# Help on Laser Atherectomy



## willnat2 (Oct 31, 2012)

I could really use some help with this procedure. I am having trouble with this.

INDICATIONS: 78 year old female with know peripheral vascular disease, who is referred for elective right PTA of a known totally occluded external iliac and right common femoral artery.

PROCEDURE PERFORMED:

1. Selective ilia and femoral angiography.
2. Laser atherectomy of the right common femoral and riht external iliac arteries.
3. Stent placement in the right exernal iliac with a 7 x 6 cm Sentinel sten.
4. Cryo balloon angioplasty of the right common femoral artery with a 5 x 4 cm cryo balloon.

No complications.

PROCEDURE:  After obtaining informed consent, the patient was brought to the cardiac cath lab in stable condition. The patient was draped and prepped in a sterile fashion. The right popliteal artery was cannulated using modified Seldinger technique, and a 6 french arterial sheath was introduced. Using a swries of 0.014 and 0.018 wires, we were able to negotiate the total occlusion at the common femoral and subsequently, at the right external iliac. Laser atherectomy was then performed using standard techniques. A 0.09 and a 1.7 mm laser catheter was used. Angiography then demonstrated antegrade flow with sever residual stenosis at the external iliac, as well as the common femoral positions. a 4 mm and subsequently a 5 mm balloon was used to dilate those segments. A 7 x 6 cm Sentinel stent was then deployed across the external iliac with excellent angiographic results. There was mild disease proximal to and distal to the stent, which was not flow limiting. There was still sever disease in the right common femoral position, which was treated with s 5 x 4 cm cryo balloon using multiple inflations. There was moderate residual stenosis, but excellent flow into the SFA, as well as the prfunda femoris. In light of good flow and overall dense calcification of the segment, and overall low likelihood of good angiographic results, a decision was made not to proceed with more aggressive attemts.

IMPRESSION: Successful laser atherectomy, balloon angioplasty and stenting of the right external iliac artery and the right common femoral iliac arter with overall very good angiographic results and excellent flow.


Thanks for your help, I would really appreciate it.


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## Jim Pawloski (Oct 31, 2012)

willnat2 said:


> I could really use some help with this procedure. I am having trouble with this.
> 
> INDICATIONS: 78 year old female with know peripheral vascular disease, who is referred for elective right PTA of a known totally occluded external iliac and right common femoral artery.
> 
> ...



Try 0238T for iliac atherectomy, 37221 for iliac stent placement, and 37227 for stent w/ atherectomy and angioplasty in fem-pop region.
HTH,
Jim Pawloski, CIRCC


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## willnat2 (Dec 1, 2012)

Thanks so much!


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