Question 2

What is the approximate annual risk of rupture of an AAA with a maximum diameter of 62 mm?

A.  Less than 5%

B.  Between 5% and 10%

C.  Between 10% and 20% D.  Greater than 20%

Question 3

Regarding intervention in asymptomatic AAA

A.  Current evidence supports operative management for aneurysms greater than 55 mm in diameter

B.  Rupture risk is higher for women and a lower threshold for intervention in this group has been proposed

C.  All diagnosed aneurysms warrant expeditious intervention as they will inevitably grow

D.  Surveillance is safe for aneurysms with diameters ranging from 40 to 55 mm

E.  Fast growth is not associated to increased risk of rupture in asymptomatic aneurysms under 55 mm in diameter. Close surveillance is the best option

Question 4

In anatomically similar aneurysms, suitable for both open and endovascular repair

A.  Open repair is a safer option for high-risk patients

B.  The early survival benefit of EVAR applies only to high-risk patients

C.  The presence of chronic renal failure is an absolute contra-indication for EVAR D.  Patient preference should be weigh significantly in the decision process

E.  Level I evidence has shown that EVAR results in a threefold reduction in 30-day operative mortality compared to open repair in low-risk patients

Question 5

Which anatomical features may limit EVAR?

A.  Length and diameter of the aneurysm sac

B.  Length and diameter of the aneurysm neck

C.  Angulation of the aneurysm neck

Question 6

Endoprosthesis with supra-renal open stent fixation

A.  Are associated with a higher rate of migration

B.  Are associated with a higher rate of renal complications, particularly embolism and occlusion

C.  Are particularly useful in unfavorable aneurysm necks D.  May complicate a conversion procedure

Question 7

In choosing a suitable endoluminal graft, one should

A.  Take the graft that resembles your measurements most closely B.  Oversize all diameters by 5%

C.  Oversize all diameters by 15–20%

D.  Oversize the proximal diameter by 20% and the limb diameters by 30%

E.  Undersize all diameters by 10% and balloon-expand them to proper size at the end of the procedure

Question 8

Fenestrated grafts are best applied in

A.  Ruptured juxta-renal AAAs

B.  Elective juxta-renal or supra-renal AAAs

C.  Very angulated aneurysm necks, to avoid migration

D.  All cases, being limited only by availability and cost

Question 9

At 2 years, outcomes after EVAR using fenestrated grafts

A.  Are equivalent to standard EVAR

B.  Are generally worse than those of open repair for juxta-renal or supra-renal AAA C.  Closely relate to the expertise of the operating center

D.  Are linked to branch vessel complications, particularly renal artery stenosis or occlusions E.  Are worse than those of standard EVAR, because of a higher percentage of type I and

III endoleaks

Question 10

Unilateral common iliac aneurismal involvement

A.  Makes EVAR unadvisable

B.  May be treated using branched limbs, in order to preserve pelvic blood flow

C.  May be treated by internal iliac occlusion and extension of the limb into the external iliac artery

D.  Favors the use of aorto-uni-iliac devices and femoro-femoral crossover E.  Should be treated by open repair

The patient was operated under general anesthesia. The abdomen and both groins were prepared into a sterile field, and the common femoral arteries surgically exposed through short oblique incisions. Sheaths were inserted and the patient was given 5,000 U of nonfractioned heparin. Wires were placed under fluoroscopy and the main-body device was advanced via the left side to the level of L1. An angiogram was performed at this level, using the previously determined C-arm angulation. The top-stent was deployed separately in a very controlled fashion and the contra-lateral limb cannulated. The right internal iliac artery distal to the aneurysm was coiled and the limb extended to the external iliac artery, covering the iliac bifurcation. A completion angiogram confirmed the successful exclusion of the aneurysm, without type I or III endoleaks and with maximum proximal seal. A type II endoleak was observed in the late phase of the angiogram, however (Figs. 3.5 and 3.6).

Question 11

The correct intra-operative attitude regarding on-table documentation of a type II endoleak is

A.  Do nothing

B.  Laparoscopic ligation of the inferior mesenteric artery and lumbar arteries C.  Endovascular coil embolization of the responsible vessels

D.  Laparotomy and surgical ligation of responsible vessels E.  Conversion to open repair

Question 12

The correct attitude regarding late follow-up documentation of a type II endoleak without change in aneurysm size is

A.  Laparoscopic ligation of the inferior mesenteric artery and lumbar arteries B.  Endovascular coil embolization of the responsible vessels

C.  Percutaneous or laparoscopic aortic fenestration D.  Conversion to open repair

E. Close surveillance