A 65-year-old man presents with the findings as shown in the image. What is depicted in the image, and what is the underlying pathophysiology?

A 56-year-old woman with varicose veins has had a reflux ultrasound study of the left limb. What does the white arrow in the cross-sectional image of the groin indicate?

A 64-year-old female presents to your office for evaluation of a swollen, left-lower extremity extending from the inguinal ligament distally. She underwent an isolated, left-lower extremity limb perfusion for a history of malignant melanoma. She denies pain but endorses night sweats. What is your most likely diagnosis and imaging study?

A 55-year-old man with a history of DVT while on anticoagulation had a retrievable inferior vena cava (IVC) filter placed prior to spine surgery. The filter is no longer required and has been in place for 8 months. Which factor in this scenario suggests that advanced techniques will be required for successful retrieval of the filter?

A 65-year-old man is admitted for a lower gastrointestinal hemorrhage, which is believed to be secondary to sigmoid diverticulosis. During his hospital stay, he develops right leg swelling and is diagnosed with femoral/popliteal deep venous thrombosis. Overnight, he continues to pass several large bloody stools and is slightly tachycardic/hypotensive. He becomes anemic although he is responsive to blood product resuscitation. What is the best way to manage the lower extremity venous thrombosis?

A 65-year-old man who underwent a pancreaticoduodenectomy for adenocarcinoma 7 days ago complains of acute right calf pain and swelling. You suspect that he has developed a venous thrombosis. He has a positive Homans sign. His platelet count is 699,000/µL and his D dimer is 1.5 µg/mL. A venous duplex ultrasound demonstrates noncompressibility of the popliteal vein. Which of these findings listed most strongly supports the diagnosis of venous thromboembolism?

Which of the following ultrasound criteria defines pathologic valve incompetence in patients with chronic venous disease?

A 76-year-old woman comes to your office with gangrene of the second and third toes of her right foot. Cross-sectional imaging identifies a 1-cm long severe stenosis of the midsuperficial femoral artery and occlusion of the below-knee popliteal, tibioperoneal trunk, peroneal, and posterior tibial arteries. The anterior tibial artery reconstitutes midcalf and is patent into the plantar arch. Preoperative vein mapping demonstrates a patent ipsilateral saphenous vein of adequate caliber from the saphenofemoral junction to just below the knee. The contralateral saphenous vein has been harvested for coronary bypass, and both short saphenous and all arm veins are not of adequate diameter for use. What is the best operative plan for revascularization in this patient, who is otherwise a good surgical candidate?

Which patient should undergo fasciotomy?

A 64-year-old woman is undergoing a femoral-to-peroneal bypass with ipsilateral reversed greater saphenous vein for multilevel atherosclerotic disease resulting in tissue loss. After groin cutdown, the common femoral artery is palpated and found to have a weak pulse. What is the most appropriate way to continue?

You are asked to evaluate a 45-year-old patient with right lower extremity edema. She states that she fell on the ice one week ago at which time radiographs were negative for fractures; however, since then, she has not been as mobile because of the pain and edema in her leg. A duplex is obtained; below is an image of the common femoral and external iliac vein. What is the best treatment for this patient?

A 61-year-old male postal worker presents to the emergency department with the acute onset of right leg calf cramps with ambulation, which began 3 days ago. He has new-onset atrial fibrillation and is currently taking aspirin. On examination, his right foot is cool with delayed capillary refill, but his motor function and sensation are intact. There are monophasic Doppler signals in the right foot pedal positions compared to the left leg, where pedal pulses are palpable. Which of the following is the most appropriate next step in initial management?

A 49-year-old woman with diabetes presents with a large, erythematous right first toe with expressible purulence. She has no palpable pulses, and pedal Doppler signals are faint. Her ankle pressures are not obtainable due to noncompressible vessels. What is the most appropriate management?

A 72-year-old woman with diabetes has a chronic right heel ulcer that persists despite local wound care. A magnetic resonance imaging scan demonstrates osteomyelitis of the calcaneus, and a metal probe can be inserted to the bone. She has a palpable ipsilateral dorsalis pedis pulse. Which operation would be most appropriate?

A 74-year-old female with a past medical history of IDDM with ESRD on dialysis, hypercholesterolemia, hypertension, and previous MI is referred to you for evaluation of crampy calf pain for the last 2 months with onset upon physical exertion. It has since progressed to pain at rest. You perform ABIs which reveal critical limb ischemia. Which of the following will you most likely observe when performing preoperative imaging of this patient prior to infrapopliteal bypass?

A 27-year-old man is brought to the emergency department after a motor vehicle collision. He had multiple injuries, including visceral, osseous, and peripheral vascular, for which he underwent a laparotomy and splenectomy, external fixation of bilateral lower extremity fractures, and repair of bilateral femoropopliteal injuries. Ischemia duration was around 5 hours. You are concerned that the patient is at risk for developing lower extremity compartment syndrome. Which compartment would be most commonly affected first?

A 55-year-old man, a former smoker, presents with buttock and thigh claudication that is threatening his ability to continue working as a mail carrier. Physical examination is significant for absent femoral pulses and negative for tissue loss. You order a nuclear stress test, which is negative for reversible cardiac ischemia. You then take him for an angiogram through a left brachial approach and obtain the following images. Which approach to revascularization do you recommend?

A 70-year-old man with poorly controlled diabetes and no smoking history presents to the clinic for an ischemic toe ulcer. What level of infrainguinal arterial occlusive disease is he most at risk for developing based on this history?

A 55-year-old man, a former smoker, presents with buttock and thigh claudication that is threatening his ability to continue working as a mail carrier. Physical examination is significant for absent femoral pulses and negative for tissue loss. You order a nuclear stress test, which is negative for reversible cardiac ischemia. You then take him for an angiogram through a left brachial approach and obtain the following images. Which approach to revascularization do you recommend?