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38 Multiple-Choice Questions
399
Chapter 9: Explant of Abdominal Aortic Endograft
Question 1
The incidence of late open conversion after EVAR is:
A. Less than 1%
B. 1–5%
C. 6–10%
D. Greater than 10%
Correct answer: B
Question 2
When complete excision of EVAR graft with suprarenal stent is required, the best
strategy to facilitate complete removal of suprarenal struts is:
A. Release of barbs from the main body with a wire cutter circumferentially
B. Use of a 20 cc syringe as a sheath to encircle and collapse the suprarenal
component
C. Iced saline on nitinol elements to help collapse the metal
D. All of the above
Correct answer: D
Question 3
The mortality rate for elective explant of an EVAR graft should be
A. Less than 5%
B. 5–10%
C. 11–20%
D. Greater than 20%
Correct answer: A
Chapter 10: Splanchnic Aneurysms
Question 1
Asymptomatic splenic artery aneurysm in a 56-year-old female should be repaired
once the aneurysm measures:
A. 1.5cm in AP/transverse diameter
B. 1.6–1.9cm
C. 2.0–2.4cm
D. Should be repaired regardless of its size
Correct answer: C
Question 2
Hepatic artery aneurysms constitute what percentage of splanchnic artery
aneurysms?
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S. S. Hans and A. D. Shepard
A. Less than 12%
B. 13–20%
C. 21–24%
D. 25% or greater
Correct answer: B
Question 3
Celiac artery aneurysm is considered for repair once aneurysm measures:
A. 1.5cm in AP/Tr diameter
B. 1.6–2.0cm
C. 2.1–2.4cm
D. 2.5cm or greater
Correct answer: D
Question 4
Rupture rate of SMA aneurysms is:
A. Less than 20%
B. 20–25%
C. 26–34%
D. 35% or greater
Correct answer: D
Question 5
SMA aneurysms are most commonly located at:
A. Origin of SMA
B. About 4cm from the origin of SMA
C. Near the origin of the middle colic artery
D. Near the origin of the right colic artery
Correct answer: B
Chapter 11: Renal Artery Aneurysm
Question 1
The major risk factor for a ruptured renal artery aneurysm is:
A. Size greater than 2cm with pregnancy
B. Size between 1.5 and 2cm
C. Size between 1 and 1.4cm
D. Aneurysms associated with FMD
Correct answer: A
38 Multiple-Choice Questions
401
Question 2
During repair of a renal artery aneurysm, the renal ischemia time is greater than
30min. The most practical strategy to prevent kidney injury is:
A. Optimal volume status prior to renal artery clamping and cooling the mobi-
lized kidney with the ice
B. Repair using autotransplantation technique
C. Endovascular therapy, which is preferable
D. Optimal volume status and renal perfusion with cold RL at 4°C with added
heparin and methylprednisolone
Correct answer: D
Question 3
The incidence of bilateral renal artery aneurysms is:
A. 10–12%
B. 13–15%
C. 16–20%
D. 25%
Correct answer: B
Chapter 12: Femoral and Femoral Anastomotic Aneurysm
Question 1
The guideline for repair of asymptomatic femoral aneurysms based on size alone is:
A. 2–2.5cm
B. 2.6–3.0cm
C. 3.1–3.4cm
D. Greater than 3.5cm
Correct answer: D
Question 2
An 80-year-old man presents with a leaking 10cm femoral anastomotic aneurysm.
Proximal control is most safely obtained by:
A. Exposing the proximal graft through a groin incision (old scar)
B. Suprainguinal transverse incision with exposure of the prosthetic graft
C. Endovascular balloon occlusion of the graft via contralateral femoral
artery/graft
D. Balloon occlusion using left brachial artery approach
Correct answer: B
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S. S. Hans and A. D. Shepard
Question 3
A 79-year-old man presents with a 3.8cm femoral artery aneurysm with local dis-
comfort. He has chronic occlusion of the supercial femoral artery on CTA but
without symptoms of intermittent claudication. Repair of the aneurysm is best
performed by excision of the aneurysm and interposition grafting:
A. With simultaneous femoral-popliteal bypass graft
B. To the deep femoral artery
C. Hybrid approach with excision of the aneurysm and retrograde recanaliza-
tion of the supercial femoral artery
D. Distal anastomosis to supercial femoral artery after local endarterectomy
and reimplantation of deep femoral artery into the interposition pros-
thetic graft
Correct answer: B
Chapter 13: Popliteal Artery Aneurysm Repair: Primary and Recurrent
Question 1
During repair of a popliteal aneurysm using a posterior approach, the dissection
proceeds between the two heads of the gastrocnemii. The nerve encountered in
the dissection plane in addition to the nerve to the medial head of gastrocnemius is:
A. Saphenous nerve
B. Common peroneal nerve
C. Sural nerve
D. Nerve to the lateral head of gastrocnemius
Correct answer: C
Question 2
During the repair of a popliteal aneurysm using medial approach, which supercial
nerve is encountered in the proximal part of the dissection near the adductor hiatus?
