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Self-Assessment for Vascular
and Endovascular Specialists
Including over 500 multiple choice questions covering a wide range of vascular disorders to test the skills of all vascular specialists. Suitable for postgraduate trainee vascular medicine internists, inter­ventional radiologists, vascular surgeons, and endovascular therapists as they prepare for exams or ensure that they remain up to date.
Divided into 21 subject-specific sections and meticulously written and researched, the questions and their accompanying rationales are enhanced by explanatory illustrations and supported by key refer­ences. Students and experienced clinicians w ill be prepared for both testing and teaching in all aspects of clinical practice.
Advances in the treatment of vascular disease have played a significant role in rising life expectancy over the past 70 years, resulting in lower morbidity, mortality, and quicker recoveries. However, there remai ns an urgent challenge i n controlli ng risk factors such as obesit y, sedentary li festyles, a nd tobacco abuse. As explosive growth in endovascular technology continues, it is more important than ever for vascular specialists to remain proficient and stay up to date.
Self-Assessment for Vascular
and Endovascular Specialists
Sachinder Singh Hans, MD, FACS, FRCS(C)
Medical Director
Vascular and Endovascular Services
Henry Ford Macomb Hospital Clinton TWP (MI)
Clinical Assistant Professor of Surgery
Wayne State University School of Medicine, Detroit, Michigan
Board Certified in Vascular Surgery, Surgical Critical Care and General Surgery
Designed cover image: Shutterstock 181632251 First edition published 2024
by CRC Press 2385 NW Executive Center Drive, Suite 320, Boca Raton, FL 33431
and by CRC Press 4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
CRC Press is an imprint of Taylor & Francis Group, LLC
© 2024 Sachinder Singh Hans This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have be en made
to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the pub­lishers. The information or guidance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers.
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Library of Congress Cataloging-in-Publication Data
Names: Hans, S. S. (Sachinder Singh), author. Title: Self-assessment for vascular and endovascular specialists / Sachinder Singh Hans. Description: First edition. | Boca Raton, FL : CRC Press, 2023. | Includes bibliographical references and index. | Summary: “Including over 500 multiple choice questions covering a wide range of vascular disorders to test the skills of all vascular specialists. Suitable for postgraduate trainee vascular medicine internists, interventional radiologists, vascular surgeons, and endovascular therapists as they prepare for exams or ensure that they remain up to date. Divided into 21 subject specific sections and meticulously written and researched, the questions and their accompanying rationales are enhanced by explanatory illustrations and supported by key references. Students and experienced clinicians will be prepared for both testing and teaching in all aspects of clinical practice. Advances in the treatment of vascular disease have played a significant role in rising life expectancy over the past 70 years, resulting in lower morbidity, mortality, and quicker recoveries. However, there remains an urgent challenge in controlling risk factors such as obesity, sedentary lifestyles, and tobacco abuse. As explosive growth in endovascular technology continues, it is more important than ever for vascular specialists to remain proficient and stay up to date”-- Provided by publisher. Identifiers: LCCN 2023023082 (print) | LCCN 2023023083 (ebook) | ISBN 9781032486123 (hardback) | ISBN 9781032485553 (paperback) | ISBN 9781003389897 (ebook) Subjects: MESH: Vascular Diseases | Vascular Surgical Procedures | Problems and Exercises Classification: LCC RC691 (print) | LCC RC691 (ebook) | NLM WG 18.2 | DDC 616.1/3--dc23/eng/20230907 LC record available at https://lccn.loc.gov/2023023082
LC ebook record available at https://lccn.loc.gov/2023023083
ISBN: 9781032486123 (hbk)
ISBN: 9781032485553 (pbk) ISBN: 9781003389897 (ebk)
DOI: 10.1201/9781003389897
Typeset in Utopia Std by KnowledgeWorks Global Ltd.
Dedication
This book is dedicated to the memory of my late brother,
Dr. Jagjit Singh Hans, MD, Professor of Internal Medicine, Government Medical College Patiala (Pb), India.
He was inspirational to me for pursuing surgery as my career.
