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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3749_Библиотеки_им_академика_М_И_Перельмана
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38 Multiple-Choice Questions
419
C. Vacuum-assisted closure
D. Local wound exploration and ligation of lymphatics
Correct answer: D
Question 4
Risk of graft infection following axillofemoral graft is:
A. Less than 5%
B. 5–10%
C. 11–15%
D. Greater than 15%
Correct answer: C
Chapter 31: Iliac and Femoral Endarterectomy
Question 1
During retroperitoneal exposure of common iliac artery, the dissection plane occurs:
A. Posterior to psoas major
B. Anterior to psoas major
C. Anterior to quadratus lumborum
D. Posterior to quadratus lumborum
Correct answer: B
Question 2
The most common cause of lymphocele following femoral endarterectomy is:
A. Postoperative hematoma
B. Interruption of groin lymphatics
C. Prior groin radiation
D. Vertical skin incision
Correct answer: B
Question 3
The preferred groin incision for femoral endarterectomy in a morbidly obese
patient is:
A. Vertical
B. Hockey stick
C. Horizontal (transverse)
D. Common femoral atherectomy being preferred to endarterectomy
Correct answer: C
420
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
S. S. Hans and A. D. Shepard
Chapter 32: Femoral-Popliteal Bypass Graft
Question 1
Using autologous saphenous vein for femoral-popliteal bypass graft, 5-year
patency is:
A. 90% above knee and 70% below knee
B. 80% above knee and 60% below knee
C. 70% above knee and 50% below knee
D. 60% above knee and 40% below knee
Correct answer: C
Question 2
The origin of the profunda femoris artery is crossed by:
A. Lateral circumex femoral vein anteriorly
B. Lateral circumex femoral vein posteriorly
C. Medial circumex femoral vein anteriorly
D. Medial circumex femoral vein posteriorly
Correct answer: A
Question 3
During exposure of the common femoral artery:
A. The inguinal lymphatics and lymph nodes.
B. The lymphoadipose tissue is mobilized medially.
C. Dissection is performed through the lymphoadipose tissue.
D. Lymphoadipose tissue is only encountered in the groin of patients with mor-
bid obesity.
Correct answer: B
Chapter 33: Femoral-Infrapopliteal (Crural and Paramalleolar) Bypass
Graft
Question 1
During performance of femoral-tibial bypass with in situ technique, the proximal
GSV cannot be brought to the common femoral artery with signicant stenosis.
The most useful adjunct is:
A. Common femoral stent using contralateral access
B. Common femoral atherectomy using contralateral access
C. Common femoral artery endarterectomy with patch graft
D. Using a composite graft from distal external iliac artery (PTFE) and in situ
bypass distally
Correct answer: C
38 Multiple-Choice Questions
421
Question 2
The tourniquet occlusion technique for infrainguinal bypass graft is best utilized for:
A. Above-knee femoral-popliteal bypass graft
B. Below-knee femoral-popliteal bypass graft
C. Femoral-mid posterior tibial bypass graft
D. Femoral-popliteal bypass graft using PTFE graft with distal anastomosis
behind the knee
Correct answer: C
Question 3
Anterior tibial artery in its mid-segment is exposed between:
A. Lateral border of tibia and tibialis anterior
B. Tibialis anterior and extensor digitorum longus
C. Tibialis anterior and extensor hallucis longus
D. Extensor digitorum longus and extensor hallucis longus
Correct answer: C
Question 4
The incidence of major amputation (BK/AK) following femoral-infrapopliteal
bypass is:
A. Less than 1%
B. 1–1.5%
C. 1.6–2%
D. Greater than 2%
Correct answer: C
Chapter 34: Upper Extremity Bypass Graft
Question 1
Anatomically, axillary artery becomes brachial artery at the:
A. Lateral border of pectoralis minor
B. Lateral border of latissimus dorsi
C. Lateral border of teres major
D. Origin of brachialis
Correct answer: C
Question 2
Advanced ischemic changes with gangrene in the hand and ngers are most often
associated with:
A. Diabetes mellitus
B. Scleroderma
422
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S. S. Hans and A. D. Shepard
