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Chapter 54. Peripheral Arterial Disease

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According to the authors, which of the following statements regarding duplex ultrasound uses for surveillance after endovascular revascularization of the femoropopliteal territory is true?

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A. Duplex ultrasound examination is warranted when claudication or signs of critical limb ischemia recur.

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B. Duplex ultrasound examination is recommended to monitor for restenosis 6 and 12 months after revascularization.

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C. Duplex ultrasound examination is recommended to monitor restenosis within 1 month after the procedure, at 3 and 6 months, and then once a year after revascularization.

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D. Concomitant ankle-brachial index (ABI) is recommended 6 and 12 months after procedure.

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The correct answer is C

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Patients undergoing lower extremity revascularization with endovascular techniques require a baseline ABI and a duplex ultrasound examination of the treated vascular segment within 1 month of the procedure. In addition to the baseline study, the authors routinely repeat the ABIs and duplex ultrasound examinations at 3 and 6 months after the endovascular intervention to monitor for patency of the target vessel site. Patients are at highest risk for restenosis during the first 6 months after the procedure, and symptoms of recurrent disabling claudication may occur too late, after (re)occlusion of the index lesion. Repeat revascularization of a completely occluded artery from restenosis is expected to be difficult and time consuming, while also exposing both the patient and the operators to excessive direct radiation; therefore, early detection of physiologic (ABI/ pulse volume recording [PVR]) or anatomic (duplex ultrasound) signs of significant restenosis will permit planning for re-intervention, before progression to a total occlusion.

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Surgical treatment of symptomatic common and external iliac artery stenosis should be considered in all of the following conditions, EXCEPT:

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A. 100% flush occlusion of the ostium of the common iliac artery with severe calcification and no “beak” at the origin of the diseased segment

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B. 6.5-cm concomitant abdominal aortic aneurysm (AAA)

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C. 100% occlusion of the distal abdominal aorta

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D. Lack of contralateral or ipsilateral femoral access

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The correct answer is D

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Most patients with symptomatic common and external iliac artery stenosis are treated using endovascular techniques unless: (1) there is an infrarenal AAA requiring repair; (2) there is a 100% flush occlusion with no “beak” or “nubbin” at the ostium of the common iliac artery and there is severe calcification and intermediate (>5 cm) length occlusion; or (3) there is a long occlusion (>10 cm) with severe calcification.

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The decision to use endovascular techniques versus open ...

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