Vascular Surgery (Arterial, Venous, Lymphatic Disorders) MCQs

Surgery · 135 free questions with answers & explanations.

1. A 70-year-old hypertensive man presents to the emergency department with sudden onset tearing chest pain radiating to the back. CT aortography shows a dissection extending from the ascending aorta into the descending thoracic aorta. According to the Stanford classification, this is:
2. A 65-year-old man presents with a pulsatile, expansile, non-tender abdominal mass on routine examination. USS confirms an infrarenal abdominal aortic aneurysm of 6 cm diameter. He is otherwise asymptomatic. The best management is:
3. A 72-year-old hypertensive man has an asymptomatic abdominal aortic aneurysm (AAA) with a maximum diameter of 5.6 cm detected on ultrasound. He is fit for intervention. The preferred treatment and its primary advantage over open repair is:
4. A patient with chronic venous insufficiency has CEAP classification C4b. This corresponds to which clinical finding?
5. A 72-year-old hypertensive smoker is found to have a 5.8 cm infrarenal abdominal aortic aneurysm (AAA) on surveillance ultrasound. He is high risk for open surgery due to severe COPD (FEV1 45%). The most appropriate management is:
6. The CEAP classification for chronic venous disease categorises disease severity. A patient with active venous ulceration at the medial malleolus is classified as CEAP class C6. The pathophysiological mechanism most specific to ulcer formation in chronic venous insufficiency is:
7. Thoracic outlet syndrome (TOS) has three subtypes. Which subtype is the most common, accounts for >95% of cases, and is characterised by compression of the lower trunk/medial cord of the brachial plexus causing hand weakness and paraesthesias in a C8/T1 distribution?
8. A 72-year-old man with a 6.2 cm infra-renal abdominal aortic aneurysm (AAA) is evaluated for intervention. He has a history of COPD with FEV1 of 45% predicted and creatinine of 160 μmol/L. CTA shows an aneurysm neck of 2.5 cm length, neck angulation of 35°, and bilateral common iliac artery dilatation to 20 mm. The most appropriate intervention and rationale is:
9. A 65-year-old man with critical limb ischemia (rest pain, ABI 0.35) has a CT angiogram showing an isolated occlusion of the superficial femoral artery from its origin to the distal popliteal artery (segment length 24 cm). The femoral and tibial vessels are patent. The most appropriate revascularization strategy according to current TASC II/ESVS guidelines is:
10. The EVAR-1 trial (Endovascular Aneurysm Repair 1) compared EVAR with open surgical repair for abdominal aortic aneurysm (AAA). Which is the correct long-term finding?
11. In carotid endarterectomy (CEA) for symptomatic carotid stenosis, the NASCET trial defined 'symptomatic significant stenosis' requiring surgery. What degree of stenosis and symptom criterion defines the population with greatest absolute benefit from CEA?
12. A 65-year-old woman presents with a non-healing ulcer on the medial aspect of the right lower leg above the medial malleolus. Duplex ultrasound shows deep venous insufficiency (venous reflux in the popliteal and long saphenous veins). ABIs are 0.95. What is the first-line treatment?
13. A 70-year-old man with a known 5.2 cm infrarenal abdominal aortic aneurysm (AAA) is being monitored. The UKSAT and ADAM trials established which diameter threshold for elective AAA repair in men to achieve a mortality benefit?
14. A 65-year-old woman presents with acute limb ischaemia (ALI) of her right leg — cold, pale, pulseless, with paraesthesia but preserved motor function. She has atrial fibrillation. Ankle-brachial index cannot be measured. This represents Rutherford Class IIa ALI. What is the immediate treatment of choice?
15. In the management of varicose veins, which intervention has been shown in the CLASS trial and NICE TA232 guidelines to be preferred over conventional surgery for primary uncomplicated great saphenous vein reflux?
16. The EVAR-1 trial compared endovascular aneurysm repair (EVAR) with open repair for abdominal aortic aneurysm. What was the 10-year follow-up finding that tempered initial enthusiasm for EVAR?
17. A 55-year-old man presents with bilateral thigh claudication and impotence. Femoral pulses are absent bilaterally. ABI is 0.35 on both sides. Imaging confirms complete occlusion of the aortoiliac segment (Leriche syndrome). The preferred bypass procedure for long-segment aortoiliac occlusion in a fit patient is:
18. A 72-year-old woman presents with a tender, pulsatile, 6.5-cm abdominal aortic aneurysm. She is on warfarin for atrial fibrillation. Which of the following is an absolute indication for surgery for AAA?