C. ESRD
D. Subclavian artery aneurysm with thoracic outlet syndrome
Correct answer: C
Question 3
Following brachial artery occlusion, the most important collateral supply to forearm
and hand is:
A. Anterior and posterior circumex humeral artery
B. Deep (profunda) brachial artery
C. Radial recurrent artery
D. Palmer branch of ulnar artery
Correct answer: B
Chapter 35: Arterial Reconstructions in Hostile Groin
Question 1
A 68-year-old male presented with bleeding in the left groin. He had undergone
aortobifemoral graft performed 10 years ago. Graft thrombectomy for occlusion
of the left limb was required 2 years and 9 months ago. The patient was hemodynamically stable with slight erythema in the left groin. CTA of abdomen and
pelvis showed normal body and right limb of the graft with peri-graft uid
around the left limb. WBC scan showed increased uptake in the left limb. The
patient is at high risk for complete graft removal. The best option in this situation is:
A. Axillofemoral graft with left-side anastomosis to mid-supercial femoral
artery followed by graft removal
B. Left axillopopliteal bypass with graft routed over the iliac crest
C. Reconstruction with a new graft ush from the origin of the left limb of aor-
tobifemoral graft with distal anastomosis to left mid-supercial femoral
artery via obturator canal
D. Local debridement and sartorius myoplasty
Correct answer: C
Question 2
Mid-supercial femoral artery is located:
A. Anterior to sartorius
B. Posterior to sartorius
C. Medial to vastus medialis
D. Behind the adductor magnus
Correct answer: B
38 Multiple-Choice Questions
423
Question 3
A 66-year-old male with hostile graft is scheduled to undergo iliofemoral graft with
distal anastomosis to the mid-supercial femoral artery. An incision is made lateral to the sartorius. The dissection plane should be:
A. Adductor longus and vastus medialis
B. Adductor longus and adductor magnus
C. Vastus medialis and gracilis
D. Vastus medialis and rectus femoris
Correct answer: A
Question 4
During passage of graft through the obturator canal, the graft in the thigh should be:
A. Posterior to adductor longus
B. Posterior to vastus medialis
C. Anterior to adductor longus
D. Posterior to gracilis
Correct answer: C
Chapter 36: Lower Extremity Amputation
Question 1
The most common indication for below-knee amputation is:
A. Trauma
B. Failed arterial reconstruction for critical limb ischemia
C. Sarcoma involving lower leg
D. Critical limb ischemia in patients with diabetes mellitus with infected
gangrene
Correct answer: D
Question 2
The risk of venous thromboembolism following below-knee amputation is:
A. Less than 5%
B. >5–<10%
C. 10–15%
D. Greater than 15%
Correct answer: C
Question 3
Conversion of below-knee amputation to above-knee amputation occurs in:
A. <10%
B. 10–20%
424
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S. S. Hans and A. D. Shepard
C. 21–25%
D. Greater than 25%
Correct answer: B
Question 4
The incidence of phantom pain following above-knee amputation is:
A. <1%
B. 1–2%
C. >2–4%
D. Approximately 5%
Correct answer: D
Question 5
The incidence of wound complications following hip disarticulation is:
A. <10%
B. 10–25%
C. >25–40%
D. >40–60%
Correct answer: D
Chapter 37: Carotid Body Tumor
Question 1
Preoperative embolization of a 6cm carotid body tumor is planned. It is most ideal
for the patient to be operated:
A. Within 24h of embolization
B. Within 48h of embolization
C. Within 72h of embolization
D. Immediately after embolization
Correct answer: B
Question 2
A 4 cm Shamblin type 3 carotid body tumor adherent to carotid artery is best
treated by:
A. Local excision
B. Local excision following preoperative embolization
C. Resection of the tumor and involved ICA and ECA with interposition of a
greater saphenous vein graft from CCA to ICA
D. Resection of the tumor and involved artery with reconstruction using super-
cial femoral artery as an interposition graft
Correct answer: C
38 Multiple-Choice Questions
425
Question 3