A. Sural
B. Saphenous
C. Posterior tibial
D. Common peroneal
Correct answer: B
Question 3
A 60-year-old man has a 3.5cm Tr/AP diameter popliteal artery aneurysm present
behind the knee extending 2 cm above the knee joint and 1 cm below, with
extrinsic compression of the popliteal vein. The best management option is:
A. Medial approach for exclusion of the aneurysm and bypass using GSV
38 Multiple-Choice Questions
403
B. Posterior approach for complete excision and bypass using lesser saphe-
nous vein
C. Posterior approach for complete excision of the aneurysm and bypass using
greater saphenous vein
D. Endovascular exclusion using covered stent
Correct answer: C
Chapter 14: Extracranial Carotid Aneurysm
Question 1
During repair of an extracranial carotid aneurysm, the stylohyoid muscle was tran-
sected and styloid process needs to be removed in order to gain distal exposure
of the internal carotid artery. The commonest nerve to be injured during this
maneuver is:
A. Spinal accessory
B. Hypoglossal
C. Sympathetic chain
D. Glossopharyngeal
Correct answer: D
Question 2
During repair of a giant internal carotid aneurysm in the neck extending to the base
of the skull, the cephalad portion of the ICA above the aneurysm cannot be visualized despite all the techniques used to gain high exposure of ICA.The mean
ICA stump (back) pressure is 52 mmHg. The best option in managing this
aneurysm is:
A. EC-IC bypass by a vascular neurosurgeon and ligation of ICA
B. Ligation of ICA near its origin
C. Transcranial Doppler assessment of MCA velocity
D. OR consult with interventional neuroradiology? Neurosurgery
Correct answer: B
Question 3
During repair of 2cm diameter ICA aneurysm arising 1.5cm distal to the origin of
ICA, with signicant redundancy of the ICA, the continuity of ICA following
excision of the aneurysm is best achieved by:
A. End-to-end anastomosis behind the hypoglossal nerve
B. End-to-end anastomosis with transposition of ICA in front of hypoglos-
sal nerve
C. Interposition vein graft
D. Interposition prosthetic graft
Correct answer: B
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S. S. Hans and A. D. Shepard
Question 4
The commonest complication following repair of an ICA aneurysm is:
A. Myocardial infarction
B. Lymph leak
C. Cranial nerve injury
D. Perioperative stroke
Correct answer: C
Question 5
In managing a large post-endarterectomy pseudoaneurysm of the carotid artery,
which was patched with Dacron, the best repair technique is:
A. Ligation proximally and distally
B. Repatching the artery with bovine pericardium
C. Interposition grafting from the common carotid artery to the internal carotid
artery with PTFE
D. Interposition grafting from the common carotid artery to the internal carotid
artery with autologous vein
Correct answer: D
Chapter 15: Subclavian Artery Aneurysm
Question 1
Aneurysm associated with aberrant right subclavian artery causing dysphagia is
best managed by:
A. Transthoracic repair
B. Right carotid-subclavian artery bypass or transposition followed by thoracic
aortic stent grafting
C. Medical management only
D. Endoscopic dilatation of the esophagus prior to hybrid repair
Correct answer: B
Question 2
Which nerve courses lateral to medially in the neck over the anterior surface of the
anterior scalene muscle?
A. Phrenic
B. Spinal accessory
C. Vagus
D. Recurrent laryngeal
Correct answer: A
38 Multiple-Choice Questions
405
Question 3
A 30-year-old female has right thoracic outlet syndrome with a 2.2 cm axillo-
subclavian artery aneurysm. This is best managed by a:
A. Covered stent
B. Transaxillary approach
C. Supraclavicular approach
D. Supraclavicular and infraclavicular exposure
Correct answer: D
Chapter 16: Axillary and Brachial Artery Aneurysms
Question 1
The incidence of axillary and brachial artery aneurysms among peripheral artery
aneurysm is:
A. Less than 1%
B. 1–3%
C. Greater than 3% but less than 5%
D. 5%
Correct answer: A
Question 2
The most common cause of mycotic brachial artery aneurysm is:
A. Brachial artery access for coronary intervention
B. Cocaine abuse
C. Intravenous drug abuse
D. Open supracondylar fracture
Correct answer: C
Question 3
Repair of axillary and brachial artery aneurysm is recommended for aneurysm
size of:
A. 0.5–1cm
B. Greater than 1–1.5cm
C. Greater than 1.5cm–less than 2.0cm
D. Greater than 2cm
Correct answer: D
Chapter 17: Carotid Endarterectomy
Question 1
Superior thyroid artery is intimately related to:
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S. S. Hans and A. D. Shepard
A. Internal laryngeal nerve
B. External laryngeal nerve
C. Lingual nerve
D. Recurrent laryngeal nerve
Correct answer: B
Question 2
Six hours following carotid endarterectomy, the patient has a large neck hematoma
with stridor.