19. The EVAR 1 trial compared endovascular aneurysm repair (EVAR) with open surgical repair for infrarenal AAA ≥5.5 cm. What was the long-term finding at 15-year follow-up?
20. A 60-year-old male with peripheral arterial disease has an ankle-brachial pressure index (ABPI) of 0.45 with rest pain. CT angiography shows a long segment SFA occlusion (TASC II class D). Which treatment modality is recommended by TASC II guidelines?
21. In the CEAP classification of chronic venous disease, what does the number '4b' refer to?
22. A 72-year-old man with a 6.2 cm infrarenal abdominal aortic aneurysm (AAA) is fit for surgery (EVAR or open repair). His CT angiography shows a neck length of 14 mm, neck angle of 58°, and maximum neck diameter of 27 mm with moderate thrombus. Which EVAR-related anatomical factor most contraindicates a standard EVAR stent-graft?
23. A 55-year-old diabetic smoker with critical limb ischaemia (CLI) and ABI 0.35 has extensive femoropopliteal occlusion (TASC II Class D lesion) on angiography. Crural vessels show single vessel run-off (peroneal artery). According to TASC II and BASIL trial evidence, which revascularisation strategy should be considered as first-line for suitable surgical candidates?
24. A 45-year-old woman presents with sudden severe headache 'thunderclap', photophobia, and neck stiffness. Non-contrast CT head shows subarachnoid blood in the basal cisterns. DSA (digital subtraction angiography) identifies a 9 mm right posterior communicating artery aneurysm with a daughter sac (indicating instability). She is WFNS grade II. Which management is first-line according to current guidelines (ISAT trial data)?
25. A 72-year-old man with a 5.8 cm asymptomatic infrarenal abdominal aortic aneurysm (AAA) is fit for surgery. Comparing open repair versus EVAR, which finding from the EVAR-1 trial is most clinically relevant at 15-year follow-up?
26. A 65-year-old diabetic with critical limb ischemia (CLI) has an ABI of 0.35. Angiography shows a long segment SFA occlusion with patent popliteal and tibial vessels. Endovascular treatment is not feasible. The preferred bypass conduit for femoro-popliteal bypass is:
27. A patient presents with acute limb ischemia (6 hours duration) of the left leg — cold, pale, pulseless, with paresthesia but no motor loss. This corresponds to which Rutherford category?
28. A 72-year-old man with an incidentally discovered 5.6 cm infrarenal abdominal aortic aneurysm (AAA) and hypertension is being assessed for repair. He is anatomically suitable for both EVAR and open repair. The EVAR-1 and DREAM trials established which long-term conclusion regarding EVAR versus open repair?
29. A 65-year-old diabetic smoker presents with Fontaine Stage IIb critical limb ischaemia (claudication at 80 metres) and an ankle-brachial index of 0.55. Duplex imaging shows a 7 cm stenosis in the superficial femoral artery at Hunter's canal. According to TASC II classification, this lesion is classified as TASC C. Which management approach is preferred?
30. A 55-year-old woman presents with recurrent right leg deep vein thrombosis (DVT). Thrombophilia testing reveals homozygous Factor V Leiden mutation. She asks about the mechanism by which Factor V Leiden causes thrombophilia:
31. A 68-year-old male smoker is found on screening ultrasonography to have an infrarenal abdominal aortic aneurysm (AAA) of 5.6 cm diameter. He is asymptomatic and medically fit. Current UK NICE and ESVS guidelines recommend elective repair at diameter threshold of:
32. A 55-year-old diabetic woman presents with rest pain and gangrene of the right second toe (Rutherford Category 5 CLI). Duplex Doppler shows tibial vessel disease. ABI is 0.45. The most appropriate first-line intervention according to TASC II and GVG guidelines is:
33. In CEAP classification of chronic venous disorders, a patient with healed venous ulceration (no active ulcer) with skin changes (lipodermatosclerosis and pigmentation) is classified as:
34. A 72-year-old man with a 6.2 cm infrarenal abdominal aortic aneurysm (AAA) is assessed for repair. He has COPD (FEV1 55% predicted) and creatinine 130 µmol/L. Which outcome does the EVAR-1 trial most importantly demonstrate when comparing EVAR to open repair in this patient's risk profile?
