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June, 2005
Evaluation of Lower Extremity Bypass Grafts


1. The earliest indication of a vein graft stenosis is which of the following?:

a. Lower extremity symptoms

b. A drop in ankle-arm pressures

c. A local region of blood flow elevation

 

2. Graft surveillance of a synthetic bypass graft should be performed:

a. Every three months.

b. Every six months

c. At most every one to two years

 

3. A patient presents with a focal area of increased blood flow velocities in a mid graft conduit. The ratio of peak systolic velocity at this point is three times that of a point located 2 cm above. This finding indicates

   1. A stenosis close to 50% diameter narrowing
   2. A stenosis of 50 to 75% diameter narrowing
   3. The need for close surveillance
   4. The need to insure the next routine 6 month surveillance visit

a. 1 and 3

b. 1 and 4

c. 2 and 3

 

4. A Doppler velocity measurement in a proximal "in-situ" vein graft shows decreased blood flow velocities. This is least likely due to:

a. Use of a large diameter saphenous vein

b. Low cardiac ouptut

c. High grade stenosis in the graft

d. A persistent fistula (communicating vein) distally


5. Vein valves are more often the site of developing vein graft stenosis.

a. If the vein was originally varicose

b. When the in situ technique is used

c. In a reversed vein graft

d. Only if the valve is close to an anastomosis

 

6. Comparing the distal anastomosis of a in situ to a reversed vein graft. Distal blood flow velocities in the anastomosis are more likely to be

a. Higher with the reversed graft

b. The same in the reversed and in situ grafts

c. Lower with the reversed graft

 

7. A rapid upstroke monophasic Doppler blood flow velocity waveform with low diastolic amplitude is obtained in a femoro-popliteal graft. This is least likely to indicate:

a. Normal graft

b. Possible graft stenosis

c. Probable occlusion of the ipsilateral iliac artery

d. Possible distal native disease

e. Relative vasoconstriction of the distal native arteries

 

8. A peak systolic velocity of 150 cm/sec is detected at the distal anstomosis of a reversed bypass graft. Peak systolic velocity in the conduit 4 cm above is 50 cm/sec. Peak systolic velocity in the native posterio-tibial artery is 100 cm/sec. This graft has:

a. A distal anastomotic stenosis of 50 to 75%

b. A blood flow velocity increase due to the geometry of the anstomosis

c. Evidence of native arterial disease in the posterior tibial artery

9. A patient presents without symptoms, one month after surgery for a femoro-popliteal bypass graft. A Doppler waveform obtained in the proximal graft shows absent signals. The most likely possibility is:

a. Graft occlusion due to technical factors

b. Graft occlusion due to development of a fibro-intimal hyperplastic lesion

c. Graft occlusion due to native arterial disease

d. Poor technique: because the patient has no symptoms, the graft has to be open

10. A patulous distal anastomosis of a bypass graft.

a. Is more often seen with an in-situ graft

b. Is almost always an indication of aneurysm formation

c. Is often seen with reversed bypass grafts

d. Indicates a higher risk of stenosis development

 


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