Preoperative imaging studies show that the superior limit of a large carotid body
tumor extends to the junction of C1–C2 vertebrae. Optimal anesthetic consideration consists of:
A. Excision under cervical block anesthesia
B. Excision under GA with orotracheal intubation
C. Excision under GA with nasotracheal intubation
D. Excision under GA with nasotracheal intubation and mandibular subluxation
Correct answer: D
Index
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A
Abdomen/pelvis and bilateral lower
extremities (LE), 259
Abdominal aorta
anatomical relations, 32
anterior suture line, 41
horizontal mattress suture technique, 43
incision for repair, 34
indications for repair, 33
proximal aortic anastomosis, 39
retroperitoneal approach
open repair of AAA, 50
patient position, 47–50
retroperitoneal exposure, 48, 49
suprarenal aortic control, 36
surgical anatomy, 31–32
telescopic proximal anastomosis, 42
transperitoneal approach, 33–47
Abdominal aortic aneurysm (AAA), 51, 122,
292, 392, 396
Above knee amputation (AKA), 369–373
Accessory spinal nerve, 188
Acromial artery, 307
Activated clotting time (ACT), 244
Acute aortic syndromes, 23
Acute kidney injury (AKI), 55
Acute mesenteric ischemia (AMI), 280
Adductor canal, 354
Adjunctive Miller vein cuff, 324
Adventitia, 6
Aneurysm plication, 137
Aneurysmorrhaphy, 133
Ankle brachial index (ABI), 154
Ansa cervicalis, 189
Antecubital fossa, 181
Anterior scalene muscle, 173, 174
Aortic dissection, 23
Aortic rupture, 23
Aortoenteric stula (AEF), 397
complications, 96
cryopreserved arterial allograft, 93
in-line graft replacement, 86, 87
procedure, 87–94
proximal anastomosis involvement, 86
Rifampin-impregnated (soaked) Dacron
graft, 95
Aortofemoral bypass (AFB), 355, 413
abdominal exposure, 261, 263–265
groin dissection, 260
infra-mesocolic approach, 260
juxtarenal aortic occlusion, 266
peripheral artery disease procedure, 259
re-do AFB, 269, 270
retroperitoneal approach, 268–269
vascular anomalies, 259
Aortoiliac occlusive disease (AIOD), 259, 292
Aortomesenteric bypass graft, 415
Aortotomy, 9
Argyl carotid shunt, 193
Arterial dilator, 3
Arterial reconstruction, 125
adductor canal, 354
anatomic variations, 354
CFA, 353, 354
deep femoral artery, 354
hostile groin, 355
lateral approach, 357, 359
obturator bypass, 355
profunda femoral artery, 359–361
© The Editor(s) (if applicable) and The Author(s), under exclusive license to
Springer Nature Switzerland AG 2023
S. S. Hans et al. (eds.), Primary and Repeat Arterial Reconstructions,
https://doi.org/10.1007/978-3-031-13897-3
427
428
Index
Arterial techniques
arterial dissection, 1–3
arterial incision and closure, 5–6
arterial suturing techniques, 6–9
endarterectomy, 12
end-to-end anastomosis, 10
end to side anastomosis, 10–12
eversion endarterectomy, 19
mobilization, 1–3
open endarterectomy, 13–17
semi-closed endarterectomy, 17
suture materials, 6–9
suturing technique, 19
systemic heparinization, 4–5
types of grafts, 9
vascular clamps, 3, 4
vascular grafts, 19
Arteriogram, 407
Arteriotomy, 5, 11, 220
Arterio-venous stula, 335
Artery anastomosis, 9
ASTRAL trial, 291
Asymptomatic splenic artery aneurysms, 118
Autogenous conduit, 323
Autologous saphenous vein, 293
Axillary artery aneurysms, 347, 349–350
deep brachial artery, 178
operative steps for, 178–180
pectoralis minor, 177
Axillobifemoral bypass, 307, 309, 311
Axillo-femoral bypass graft, 418
B
Backbleeding lumbars, 54
Balloon catheter occlusion, 394
Below knee amputations (BKA), 366–369
Bio-Medicus pump, 71
Bipolar cautery, 385
BKA skin incision, 368
Blind endarterectomy, 261
Bookwalter 3 systems, 34
Bovie cauterization, 287
Bovine pericardium, 234
Brachial artery, 347–348, 350
Brachial artery aneurysm, 405
interosseous and ulnar arteries, 177
operative steps for, 180–182
Brachial plexopathy, 169
Brachiocephalic reconstruction, 413
anatomy, 252
complications, 258
details of procedure, 252–256
indications, 251
median sternotomy incision site, 253
myocardial perfusion scans, 252
post operative care, 258
preoperative planning, 252