35. A 68-year-old woman presents with acute limb ischemia. On examination, the right leg is cold, white, and paralyzed with absent sensation. Onset is estimated at 4 hours. Doppler confirms absence of pedal signals. Embolectomy is performed. Intraoperatively, the clot shows a 'cast' of the femoral bifurcation with a characteristic pale appearance. What underlying cardiac condition most commonly causes this presentation?
36. In a patient with critical limb ischemia (CLI) and an ankle-brachial index of 0.3 with non-healing heel ulcer, duplex ultrasound identifies a 8 cm occlusion of the superficial femoral artery (SFA) with good run-off. Which revascularization strategy is most appropriate as per TASC-II classification?
37. A 72-year-old male with a known 4.8 cm infrarenal abdominal aortic aneurysm (AAA) presents with sudden severe back pain, hypotension, and a pulsatile abdominal mass. CT scan shows a contained retroperitoneal hematoma. What is the immediate management?
38. The BASIL trial compared bypass surgery versus balloon angioplasty for severe lower limb ischaemia. What was the key finding regarding patient selection?
39. A 55-year-old female presents with left leg swelling, pain, and pitting oedema for 3 weeks following pelvic malignancy treatment. May-Thurner syndrome is suspected. Which of the following best describes the anatomical basis of this syndrome?
40. A 72-year-old male smoker has a 6.2 cm asymptomatic abdominal aortic aneurysm (AAA). Cardiac risk assessment reveals significant coronary artery disease. Which statement best reflects the evidence from the UK EVAR trials 1 and 2 regarding treatment selection?
41. A 65-year-old man presents with a cold, painful, pulseless right leg 3 hours after onset. Doppler ultrasound at the popliteal level is absent. He has known atrial fibrillation. The ankle-brachial pressure index cannot be obtained. Categorising this as acute limb ischaemia, which Rutherford category describes a viable limb with no motor or sensory loss and audible venous but absent arterial Doppler signals?
42. A 40-year-old woman has recurrent left leg deep vein thrombosis and ultrasound reveals a non-compressible left common iliac vein with a filling defect extending to the external iliac vein. MR venography shows extrinsic compression of the left common iliac vein by the right common iliac artery. This condition is known as:
43. A 72-year-old hypertensive male has a 5.8 cm infrarenal abdominal aortic aneurysm (AAA) discovered incidentally. He is fit for intervention. According to current guidelines (ESVS/SVS), what is the preferred intervention?
44. Leriche syndrome presents with the classic triad of: buttock and thigh claudication, absent femoral pulses, and impotence in males. This results from occlusion at which anatomical level?
45. Varicose vein recurrence after endovenous thermal ablation (EVTA) of the great saphenous vein most commonly occurs due to which mechanism?
46. The EVAR-1 trial compared endovascular aneurysm repair (EVAR) with open repair for AAA. What was the key long-term finding that changed practice regarding EVAR surveillance?
47. CEAP classification C6 chronic venous disease indicates which clinical finding, and what is the pathophysiological mechanism leading to this?
48. Critical limb ischaemia (CLI) is defined by which haemodynamic parameters, and what distinguishes it from intermittent claudication in terms of revascularisation urgency?
49. The EVAR-1 trial compared endovascular aneurysm repair (EVAR) versus open repair for infrarenal AAA. What was the key finding regarding long-term overall survival?
50. A patient with type B aortic dissection (Stanford classification) involving the descending thoracic aorta is hemodynamically stable without malperfusion. What is the initial management of choice according to current TEVAR guidelines?
51. In critical limb ischemia (CLI), the Rutherford classification grade III category 6 indicates which clinical presentation?
52. A 68-year-old hypertensive male smoker presents with a pulsatile, expansile epigastric mass. CT angiography confirms an infrarenal abdominal aortic aneurysm measuring 5.8 cm in maximum diameter with a suitable neck for EVAR. The patient is of intermediate operative risk. What is the recommended intervention?