Contents
Preface viii Acknowledgments ix Author x
SECTION 1: ANATOMY, PHYSIOLOGY, AND HEMODYNAMICS �������������������������������������������� 1
SECTION 2: VASCULAR LABORATORY ����������������������������������������������������������������������������������� 12
SECTION 3: RADIATION SAFETY ���������������������������������������������������������������������������������������������� 30
SECTION 4: VASCULAR MEDICINE ����������������������������������������������������������������������������������������� 34
SECTION 5: CEREBROVASCULAR DISEASE ������������������������������������������������������������������������� 42
SECTION 6: VASCULAR SURGICAL CRITICAL CARE ����������������������������������������������������������� 79
SECTION 7: THORACIC OUTLET SYNDROME ����������������������������������������������������������������������� 88
SECTION 8: AORTOILIAC DISEASE ����������������������������������������������������������������������������������������� 95
SECTION 9: LOWER EXTREMITY ARTERIAL DISEASE �����������������������������������������������������182
SECTION 10: RENAL AND MESENTERIC DISEASE ������������������������������������������������������������ 215
SECTION 11: UPPER EXTREMITY ARTERIAL DISEASE ����������������������������������������������������237
SECTION 12: VASCULAR TRAUMA ����������������������������������������������������������������������������������������243
SECTION 13: VENOUS DISEASE �������������������������������������������������������������������������������������������� 257
SECTION 14: LYMPHOLOGY ����������������������������������������������������������������������������������������������������292
SECTION 15: DIALYSIS ACCESS ��������������������������������������������������������������������������������������������303
SECTION 16: AMPUTATIONS ���������������������������������������������������������������������������������������������������324
SECTION 17: ENDOVASCULAR RETRIEVAL OF FOREIGN BODIES ��������������������������������� 329
SECTION 18: GRAFT INFECTIONS �����������������������������������������������������������������������������������������333
SECTION 19: VASCULAR CLOSURE DEVICE �����������������������������������������������������������������������338
SECTION 20: RARE VASCULAR ENTITIES ���������������������������������������������������������������������������� 341
SECTION 21: BIOSTATISTICS ��������������������������������������������������������������������������������������������������357
Index 364
Preface
Vascular disease affects a large segment of Western populations and results in serious complications if not managed appropriately. During the past seven decades, the treatment of vascular disease has progressed from medical management to open reconstruction. More recently, the explosive growth of endovascular technologies has resulted in lower morbidity, mortality, and quicker recoveries.
In spite of the availability of recent advances and technological successes, there remains an urgent challenge in controlling risk factors causing vascular disease. These include obesity, sedentary lifestyles, unhealthy diets, and tobacco abuse, as well as increasing incidence of diabetes mellitus and uncontrolled hypertension in patients of low socioeconomic status, resulting in renal failure and kidney replacement therapy.
The complexity of vascular diseases has meant that some vascular specialists are limiting their practice in many categories of vascular pathology, including complex aortic disease, limb salvage, venous disease, thoracic outlet syndrome, and vascular access procedures for end-stage kidney disease. In order to remain proficient as a vascular specialist, one has to keep up with the knowledge of the current literature; specialists must thus engage in self-assessment of their skills. Additionally, throughout the world vascular specialists must become certified and pass maintenance or certifica­tion examinations.
This book thus provides the tools for self-assessment, with over 500 questions (each with four possible answers, an explanation for the best answer, and one to two references). This book is not a substitute for a textbook in vascular surgery, leading vascular journals, and experience gained during clinical practice. It should primarily be considered a primer for taking the vascular examinations and a quick reference for a clinical problem. As the literature advances and technology evolves, some answers may become out of date, and the reader is advised to consult the latest literature.
Acknowledgments
First and foremost, I wish to thank Miranda Bromage, Senior Medical Editor, CRC Press/Taylor & Francis, for providing unrelenting support starting from acceptance of the proposal to the final pub­lication of this work. I appreciate the support of Hudson Greig, Editorial Assistant at CRC Press/Taylor & Francis. My sincere thanks to Juliet Mullenmeister, MLIS, AHIP, and Melanie Bednarski, MLIS, AHIP, from the Library Department of Henry Ford Macomb Hospital for their diligent medsearch and editorial support. Miss Kait Fecteau helped in transcription, and Dr. Shyamal Pansurya, sur­gery resident at Henry Ford, provided IT support to complete the submission to CRC Press. Dr. Scott Dulchavsky, MD, PhD, Chairman of Surgery, Henry Ford Health, provided the leadership in getting this project completed, as well as the financial support from the department for which I will always be grateful. My thanks to my wife, Dr. Bijoya Hans, for attending to the tasks in my absence because of the time commitment for preparation of this work and to my son, Gautam Hans, JD, MS, for proof­reading and editing the Preface.