Vascular Surgery — MCQs

Vascular Surgery Indian Medical PG Practice Questions and MCQs

Question 541: What is the next step in the management of a young basketball player who develops an acute onset of subclavian vein thrombosis (effort thrombosis) after heavy exercise?

A. Thrombolytic therapy (Correct Answer)
B. Antibiotics
C. Physical therapy and rehabilitation
D. Anti-inflammatory drugs for pain management

Explanation: ***Thrombolytic therapy (Catheter-directed thrombolysis)*** - In **Paget-Schroetter syndrome** (effort thrombosis), young active patients presenting within **14 days** of symptom onset are candidates for **catheter-directed thrombolysis (CDT)** after initial anticoagulation - This approach aims to restore venous patency and prevent **post-thrombotic syndrome**, which occurs in up to 50% of conservatively managed cases - **Standard protocol**: Immediate therapeutic anticoagulation → CDT (if eligible) → subsequent thoracic outlet decompression (first rib resection) → rehabilitation - CDT is preferred over systemic thrombolysis due to lower bleeding risk and higher success rates in restoring patency - **Key point**: While anticoagulation is initiated immediately, definitive management in young athletes involves thrombolysis followed by surgical decompression *Physical therapy and rehabilitation* - Rehabilitation is **essential after definitive treatment** (post-thrombolysis and post-surgical decompression) but not the immediate next step - Starting rehabilitation without addressing the acute thrombosis would risk clot propagation, pulmonary embolism, and permanent venous damage *Antibiotics* - Antibiotics treat bacterial infections and have **no role in thrombosis** management - Paget-Schroetter syndrome is a **mechanical compression** issue (thoracic outlet obstruction) causing hypercoagulability, not an infectious process - Use of antibiotics would delay appropriate treatment *Anti-inflammatory drugs for pain management* - NSAIDs may provide symptomatic relief but do **not address the underlying thrombus** - Pain management alone would be inadequate and potentially dangerous, allowing thrombus propagation - Anti-inflammatory drugs do not prevent post-thrombotic syndrome or restore venous patency

Question 542: Among the following arteries, which is dissected most frequently during angiography performed via the femoral route?

A. Celiac trunk (Correct Answer)
B. Inferior mesenteric artery
C. Gastroduodenal artery
D. Superior mesenteric artery

Explanation: ***Celiac trunk*** - The **celiac trunk** is the **most frequently dissected artery** during femoral route angiography due to its **challenging anatomical characteristics**. - It arises at a **steep downward angle** (typically 45-90°) from the anterior aorta, requiring significant **catheter manipulation and torque** to engage the orifice. - The acute angulation increases the risk of **subintimal catheter passage** during selective cannulation attempts, leading to iatrogenic dissection. - The need for **repeated attempts** and catheter repositioning when engaging the celiac trunk further elevates dissection risk. *Superior mesenteric artery* - While the **SMA** is frequently cannulated during abdominal angiography, it has a **more favorable anatomy** for catheter engagement. - Its **less acute angle** of origin (typically 30-45° caudally) and more anterior takeoff make it **easier to cannulate** with less manipulation. - Easier cannulation translates to **lower dissection risk** compared to the celiac trunk, despite being commonly studied. *Inferior mesenteric artery* - The **IMA** is a smaller vessel with lower flow, originating from the lower abdominal aorta. - It is **less frequently cannulated** in routine angiography due to its small caliber and distal location. - Lower frequency of selective cannulation means fewer opportunities for dissection. *Gastroduodenal artery* - The **GDA** is a **secondary branch** arising from the hepatic artery (itself a celiac trunk branch). - Due to its **distal location** and smaller size, selective GDA catheterization is uncommon in routine angiography. - Its infrequent selective cannulation makes dissection during femoral angiography extremely rare.

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