transthoracic echo, 252
C
Cardiac arrhythmias, 202
Carotid artery stenting (CAS), 203
Carotid bifurcation, 204
Carotid body tumor resection, 424
anatomic structures, 384
anatomy, 383–385
preoperative planning, 383–385
surgical management, 385–389
Carotid-carotid bypass, 412
Carotid endarterectomy (CEA), 405, 406
accessory spinal nerve, 188
anesthesia, 189
ansa cervicalis, 189
arterial dilator, 205
CCA, 185
complications, 200–202
ECA, 187
eversion CEA, 196, 198
external laryngeal nerve, 188
glossopharyngeal nerve, 187–188
hypoglossal nerve, 188
indications, 189
internal carotid artery, 187
intraoperative carotid stenting, 207–208
oblique incision for, 191
patch closure, 207
patch graft infection, 202
positioning and incision, 190
postoperative care, 200
postoperative myocardial infarction, 202
postoperative stroke, 201, 202
Ramus mandibularis, 188
shunt placement, 191–195
silastic loop, 206
silastic vessel loop, 204
types of shunts, 192–193
Yasergill clamp, 205
Carotid interposition graft, 408
complications, 215
failed carotid stenting, 210
interposition graft without shunt, 211–214
shunt placement, 214–215
Carotid subclavian bypass, 411
carotid-subclavian transposition, 233
complications, 234
Debakey clamp, 232
Index
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429
general anesthesia, 228
operative details, 234
semi-Fowler position, 228
surgical anatomy, 228
Celiac artery aneurysm, 125, 416
Celiac trunk, 117
Cerebrospinal uid (CSF), 52
Cervical block anesthesia (CBA), 189, 203
Chronic mesenteric ischemia (CMI), 279
Chronic obstructive pulmonary disease
(COPD), 63
Chronic repetitive trauma, 178
Clavicular artery, 307
Cobra-hood type fashion, 232
Coeliac artery aneurysm, 400
Common carotid artery (CCA), 163, 185, 205,
209, 221, 227, 237
Common femoral artery (CFA), 141, 260,
315–318, 320, 353, 354
Computed tomographic angiogram (CTA), 51,
129, 154, 169, 238, 252, 259, 333
Coselli graft limbs, 59
Cranial nerve palsy, 200–201
Critical intercostals arteries, 75
Crural bers, 53
Cut Dacron graft, 11
D
Dacron graft, 73, 150
Dacron pledget, 8
Dacron prosthesis, 72
Debakey Derra vascular clamp, 243
Deep circumex iliac artery, 301
Deep femoral artery (DFA), 141, 150, 354
Deep femoral artery implantation, 146
Deltoid artery, 307
Digital photoplethysmography (PPG),
154, 169
Digital subtraction angiogram, 171
Distal anastomosis, 255, 265, 328, 339
Distal aorto-bi-iliac prosthetic graft, 111
Distal popliteal artery, 329
Donor anastomosis, 302
Dorsalis pedis artery, 343
Dural elevator, 13
Dysphagia lusoria, 169
E
Ehlers-Danlos syndrome, 118
Electrocautery, 69, 325
Embolization therapy, 138
End to end anastomosis, 11
End to side anastomosis, 10–12
Endarterectomy, 12
Endarterectomy plane, 196
Endoluminal balloon catheter, 1
Endoluminal techniques, 259
Endovascular aortic aneurysm repair (EVAR)
endoleaks, 107
graft migration, 107
graft preservation techniques, 110
incidence and risk factors, 108
limb thrombosis and sac expansion, 107
outcomes, 114
treatment, 108–112
End-to-end anastomosis, 10, 51
Esmarch wrap, 157
Esophasogastric junction, 101
Eversion endarterectomy, 19, 196, 198,
199, 392
Expanded polytetrauorethylene (ePTFE), 228
Extent 4 TAAA repair, 58, 59
External carotid artery (ECA), 186, 187, 210
External iliac artery (EIA), 261
External laryngeal nerve, 188
Extracranial carotid aneurysm, 403
Extracranial carotid artery
complications, 167
operative repair, 164–167
physical examination, 163
F
Femoral anastomosis, 11
Femoral anastomotic aneurysms, 148, 401
anatomy, 141
indications, 141–142
operative procedure, 142–147
operative repair, 149–152
postoperative complications, 152
symptomatic aneurysm, 148
Femoral endarterectomy, 317–318
Femoral sheath, 322
Femoral triangle, 359
Femoral-femoral bypass graft, 301–303, 417
Femoral-infrapopliteal bypass
complications, 346
conduit selection, 334
distal anastomotic site, 334
in-situ bypass, 335
posterior tibial artery
anastomosis to peroneal
artery, 344–346
anterior tibial artery, 339–344
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