Question 3

Given the available information: history, pulse deficit pattern on physical exam and the non-invasive report what approach do you plan for the aortogram and runoff which you plan to perform in the interventional suite (hybrid OR suite unavailable)?

A.  Percutaneous retrograde right femoral B.  Left transaxillary

C.  Percutaneous retrograde left femoral D.  Translumbar

E.  Right transaxillary

You proceed with ultrasound localization and micropunture (0.018) technique for percutaneous retrograde right common femoral puncture and, using Seldinger technique, experience no difficulty upsizing to a 5 F introducer sheath but do experience difficulty passing the 0.035 starter J wire into the aorta. You stop and inject contrast through the flush port of the 5F introducer sheath and obtain images. What does this image demonstrate? (Fig. 19.2)

Question 4

A.   Perforation of the right common iliac artery and need for immediate transportation to the operating room for hemostasis

B.  Normal appearing aorto-iliac system and the need to push harder on the wire C.  Extensive irregularities of the artery walls but no other significant findings

Fig. 19.2 Right iliac arteriogram

D.  Dissection plane in the diseased artery wall at the distal aorta and common iliac with intravasation of contrast without perforation

E.  Normal appearing aorto-iliac system but a minor dissection of no consequence

You are able to pass a hydrophilic guide wire into the aorta and obtain an aortogram which demonstratesextensiveatheroscleroticplaque.Magnifiedviewsofthecommoniliacartery are included. You successfully deploy a self expanding bare metal stent spanning the area ofarterynarrowingandoriginofthedissectionplan.Aftertouchupanangioplastyballoon catheter, what is your next step? (Figs. 19.3 and 19.4)

Question 5

A.  Reposition the flush catheter just above the aortic bifurcation for injection and in order to obtain the planned runoff images of the femoral popliteal and infrapopliteal segments

B.  Stop the procedure at this point, the patient has had enough C.  Stop the procedure at this point the surgeon has had enough

D.  Gototheoperatingroom.Onlyafemoralpoplitealbypassispossible.Thenon-invasive study was enough information

E.  Reconsider primary amputation

Fig. 19.3 Subsequent right iliac arteriogram

Fig. 19.4 Distal aorta and right iliac arteriogram

Question 6

You obtain the runoff images. What is demonstrated in these images? (Figs. 19.5 and 19.6)

A.  There is a long segment occlusion of the left superficial femoral artery B.  The demonstrated occlusion is chronic

Fig. 19.5 Bilateral femoral arteriogram

Fig. 19.6 Bilateral popliteal arteriogram

C.  The deep femoral artery is open and provides collaterals which reconstitute the distal superficial femoral artery proximal to the popliteal artery

D.  The proximal infrapopliteal arterial segments are open E.  All of the above (A, B, C, and D)

F.  None of the above

You decide to proceed with endovascular reconstruction of the left superficial femoral artery. The following week you schedule this procedure in the operating room in the event circumstances prompt you to proceed with (open) bypass operation for limb salvage. In order to avoid crossing over the narrow and diseased aortic bifurcation from the right side you elect a (left) ipsilateral antegrade approach.

Question 7

What problem have you now encountered demonstrated in this image? (Fig. 19.7)

A.  The proximal superficial femoral artery is now occluded B.  Your wire has passed into the deep femoral artery

C.  The superficial femoral artery can be selected but the sheath needs to be pulled back into the common femoral artery first

D.  The need for a stiffer wire to forcefully cross the occluded vessel E.  Both B and C

You manage to pass a wire into the superficial femoral artery above the occlusion as demonstrated in this image (Fig. 19.8).