidence based guidelines, all of the following anticoagulants are indicated for treatment of acute deep venous thrombosis as initial therapy except:
- A.
Unfractionated heparin
- B.
Low molecular weigh heparin
- C.
Fondaprinux
- D.
Warfarin
- 15.Pharmacologic Management of CVDMicronized purified flavonoid fraction (MPFF), a mixture of diomin and hesperidin, has been shown to decrease which of the following variables?
- A.
Diameter of existing varicosities
- B.
Number of visible varicose veins
- C.
Time to ulcer healing
- D.
Rate of new varicosity formation
- 16.Horse chestnut extract (HCE) has been shown to reduce leg edema. This compound may be especially beneficial in which population?
- A.
The morbidly obese
- B.
Those with previous DVT
- C.
Women
- D.
Those with arterial insufficiency
- 17.Perforator ManagementA 49 year old male patient has venous ulcers, popliteal vein reflux, refluxing medial calf perforating veins and an otherwise normal superficial venous system, and no prior history of DVT. After maximizing his conservative therapy and wound care, the next appropriate step for treatment of this patient would be? Choose the best answer.
- A.
Treatment of the incompetent perforator veins
- B.
Treatment of the incompetent perforator veins, even if the above patient had extensive history of ileofemoral deep vein thrombosis
- C.
Treatment of incompetent perforator veins even if the patient had only edema and varicose veins (C3) and no leg ulcers.
- D.
Treatment of the incompetent perforator veins even if the patient had deep venous reflux in femoral and popliteal veins, GSV reflux, and subacute calf vein DVTs.
- 18.Live Ultrasound ImagingWhat is the most common pathologic thigh varicosity?
- A.
Anterior Accessory Saphenous Vein
- B.
Vein of Giacommini
- C.
Posterior Saphenous Vein
- D.
Vein of Stephens
- 19.The image in Duplex ultrasound is:
- A.
‘A’ mode
- B.
'B’ mode
- C.
'M’ mode
- D.
‘D’ mode
- 20.Duplex ultrasound combines:
- A.
Infrared and Doppler
- B.
Doppler and ‘B’ mode
- C.
'A’ mode and ‘B’ mode
- D.
Doppler and ‘M’ mode
- 21.Great Saphenous Vein Duplication occurs:
- A.
In the thigh
- B.
In the calf
- C.
Never
- D.
Only in the left leg
- 22.Normally, the Great Saphenous Vein
- A.
Is duplicated
- B.
Is less than 3 mm in diameter
- C.
Is within the saphenous fascia
- D.
Is right beneath the skin
- 23.The Small Saphenous Vein
- A.
Is often duplicated
- B.
Is deep to the fascia in the upper calf
- C.
Always enters the popliteal vein at the popliteal crease
- D.
Is always medial to the Achille’s tendon
- 24.The Great Saphenous Vein:
- A.
Always lies within the saphenous fascia
- B.
Can exit the fascia
- C.
Is always singular
- D.
Is > 3 mm in patients with varicose veins
- 25.The Great Saphenous Vein:
- A.
Always contributes to varicose veins
- B.
Can be normal with varicose veins
- C.
Has at least 10 valves
- D.
Is correctly called the Long Saphenous Vein
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