53. A 55-year-old woman presents with severe left leg pain at rest, pallor, paraesthesia, pulselessness, and coolness below the knee for 3 hours. She is in atrial fibrillation. The Rutherford classification and appropriate treatment are:
54. A 45-year-old woman presents with chronic swelling of the left leg, skin thickening, and recurrent erysipelas. She had pelvic radiotherapy 10 years ago. Lymphoscintigraphy confirms lymphoedema. The non-surgical management cornerstone is:
55. A 70-year-old man with a 5.6 cm infrarenal abdominal aortic aneurysm (AAA) is fit for intervention. He has no aortic neck angulation and good iliac anatomy. The EVAR1 trial and subsequent data inform the choice between open repair (OR) and endovascular aneurysm repair (EVAR). Which statement best summarises the long-term comparative outcome?
56. A 65-year-old diabetic woman presents with a non-healing ulcer on the right lateral malleolus for 3 months. The ankle-brachial pressure index (ABPI) is 0.55 on the affected side. What does this ABPI value indicate and what is the most appropriate initial management?
57. The CEAP classification system is used to classify chronic venous disease. A patient with varicose veins, skin pigmentation, lipodermatosclerosis, and a healed venous leg ulcer would be classified as:
58. In carotid endarterectomy (CEA) for symptomatic carotid stenosis, the NASCET trial established the benefit in stenosis >70%. Which statement regarding the operative timing is most consistent with current guidelines?
59. The ACST-1 and ACST-2 trials addressed carotid intervention in asymptomatic carotid stenosis. According to ACST-2 (2021), stenting versus endarterectomy for asymptomatic stenosis showed:
60. The EVAR-1 trial compared endovascular aneurysm repair (EVAR) with open repair for infrarenal AAA ≥5.5 cm. At 15-year follow-up, which of the following best describes the outcome?
61. In Fontaine classification of peripheral arterial disease, which stage corresponds to ischaemic rest pain?
62. A 55-year-old man presents with bilateral lower limb claudication and erectile dysfunction. On examination, femoral pulses are reduced bilaterally and popliteal pulses are absent. Aortobifemoral bypass is planned. The symptom triad of bilateral buttock/thigh claudication, absent femoral pulses, and erectile dysfunction is called:
63. The EVAR-1 trial compared endovascular aortic aneurysm repair (EVAR) to open surgical repair for abdominal aortic aneurysm (AAA). Which of the following best summarizes the long-term findings?
64. A 65-year-old man with type 2 diabetes presents with a non-healing foot ulcer over the heel with gangrene of the 3rd toe. ABI is 0.4. CT angiography shows a short-segment occlusion of the superficial femoral artery (SFA) and tibial vessel disease. What is the most appropriate vascular intervention?
65. A 50-year-old woman presents with bilateral leg swelling, pitting edema, and chronic skin changes (lipodermatosclerosis, haemosiderin deposits) without varicosities. Duplex ultrasound shows bilateral deep vein incompetence. What is the most likely diagnosis?
66. A 68-year-old man with an 80% asymptomatic stenosis of the right internal carotid artery is evaluated for intervention. According to the ACST-2 trial (published 2021), what was the major finding comparing carotid endarterectomy (CEA) versus carotid artery stenting (CAS)?
67. A 55-year-old man presents with acute onset right leg pain, pallor, paraesthesia, and paralysis. The limb is cold with absent pulses below the right femoral artery. The paralysis and fixed skin staining are present for 4 hours. According to Rutherford classification of acute limb ischaemia, what is the limb category and what is the appropriate management?
68. The EVAR-1 trial compared endovascular aortic aneurysm repair (EVAR) with open repair for infrarenal AAA. The key finding at 15-year follow-up was:
69. The ankle-brachial pressure index (ABPI) value that indicates critical limb ischaemia with rest pain is:
70. In management of a symptomatic carotid artery stenosis of 75%, the NASCET trial demonstrated that carotid endarterectomy (CEA) is beneficial when performed within what timeframe after a TIA or minor stroke?
71. The Fontaine classification of peripheral arterial disease — Stage IIb is characterized by:
72. A 70-year-old hypertensive smoker has a 5.8 cm asymptomatic infrarenal abdominal aortic aneurysm (AAA). He is fit for intervention. The EVAR-1 trial and UK Small Aneurysm Trial established which threshold for elective AAA repair?
