Free RCIS Peripheral Vascular Procedures Questions and Answers — Questions and Answers
Question 1: A patient's Ankle-Brachial Index (ABI) is calculated to be 0.65. This result is most consistent with:
- Normal arterial flow
- Mild to moderate peripheral artery disease (Correct answer)
- Severe peripheral artery disease
- Non-compressible, calcified arteries
Correct answer: Mild to moderate peripheral artery disease
The ABI is a ratio of the systolic blood pressure at the ankle to the systolic blood pressure in the arm. A normal ABI is 1.0-1.4. An ABI of 0.65 falls into the 0.41-0.90 range, which is indicative of mild to moderate peripheral artery disease (PAD).
Question 2: When performing an antegrade access for a superficial femoral artery (SFA) intervention, the common femoral artery (CFA) is punctured in which direction?
- In a retrograde direction, towards the aorta
- In an antegrade direction, towards the foot (Correct answer)
- Laterally, towards the femoral vein
- Medially, away from the femoral vein
Correct answer: In an antegrade direction, towards the foot
Antegrade access means puncturing the artery in the direction of blood flow. For an SFA intervention, the CFA is punctured from above, directing the needle, wire, and sheath downwards into the SFA. This is in contrast to retrograde access, where the puncture is against the direction of blood flow.
Question 3: The most common cause of renal artery stenosis, which can be treated with percutaneous angioplasty and stenting, is:
- Fibromuscular dysplasia (FMD)
- Atherosclerosis (Correct answer)
- Aortic dissection
- Vasculitis
Correct answer: Atherosclerosis
Atherosclerosis is by far the most common cause of renal artery stenosis, accounting for approximately 90% of cases. It typically affects the ostium and proximal segment of the renal artery. Fibromuscular dysplasia (FMD) is a less common, non-atherosclerotic cause, often seen in younger female patients.
Question 4: During a lower extremity peripheral intervention, the patient suddenly complains of severe, acute pain in the foot, which appears pale and cold. This is most likely a sign of:
- A retroperitoneal bleed
- A vasovagal reaction
- Distal embolization (Correct answer)
- Contrast-induced nephropathy
Correct answer: Distal embolization
Acute distal embolization is a known complication of peripheral interventions. Plaque or thrombus can be dislodged during ballooning or stenting and travel downstream, occluding smaller vessels in the foot. This leads to acute limb ischemia, characterized by the '6 Ps': pain, pallor, pulselessness, poikilothermia (coldness), paresthesia, and paralysis.
Question 5: What is the primary purpose of using an embolic protection device (EPD) during a carotid artery stenting procedure?
- To prevent vessel dissection
- To capture embolic debris and prevent stroke (Correct answer)
- To measure pressure gradients across the lesion
- To prevent stent migration
Correct answer: To capture embolic debris and prevent stroke
The primary goal of an EPD, such as a filter or a balloon occlusion system, is to prevent procedural emboli from traveling to the brain. During angioplasty and stenting of the carotid artery, atherosclerotic debris can be dislodged. The EPD is deployed distal to the lesion to capture this debris, thereby reducing the risk of periprocedural stroke.
Question 6: When treating a stenotic lesion in the common iliac artery, which of the following is a critical consideration to avoid compromising blood flow to the contralateral leg?
- Using a drug-eluting stent instead of a bare-metal stent
- Ensuring the guidewire crosses into the superficial femoral artery
- Avoiding 'jailing' the contralateral common iliac artery ostium (Correct answer)
- Performing a pre-procedure ABI measurement
Correct answer: Avoiding 'jailing' the contralateral common iliac artery ostium
The common iliac arteries bifurcate into the internal and external iliac arteries. When stenting a lesion in one common iliac artery that extends to the aortic bifurcation, care must be taken not to 'jail' or cover the ostium of the contralateral common iliac artery. This could compromise blood flow to the other leg, a complication that may require complex 'kissing stent' techniques to resolve.
Free RCIS Peripheral Vascular Procedures Questions and Answers
A patient's Ankle-Brachial Index (ABI) is calculated to be 0.65.
This result is most consistent with: