Peripheral Vascular Procedures Flashcards

A patient's Ankle-Brachial Index (ABI) is calculated to be 0.65. This result is most consistent with:

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).

When performing an antegrade access for a superficial femoral artery (SFA) intervention, the common femoral artery (CFA) is punctured in which direction?

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.

The most common cause of renal artery stenosis, which can be treated with percutaneous angioplasty and stenting, is:

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.

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:

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.

What is the primary purpose of using an embolic protection device (EPD) during a carotid artery stenting procedure?

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.

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?

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.