73. A 65-year-old woman with severe chronic limb-threatening ischemia (CLTI) has an ankle-brachial index (ABI) of 0.3. Angiography shows a 15 cm occlusion of the superficial femoral artery. TASC II classification categorizes this lesion as:
74. A 40-year-old woman presents with superficial thrombophlebitis of the great saphenous vein (GSV) extending to within 3 cm of the saphenofemoral junction (SFJ). The current ACCP/ESC recommended treatment is:
75. The Rutherford classification for chronic limb ischaemia Grade 3, Category 6 describes:
76. A 65-year-old man with a 6 cm infrarenal abdominal aortic aneurysm is being considered for endovascular aortic repair (EVAR). Which anatomical criterion is a contraindication to standard EVAR?
77. In the CEAP classification of chronic venous disease, a patient with active venous ulceration on the medial aspect of the gaiter area but without any evidence of skin changes elsewhere on the leg would be classified as:
78. A 70-year-old hypertensive male smoker is found to have a 5.6 cm fusiform abdominal aortic aneurysm (AAA) on routine ultrasound. He is asymptomatic. According to UK Small Aneurysm Trial and current guidelines, the appropriate management is:
79. The ankle-brachial pressure index (ABPI) is used to assess severity of peripheral arterial disease. An ABPI of 0.4 in a patient with rest pain and ulceration indicates which category of chronic limb-threatening ischaemia (CLTI)?
80. In varicose vein surgery, the CEAP classification of venous disease is used for grading. Which CEAP class is characterised by active venous ulceration?
81. The EVAR-1 trial compared endovascular aneurysm repair (EVAR) versus open repair for abdominal aortic aneurysm (AAA) in patients fit for both. What is the most clinically important long-term finding?
82. A patient with critical limb ischemia (rest pain) has an ABPI of 0.35. She is not a candidate for revascularization. What is the CEAP classification stage for her condition?
83. In thoracic outlet syndrome (TOS), the arterial variant is least common but most dangerous. Which structure is characteristically involved in arterial TOS?
84. The EVAR-1 trial compared endovascular aneurysm repair (EVAR) versus open surgery for abdominal aortic aneurysm (AAA). Which of the following most accurately summarises its long-term findings?
85. The CREST trial compared carotid endarterectomy (CEA) versus carotid artery stenting (CAS) for symptomatic and asymptomatic carotid stenosis. What was its key finding regarding periprocedural stroke risk?
86. A 55-year-old woman presents with swollen, heavy left leg and varicose veins. Duplex ultrasound confirms great saphenous vein (GSV) incompetence with sapheno-femoral junction (SFJ) reflux. The CEAP classification scores clinical severity. She has skin hyperpigmentation and lipodermatosclerosis without active ulcer. What CEAP clinical class is she?
87. A 70-year-old hypertensive smoker is found to have an incidental 5.8 cm infrarenal abdominal aortic aneurysm (AAA) on ultrasound. He is otherwise fit. According to ESVS guidelines, the preferred repair strategy is:
88. A 55-year-old woman develops a painful, non-pitting swelling of the right lower limb. Lymphoscintigraphy confirms lymphoedema. She is classified as stage II (spontaneously irreversible). What is the gold-standard conservative treatment?
89. A 65-year-old man with known peripheral arterial disease (PAD) develops rest pain in the right foot and a 1.5 cm ulcer over the right heel. ABI is 0.35. He has Type 2 diabetes. This is classified as Rutherford category:
90. A 68-year-old hypertensive smoker is found on CT to have an infrarenal abdominal aortic aneurysm (AAA) measuring 5.6 cm in maximum diameter. He is otherwise fit. According to UK Small Aneurysm Trial and ESVS 2019 guidelines, the appropriate management is:
91. A 55-year-old woman has a venous ulcer above the medial malleolus. Duplex ultrasound confirms incompetent perforators and great saphenous vein reflux. Her ABPI is 0.92. The Venous Clinical Severity Score (VCSS) is used. Which pathophysiological mechanism primarily drives venous ulcer formation?
92. A patient with Type B aortic dissection (Stanford) involving the descending thoracic aorta has persistent chest/back pain, hypertension refractory to medical therapy, and an enlarging aortic diameter on serial CT (48 mm to 55 mm in 3 months). This constitutes which category of Type B dissection mandating intervention?
93. A 55-year-old diabetic man presents with rest pain in the right foot and a non-healing plantar ulcer. ABPI is 0.42 on the right. CTA shows a long superficial femoral artery (SFA) occlusion (TASC II Class C) and a patent popliteal artery. The TASC II classification recommends for Class C femoropopliteal lesions:
94. A 65-year-old man is found to have an incidental 5.8 cm infrarenal abdominal aortic aneurysm (AAA). He is otherwise fit with no major comorbidities. According to current vascular surgery guidelines, what is the most appropriate management?
95. A 55-year-old woman has a 2-week history of a painful, red, and swollen right calf. Duplex ultrasound shows isolated calf (tibial vein) DVT with no proximal extension. She has no cancer and no prior VTE. According to current guidelines, what is the most appropriate management?
96. A 70-year-old diabetic man with a history of smoking presents with rest pain and a non-healing ulcer on the right big toe. Ankle-brachial pressure index (ABPI) is 0.35 on the right. Angiography shows a long-segment occlusion of the right superficial femoral artery (SFA) and tibial vessel disease. TASC classification would categorise a long-segment SFA occlusion (>15 cm) with tibial disease as:
97. The EVAR-1 trial compared endovascular aneurysm repair (EVAR) with open surgical repair for AAA >5.5 cm in fit patients. The long-term (15-year) finding showed:
98. In the treatment of deep vein thrombosis, the EINSTEIN-PE and EINSTEIN-DVT trials demonstrated non-inferiority of which agent compared to conventional heparin–warfarin therapy?
99. Leriche syndrome is caused by aortoiliac occlusive disease. The classic clinical triad consists of:
100. CEAP classification of chronic venous insufficiency assigns C2 status to which clinical finding?
101. A 70-year-old man with atrial fibrillation presents with sudden severe abdominal pain and bloody diarrhoea. CT angiography reveals occlusion of the superior mesenteric artery (SMA) at its origin. His lactate is 8 mmol/L. The primary diagnosis and immediate management is:
102. Buerger's disease (thromboangiitis obliterans) predominantly affects young male smokers. The diagnostic criteria require all of the following EXCEPT:
103. In the EVAR-1 trial comparing endovascular aneurysm repair (EVAR) to open repair of abdominal aortic aneurysm, what was the 15-year all-cause mortality finding?
104. In chronic venous insufficiency, the CEAP classification is the gold standard. A patient with active venous ulceration that has been present for 3 months, with varicose veins and telangiectasias, with saphenofemoral junction incompetence on duplex, is classified as:
105. The Fontaine classification of peripheral arterial disease categorizes a patient with rest pain in the foot, present for 2 weeks, without tissue loss as which stage?
106. The NASCET trial established the benefit of carotid endarterectomy (CEA) in symptomatic carotid stenosis. The greatest absolute risk reduction in stroke was demonstrated for stenosis of what degree?
107. The EVAR-1 trial established that endovascular aortic aneurysm repair (EVAR) versus open repair for AAA >5.5 cm provides what survival advantage at 15 years?
108. In the management of acute limb ischaemia, which Rutherford classification category indicates a limb with no sensory loss, no muscle weakness, and an audible Doppler signal — still viable but requiring urgent treatment?
109. The BASIL trial compared bypass surgery versus balloon angioplasty for severe limb ischaemia (CLI) due to infrainguinal disease. The key finding regarding survival at 2 years was:
110. A CEAP classification of C4b E p A s P r in chronic venous disease indicates which clinical finding?
111. The EVAR-1 trial comparing endovascular aortic aneurysm repair (EVAR) versus open repair in patients fit for open surgery demonstrated which of the following long-term (10-year) outcomes?
112. The CEAP classification for chronic venous insufficiency categorises disease based on Clinical, Etiological, Anatomical, and Pathophysiological findings. A patient with active venous ulceration due to post-thrombotic deep venous incompetence is classified as:
113. Critical limb ischaemia (CLI) is defined by which haemodynamic parameters in addition to clinical criteria (rest pain, ulceration, or gangrene)?
114. A 72-year-old hypertensive man is found to have a 5.8 cm infrarenal abdominal aortic aneurysm (AAA) on surveillance ultrasound. He is otherwise fit. What is the MOST appropriate management?
115. A 55-year-old woman presents with chronic leg ulcer at the medial gaiter area (just above medial malleolus). The ulcer has sloping edges, surrounding lipodermatosclerosis, and haemosiderin deposits. What is the MOST likely aetiology and the initial management?
116. Which named sign in a patient with lower limb ischaemia indicates that the level of arterial occlusion is at the aortoiliac segment (Leriche syndrome)?
