Post-Test Questions

Article 1 (3–5)

1. Which of the following are NOT advantages of peritoneal dialysis over hemodialysis with a dialysis catheter?

   • Peritoneal dialysis can be initiated with high clearances more quickly than hemodialysis with a catheter.

   • Peritoneal dialysis does not damage central veins.

   • Peritoneal dialysis carries a lower risk of bacteremia.

   • Peritoneal dialysis can be performed at home and does not require a venous dialysis center.

   • All of the above are advantages of peritoneal dialysis over hemodialysis with a catheter.

2. Which of the following have been used in placement of peritoneal dialysis?

   • Peritoneoscope

   • Laparoscope

   • Open Surgery

   • Flouroscopically-guided procedures without a scope

   • All of the above

3. Which of the following are NOT contraindications to PD catheter placement?

   • Peritonitis

   • Abdominal hernia

   • Obesity

   • Crohn's disease

   • Clostridium Difficile

     Article 2 (6–9)

4. Surgical creation of an AVF's are associated with:

   • a >80% maturity rate

   • no interventions following creation to facilitate maturation

   • a <20% maturity rate

   • a 20–60% failure to mature rate

5. For options to assist maturation in surgical fistulas:

   • the Optifl ow device has been found to be superior to traditional surgery for maturation of AVF's

   • long term data regarding the efficacy of the Optifl ow device and PRT-201 has been published.

   • Bioengineered blood vessels are derived from fetal stem cells

   • None of the above

6. Nonsurgical creation of AVF's is associated with:

   • initial results indicate improved technical success rates and time to maturation compared to historical surgical outcomes

   • long term published outcomes that validate superiority over surgical creation

   • feasibility studies are completed but long term studies are not yet recruiting

   • none of the above

     Article 3 (10–14)

7. Which of the following statements are supported by prospective randomized controlled trials?

   • Wallstents improve the usable life expectancy of AV grafts with venous anastamotic stenoses.

   • Fluency stents improve the patency of AV fistulae

   • Flair stents have better 6 month primary patency than angioplasty alone for AV gvenous anastamotic stenoses.

   • SMART stent use improves primary patency of AVF over angioplasty alone.

   • Viabahn stent-graft off ers better access patency when used in venous outfl ow stenoses in AVF

8. Which of the following is a CORRECT statement about stent or stent-graft treatment of AV Graft psuedoaneurysms?

   • There is good prospective randomized evidence that stent graft use to exclude psuedoaneurysms in grafts is less eff ective than surgical revision of the graft.

   • Stents have been demonstrated to be successful at excluding graft pseudoanneurysms while maintaining usability of the graft

   • There is an increased risk of infection associated with intra-graft exclusion of psuedoaneurysms

   • Stent grafts have obviated the need for surgical revision of grafts with pseudoaneurysms.

   • All of the above

9. Which of the following statements is INCORRECT?

   • The use of the Flair device across the venous anastamoses of grafts has an improved primary access patency when compared to angioplasty alone after 6 months.

   • Viabahn use in the cephalic arch has an improved target lesion patency over angioplasty alone

   • Wallstent use in venous stenoses associated with AV grafts decreases the number of interventions needed to maintain patency of the access, but do not prolong the life of the access

   • Use of the SMART stent in AV fistulae increases the life of the access when compared to angioplasty alone.

   • There are no prospective randomized data to support stent graft use versus surgical revision for the exclusion of pseudoaneurysms in grafts after venous stenoses have been managed.

     Article 4 (15–20)

10. Which of the following biological factors is NOT a major contributor to the development of AV access stenosis?

    • Uremia

    • Hypoxia

    • Over production of Nitric Oxide

    • Increased Shear Stress

11. Uremia predisposes to intimal hyperplasia in dialysis access by which of the following?

    • Increasing infl ammatory cytokine production

    • Decreasing macrophage & monocyte attraction to the AVF

    • Increased TGF-β1 expression

    • All of the above

    • a & c

12. Shear stress causes all of the following in endothelial cells at the anastomosis of an AVF EXCEPT:

    • Rearrangement of the cytoskeleton

    • Increases VEGF production

    • Decreases infl ammatory cytokine production

    • Decreases vasodilation

      Article 5 (21–24)

13. According to the Fistula First Breakthrough Initiative, which of the following is the first choice for hemodialysis vascular access?

    • Radial artery to cephalic vein arteriovenous fistula

    • Brachial artery to basilic vein arteriovenous fistula

    • Radial artery to cephalic vein prosthetic bridge graft

    • Tunneled dialysis catheter

14. Which of the following physical exam findings suggest a central venous stenosis?

    • Hand weakness

    • Unequal pulses between extremities

    • Multiple surgical scars on extremity from access procedures

    • Arm swelling

15. If a patient does not have adequately sized basilic or cephalic veins for arteriovenous fistula creation, which of the following is the best option without using prosthetic graft material?

    • Brachial artery to brachial vein conditioning arteriovenous fistula

    • Using saphenous vein graft for creation of an autogenous bridge graft

    • No other options outside of prosthetic graft

    • None of the above

      Article 6 (25–30)

16. Which of the following is NOT a normal finding of an arteriovenous fistula or graft during a physical exam?

    • Fistula collapses on arm elevation

    • Thrill at the arterial anastomosis

    • Pulsation at the anastomosis

    • Low pitch bruit at auscultation

17. According to National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines, which of the following cases should prompt further evaluation for access surveillance?