The patient is taken to OR for evacuation of the hematoma. Anesthetic consider-
ations for safer outcome are:
A. Attempt of standard orotracheal intubation
B. Tracheostomy
C. Intubation aided with glidescope
D. Removal of staples and sutures under local anesthesia, evacuation of the
hematoma, and consideration of intubation if stridor is not relieved
Correct answer: D
Question 3
The most common nerve injured during carotid endarterectomy is:
A. Vagus
B. Ramus mandibularis
C. Hypoglossal
D. Glossopharyngeal
Correct answer: C
Question 4
Perioperative stroke rate for carotid endarterectomy is:
A. Less than 1%
B. 1–4%
C. 5–6%
D. Greater than 6%
Correct answer: B
Chapter 18: Carotid Endarterectomy for High Plaque
Question 1
A necessary maneuver for exposure of the internal carotid artery during carotid
endarterectomy for high plaque is:
A. Cephalad mobilization and retraction with or without division of post-belly
of digastric
38 Multiple-Choice Questions
407
B. Division of inferior belly of omohyoid
C. Removal of tip of mastoid process
D. Mandibular osteotomy
Correct answer: A
Question 2
Cephalad mobilization of hypoglossal nerve is facilitated by division of:
A. Sternocleidomastoid branch of occipital artery and if necessary occipital
artery itself
B. Facial artery
C. External carotid artery
D. Transecting internal carotid artery at its origin and mobilization of hypoglos-
sal nerve cephalad and transposition of internal carotid artery anterior to the
nerve followed by reanastomosis of the divided internal carotid artery
Correct answer: A
Question 3
During performance of eversion carotid endarterectomy, the distal end of the plaque
could not be well visualized. The best option is:
A. Interposition graft between distal CCA and ICA
B. Convert to standard CEA with patch graft
C. Intraoperative carotid stenting
D. Transection of ICA at its origin and extending the arteriotomy cephalad to
reach the end point and transposition of ICA anterior to hypoglossal nerve
with reanastomosis of ICA at the carotid bifurcation
Correct answer: D
Question 4
During CEA for high plaque, the surgeon is uncertain about the end point of the
plaque. The next best option is:
A. Intraoperative carotid duplex imaging
B. Obtain CTA neck
C. Closure of endarterectomy with patch graft and perform intraoperative
carotid arteriogram
D. Closure of endarterectomy with patch graft and obtain transcranial
Doppler study
Correct answer: C
Question 5
Intraoperative carotid arteriogram in aforementioned patient shows no ow in the
internal carotid artery. The optimal management consists of:
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S. S. Hans and A. D. Shepard
A. Open the endarterectomy site and place tacking sutures in the arterial wall at
the cephalad end
B. CCA-to-ICA interposition graft
C. Ligate the ICA if stump pressure is greater than 40mmHg and postoperative
unfractionated heparin
D. Intraoperative carotid stenting
Correct answer: D
Chapter 19: Carotid Interposition Graft
Question 1
Four months following CEA with a knitted Dacron patch graft, the patient develops
sinus in the neck and undergoes unsuccessful local exploration of the neck. CTA
neck shows a small mass around the origin of ICA.Optimal management besides
antibiotics and debridement consists of:
A. Removal of Dacron patch and its replacement with bovine pericardial patch
B. Removal of Dacron patch and placement of vein patch
C. Resection of proximal ICA including patch and interposition PTFE graft
D. Resection of proximal ICA with interposition greater saphenous vein bypass
graft from mid-CCA to mid-ICA
Correct answer: D
Question 2
During radical neck dissection for squamous cell carcinoma of oral cavity, tumor is
rmly adherent to the common carotid artery. Tumor is removed en bloc with a
3cm segment of the common carotid artery. Arterial reconstruction is best performed by:
A. PTFE interposition graft
B. Interposition lesser saphenous vein graft
C. Cryopreserved arterial homograft
D. Interposition with supercial femoral artery graft
Correct answer: D
Question 3
Six months following carotid stenting, the patient develops carotid in-stent resteno-
sis with a densely calcied plaque at the superior end of the stent, which is at the
level of the C2 vertebral body. Carotid interposition graft with removal of the
stent is planned. Distal control of the ICA is best obtained by:
A. Mandibular subluxation
B. Mandibular osteotomy
C. Standard exposure of ICA and application of distal clamp to ICA