117. A 72-year-old man with hypertension and a 50 pack-year smoking history presents to the emergency department with sudden-onset severe tearing chest pain radiating to the interscapular region. His BP is 185/100 mmHg in the right arm and 140/80 mmHg in the left arm. ECG shows no ST changes. CXR reveals a widened mediastinum. CT aortogram confirms a Type A aortic dissection involving the ascending aorta. What is the definitive management?
118. A 68-year-old woman is found to have a 5.8 cm infra-renal abdominal aortic aneurysm (AAA) on ultrasound surveillance. She is cardiovascularly fit with no significant comorbidities. CT angiography confirms an infra-renal AAA with a 15 mm neck below the renal arteries, without significant angulation or iliac involvement. What is the recommended treatment?
119. A 65-year-old diabetic man presents with a 2-hour history of sudden-onset cold, pale, pulseless, and painful left foot and lower leg. There is mild paraesthesia in the toes but he can flex and extend them. On examination no pulses are palpable below the left femoral pulse. His ECG shows atrial fibrillation. What is the Rutherford classification and the appropriate management?
120. A 58-year-old man with a history of hypertension and dyslipidaemia presents with intermittent claudication of the right calf at 100 metres. ABPI of the right leg is 0.62. Duplex ultrasound shows a significant stenosis at the right superficial femoral artery (SFA) in Hunter's canal. His symptoms have not responded to 3 months of supervised exercise therapy. What is the most appropriate intervention?
121. A 70-year-old man presents with a 2-month history of left-sided amaurosis fugax and a right-sided hemispheric TIA. Duplex ultrasound shows an 80% stenosis of the right internal carotid artery at the bifurcation. He is on aspirin 75 mg and a statin. He has no significant surgical comorbidity. What is the recommended intervention to reduce his future stroke risk?
122. A 60-year-old man presents with a pulsatile abdominal mass, severe back pain, and hypotension. Which of the following is the MOST appropriate immediate management?
123. Regarding Buerger's disease (thromboangiitis obliterans), which of the following statements is MOST accurate?
124. A 55-year-old man with Leriche syndrome has bilateral leg claudication, buttock claudication, and erectile dysfunction. Angiography shows complete aortoiliac occlusion. The most appropriate revascularization is:
125. A 72-year-old man presents with acute limb ischemia of the left leg with onset 4 hours ago. He has atrial fibrillation. The limb is cold, pale, pulseless, with paresthesias but no paralysis (Rutherford IIa). The most appropriate treatment is:
126. A 65-year-old diabetic man presents with a gangrenous right fifth toe, rest pain, and an ankle-brachial pressure index (ABPI) of 0.35. CTA shows a diffuse infra-popliteal arterial disease with patent anterior tibial and peroneal arteries. What Fontaine stage is this and what is the management goal?
127. A type B aortic dissection (Stanford classification) is identified in a 58-year-old hypertensive man. He is haemodynamically stable with no end-organ ischaemia or malperfusion. What is the INITIAL treatment of choice?
128. The ankle-brachial pressure index (ABPI) in a diabetic patient is falsely elevated. Which alternative non-invasive test provides more accurate assessment of peripheral perfusion in such patients?
129. Klippel-Trénaunay syndrome is characterised by which classical triad?
130. Type II endoleak following endovascular aneurysm repair (EVAR) is caused by:
131. In carotid endarterectomy (CEA) for symptomatic carotid stenosis, the NASCET trial criteria for significant stenosis and the timing of surgery are both important. NASCET showed greatest benefit when CEA is performed for symptomatic stenosis in which range, and within what timeframe?
132. Type I endoleak following endovascular aortic aneurysm repair (EVAR) is defined as:
133. Carotid endarterectomy (CEA) is indicated in symptomatic patients with carotid artery stenosis. The NASCET trial established benefit of CEA over medical management when stenosis (measured by NASCET method) exceeds which percentage?
134. A 70-year-old woman presents with sudden onset severe tearing chest pain radiating to the back. BP is 180/100 mmHg in the right arm and 155/90 mmHg in the left. CXR shows a widened mediastinum. CT aortogram confirms a Type A aortic dissection (Stanford classification). Appropriate management is:
135. A 55-year-old woman has a 6 cm femoral artery pseudoaneurysm following cardiac catheterisation. It is symptomatic with local pain and compresses the femoral vein. What is the first-line treatment?