    • Access flow rates <600 ml/min in grafts or <400–500 ml/min in fistulae

    • Venous segment static pressure ratio >0.5 in grafts and fistula

    • Arterial segment static pressure ratio >0.75 in grafts

    • All of the above

18. Which of the following is NOT correct regarding ultrasound dilution (UD) technique (Krivitski method) for intra-access blood fl ow measurement (Q_a)?

    • UD is a noninvasive method and require dialysis bloodline reversal

    • Cardiopulmonary recirculation (CPR) does not infl uence Qa measurement

    • Measurement requires thorough mixing of indicator

    • None of the above are correct

      Article 7 (31–38)

19. On postero-anterior fl uoroscopy, how far below the carina is the superior vena cava – right atrial junction?

    • 2 cm

    • 4 cm

    • 6 cm

    • 8 cm

    • At the level of the carina

20. Which of the following is CORRECT regarding placement of tunneled dialysis catheters?

    • The catheter tip should be placed 2–4 cm above the right atrium

    • If the right internal jugular vein cannot be used, the next best access vessel is the left internal jugular vein

    • The internal jugular puncture site should be made halfway between the clavicle and skull base

    • The cuff should be at least 4 cm from the entry site and 2 cm from the exit site

    • None of the above

21. Etiologies of catheter dysfunction include all of the following EXCEPT:

    • Fibrin sheath formation.

    • Catheter kinks

    • Catheter tip adherent to the vessel wall.

    • Catheter fracture

    • All of the above can cause catheter dysfunction

      Article 8 (39–45)

22. Which of the following is INCORRECT regarding options that could be used in the treatment of failing dialysis accesses?

    • Surgery

    • Percutaneous stent placement

    • Percutaneous stent graft placement

    • Catheter placement for dialysis

    • All are correct

23. Which of the following is CORRECT regarding heparin-bonded stent graft placement?

    • Heparin bonded grafts must be special ordered

    • Heparin bonded grafts generally cost more than double non-bonded grafts

    • Heparin bonding for Viabahn grafts utilize the equivalent of ∼200 IU of heparin that elute over an extended period of time

    • Heparin bonded grafts should never be used in patients with a heparin allergy

    • The Flair stent graft (Bard) has been shown to be superior to the Viabahn stent graft (Gore)

      Article 9 (46–51)

24. According to the study by Kitrou et al, which of the following is CORRECT regarding the use of paclitaxelcoated balloons compared to uncoated balloons?

    • Device success was greater in the coated balloon cohort

    • A significant minority of patients (∼25%) undergoing drug-coated balloon angioplasty required treatment with high pressure balloons

    • Access circuit primary patency rates were better in the drug-coated cohort than the angioplasty alone cohort

    • Paclitaxel-coated balloon success rates were improved with subsequent cutting balloon use

    • None of the above

25. According to the study by Prologo et al, which of the following is CORRECT?

    • Patients undergoing intervention in the first 24 hours showed an improved success rate compared with the other cohorts

    • Most technical factors had to do with the inability to achieve thrombolysis of the grafts at the time of the initial procedure

    • In patients who were unable to undergo a successful post-procedure dialysis session, the time to intervention was significantly longer than those patients who were successfully dialyzed.

    • Patients who underwent thrombolysis following >72 hours of a clotted graft had worse outcomes than those in the earlier time periods.

    • None of the above

26. According to the study by Saleh et al, which of the following is CORRECT regarding cutting balloon angioplasty versus conventional angioplasty?

    • 6 and 12 month patency rates were statistically the same when comparing for all anatomic locations

    • Stenoses in native veins were excluded

    • Primary assisted patency rates were significantly improved with the use of cutting balloons at the venous anastomosis

    • Major complication rates were significantly higher in the cutting balloon cohort

    • None of the above

      Article 10 (52–55)

27. Which of the following is INCORRECT according to the 2006 K-DOQI guidelines?

    • The initial access route of choice is a forearm radiocephalic fistula

    • Catheter placement should be performed in all patients to allow fistula maturation to occur.

    • If a radiocephalic fistula cannot be placed or fails, the access of choice is a brachiocephalic fistula

    • The third fistula of choice is a transposed brachial artery to basilic vein

    • All of the above are correct.

28. Which of the following is CORRECT regarding balloon angioplasty?

    • Low pressure balloons (<10 atm) should be used in dialysis access angioplasty to prevent rupture

    • Balloon infl ations for 3 minutes shows a sustained 3-month response compared to infl ations for 1 minute

    • The Society of Interventional Radiology guidelines are 40% 6-month patency for thrombosed grafts undergoing intervention

    • Cutting ballons are superior in both the short and long term for graft-venous anastomotic stenoses

    • All of the above are correct

29. Which of the following is CORRECT regarding surgically placed dialysis accesse?

    • Steal syndrome can be seen with either AVG or AVF

    • Over the lifetime of accesses, between 50-60% of accesses will require some form of intervention.

    • AVFs have a lower rate of failure compared to AVG in both the long and short term

    • According to the Society of Interventional Radiology guidelines AVG or AVF failures requiring treatment are any >50% diameter stenosis.

    • All of the above are correct