A 61-year-old man with a history of heavy smoking, hypertension, diabetes mellitus, and chronic peripheral arterial disease with intermittent claudication presents to the ED with 3 hours of severe, acute-onset pain in his right foot. He takes aspirin daily, a beta-blocker for his hypertension, and metformin for his diabetes. He has a cool right foot compared with the left, with absent pulses and Doppler signals, loss of fine touch, and proprioception in the right foot to the ankle. He has weakness with plantar/dorsiflexion of the toes in the right foot compared with the left. What is this patient's grade of ischemia based on the Rutherford classification of acute limb ischemia?

A 64-year-old man with numerous cardiovascular risk factors and a history of chronic mesenteric ischemia presents with sudden diffuse continuous severe abdominal pain. During previous evaluation of his chronic ischemia, he underwent computed tomography angiography (CTA), which demonstrated an occluded celiac and inferior mesenteric artery with a heavily calcified 5-cm superior mesenteric artery stenosis. The CTA was also significant for severely calcified but patent bilateral common and external iliac arteries. What is the most likely intervention for this patient at this point?

A 35-year-old woman presents with sudden-onset transient monocular vision loss and aphasia, which resolve spontaneously while en route to the emergency department. She undergoes imaging that is consistent with the diagnosis of cerebrovascular fibromuscular dysplasia (FMD). Which of the following imaging findings is most commonly associated with FMD?

A 66-year-old man presents to the emergency department with severe back pain and syncope. Vital signs are heart rate of 105 beats/min and blood pressure of 80/60 mm Hg. After receiving 1 L of crystalloid, his blood pressure is 100/65 mm Hg. On examination, he has a pulsatile abdominal mass that is tender to palpation. What is the next best step in management?

An 85-year-old woman has an asymptomatic 80% right internal carotid artery stenosis. You are discussing therapeutic options with her, including medical management, carotid endarterectomy, and carotid stent placement. Which of the following is a conclusion of the Carotid Revascularization Endarterectomy versus Stent Trial (CREST)?

A 40-year-old obese woman is being evaluated for hypertension that is not controlled with three oral agents. Her family history is positive for hypertension and coronary artery disease. Serum creatinine has increased from 1.2 mg/dL to 1.6 mg/dL in the past six months. A renal ultrasound is obtained; however, it is non-diagnostic because of her body habitus. Therefore, an aortogram is pursued (see image below). What is the next best step in the management of this patient?

A 70-year-old man comes to the vascular surgery clinic for consultation. He is currently feeling well and has no complaints. He has a history of tobacco use—30 years. What is the screening recommendation for abdominal aortic aneurysm in this patient?

72-year-old man with a history of a coronary artery bypass 5 years ago for three-vessel coronary artery disease is referred to your clinic for medically refractory hypertension. In clinic, he is asymptomatic, with a systolic blood pressure of 187 mm Hg despite taking atenolol, lisinopril, and amlodipine. A renal duplex ultrasound reveals right renal artery stenosis and elevated right renal artery systolic flow velocity. What is the most appropriate treatment?

A 38-year-old man with a history of hepatitis C and intravenous drug use presents to the emergency department with a 1-month history of postprandial periumbilical pain, which acutely worsened 1 hour ago and is now associated with back pain. He is hypotensive, and his hemoglobin is 7.5 g/dL. A CT scan reveals a large retroperitoneal hematoma. What is the most likely diagnosis?

A 71-year-old man with an aortoenteric fistula undergoes an extra-anatomic bypass (axillobifemoral) followed by graft excision and infected tissue debridement. On postoperative day 2, in the intensive care unit, he experiences sudden profound hypotension. What is the most likely etiology?

A 67-year-old man is undergoing an aneurysmectomy after ligation of his common hepatic artery aneurysm. A pulse is felt in the proper hepatic artery at the conclusion of the procedure without performing a bypass. What is the most likely explanation?

A 65-year-old man is postoperative day 5 after a right carotid endarterectomy. You are called to the emergency department to evaluate him after he experiences a brief seizure that is now fully resolved. He is now complaining of a new, severe right-sided headache. Vital signs are temperature 98.9ºF, pulse 83/min, blood pressure 190/100 mm Hg, and respiratory rate 18/min. The surgical site looks good. What should be the next step in management?

A 67-year-old man, who is POD#1 from open abdominal aortic aneurysm, has an episode of bloody diarrhea along with acidosis and leukocytosis. A flex-sigmoidoscopy is performed and shows sigmoid colonic ischemia. He is treated with fluid resuscitation and broad-spectrum antibiotics. Twenty-four hours later his leukocytosis worsened, and second look sigmoidoscopy shows full-thickness colonic ischemia. What is the best management of this patient?

A 65-year-old man with an infected aortic graft will undergo an in situ reconstruction after excision of an infected aortic graft and debridement of surrounding tissues. What is the advantage of a transperitoneal approach over the retroperitoneal approach?

An 85-year-old man presents to the ED with diffuse abdominal pain and bloody stools. CT angiography reveals patent celiac and inferior mesenteric arteries but an occluded superior mesenteric artery immediately distal to the middle colic branch. He is taken emergently to the operating room and on entry to the abdomen, his bowel from the ligament of Treitz to the splenic flexure is frankly necrotic. What is the next best step in management?

A 65-year-old woman with a history of long-standing hypertension is referred to your clinic for evaluation with results of a recent arteriogram. Relevant past medical history includes hypertension, diabetes, and tobacco use for the past 30 years. CT arteriography was ordered after multiple antihypertensive medication regimens have failed to control her high blood pressure. Her laboratory studies reveal a steady increase in serum creatinine over the past several months from 1.2 mg/dL to 1.8 mg/dL. Electrolytes are within normal limits. The recent study showed severe aortic disease and significant bilateral 90% renal artery stenosis associated with large collateral vessels. What would you advise the patient regarding the role of operative intervention?

A 65-year-old man presents to the emergency department after having a 3-minute episode of right arm paralysis. The neurologist diagnoses a transient ischemic attack and suspects that carotid artery stenosis is the cause of the patient's symptoms. The patient's carotid duplex scan reveals a 75% left internal carotid artery stenosis. According to the North American Symptomatic Carotid Endarterectomy Trial (NASCET), what is this patient's future risk of stroke?

A 60-year-old man presents to the hospital for elective repair of an abdominal aortic aneurysm. Postoperatively, he develops hypotension, elevated lactic acid, and melena. What treatment should be initiated?

A 48-year-old woman presents with a 2-day history of transient vision loss, headache, and jaw claudication. A presumptive diagnosis of giant cell arteritis is made. What is the first-line therapeutic intervention for this patient?