shescka
Contributor
Is this one only 37224? 
thanks in advance for your help
PROCEDURE PERFORMED:
1. Right lower extremity angiogram.
2. Right popliteal artery chocolate balloon angioplasty with a 2.5 x
40-mm, chocolate balloon.
3. Right fem-pop graft balloon angioplasty with a 4 x 40-mm chocolate
balloon within the prior stent.
BRIEF HISTORY:
This is a 58-year-old, male, with a history of hypertension and
diabetes, with a prior right femoral-popliteal bypass graft with
recent thrombotic occlusion, for which an AngioDynamics catheter was
kept overnight for 24-hours with infusion of alteplase and heparin
through the sheath and the catheter. The patient was brought back
today to the cath lab to evaluate the effect of this thrombotic
infusion.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, both groins were prepped and
draped in a sterile fashion, and under moderate sedation. We first
removed the wire from the AngioDynamics catheter. We then performed an
angiogram of the right lower extremity through the prior 6-French
sheath, placed from the left groin going up and over, seated in the
right common femoral artery. We noted that there was complete
resolution of the thrombotic occlusion of the right femoral-popliteal
bypass graft, due to the thrombolytics infusion. We saw some in-stent
restenosis of up to 70% in the distal fem-pop bypass graft stent at
the anastomosis site of the graft with the popliteal artery, along
with severe diffuse stenosis in the popliteal artery of up to 80%
stenosis. Hence, we prepared for angioplasty of this vessel.
IV heparin was administered to maintain adequate anticoagulation,
after which a BMW wire was passed through the existing AngioDynamics
catheter into the peroneal artery, after which the AngioDynamics
infusion catheter was removed, and a 2.5 x 40-mm chocolate balloon.
Angioplasty was performed in the right popliteal artery up to the
distal edge of the stent in the popliteal artery. We then used a 4 x
40-mm chocolate balloon to perform angioplasty of the distal femoral-
popliteal bypass graft stent, and the balloon was inflated inside the
prior stent to nominal pressure. This gave a favorable angiographic
result. The stenosis in the popliteal artery was reduced from 80%,
prior to the angioplasty, to 40% stenosis post angioplasty. The
patient had three vessel runoff in the right leg at the end of the
procedure, and also stated that his pain in the right foot had
decreased after completion of the angioplasty.
Angiogram performed of the right external iliac artery and right
common femoral artery showed evidence of no obstructive stenosis with
up to 50% stenosis seen in the right common femoral artery. We then
pulled back the 6-French sheath into the left external iliac artery,
and performed an angiogram, which showed no obstructive lesions in the
left common iliac artery, external iliac artery or common femoral
artery with a chronic total left SFA ostial occlusion. All catheters
and wires were then removed, and a long 6-French sheath in the left
groin was exchanged over the wire for a short 6-French sheath, and
secured in place to be removed by manual compression in the holding
room. There were no complications during the procedure, and the
patient tolerated the procedure well.
POSTOPERATIVE DIAGNOSIS:
1. Successful thrombolytic infusion therapy over 24-hours of the right
femoral-popliteal bypass graft with complete resolution of the
thrombotic occlusion in this graft, along with good three vessel
runoff seen in the right leg.
2. Chocolate balloon angioplasty of the right popliteal artery with a
2.5-mm chocolate balloon, along with chocolate balloon angioplasty
of the right femoral-popliteal bypass graft distal stent with a 4-
mm balloon inflated within the stent, to obtain a good angiographic
result.
PLAN OF CARE:
1. Restart anticoagulation and IV heparin in six hours, after the
sheath removal.
2. Continue to monitor the patient's circulation in both legs.
thanks in advance for your help
PROCEDURE PERFORMED:
1. Right lower extremity angiogram.
2. Right popliteal artery chocolate balloon angioplasty with a 2.5 x
40-mm, chocolate balloon.
3. Right fem-pop graft balloon angioplasty with a 4 x 40-mm chocolate
balloon within the prior stent.
BRIEF HISTORY:
This is a 58-year-old, male, with a history of hypertension and
diabetes, with a prior right femoral-popliteal bypass graft with
recent thrombotic occlusion, for which an AngioDynamics catheter was
kept overnight for 24-hours with infusion of alteplase and heparin
through the sheath and the catheter. The patient was brought back
today to the cath lab to evaluate the effect of this thrombotic
infusion.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, both groins were prepped and
draped in a sterile fashion, and under moderate sedation. We first
removed the wire from the AngioDynamics catheter. We then performed an
angiogram of the right lower extremity through the prior 6-French
sheath, placed from the left groin going up and over, seated in the
right common femoral artery. We noted that there was complete
resolution of the thrombotic occlusion of the right femoral-popliteal
bypass graft, due to the thrombolytics infusion. We saw some in-stent
restenosis of up to 70% in the distal fem-pop bypass graft stent at
the anastomosis site of the graft with the popliteal artery, along
with severe diffuse stenosis in the popliteal artery of up to 80%
stenosis. Hence, we prepared for angioplasty of this vessel.
IV heparin was administered to maintain adequate anticoagulation,
after which a BMW wire was passed through the existing AngioDynamics
catheter into the peroneal artery, after which the AngioDynamics
infusion catheter was removed, and a 2.5 x 40-mm chocolate balloon.
Angioplasty was performed in the right popliteal artery up to the
distal edge of the stent in the popliteal artery. We then used a 4 x
40-mm chocolate balloon to perform angioplasty of the distal femoral-
popliteal bypass graft stent, and the balloon was inflated inside the
prior stent to nominal pressure. This gave a favorable angiographic
result. The stenosis in the popliteal artery was reduced from 80%,
prior to the angioplasty, to 40% stenosis post angioplasty. The
patient had three vessel runoff in the right leg at the end of the
procedure, and also stated that his pain in the right foot had
decreased after completion of the angioplasty.
Angiogram performed of the right external iliac artery and right
common femoral artery showed evidence of no obstructive stenosis with
up to 50% stenosis seen in the right common femoral artery. We then
pulled back the 6-French sheath into the left external iliac artery,
and performed an angiogram, which showed no obstructive lesions in the
left common iliac artery, external iliac artery or common femoral
artery with a chronic total left SFA ostial occlusion. All catheters
and wires were then removed, and a long 6-French sheath in the left
groin was exchanged over the wire for a short 6-French sheath, and
secured in place to be removed by manual compression in the holding
room. There were no complications during the procedure, and the
patient tolerated the procedure well.
POSTOPERATIVE DIAGNOSIS:
1. Successful thrombolytic infusion therapy over 24-hours of the right
femoral-popliteal bypass graft with complete resolution of the
thrombotic occlusion in this graft, along with good three vessel
runoff seen in the right leg.
2. Chocolate balloon angioplasty of the right popliteal artery with a
2.5-mm chocolate balloon, along with chocolate balloon angioplasty
of the right femoral-popliteal bypass graft distal stent with a 4-
mm balloon inflated within the stent, to obtain a good angiographic
result.
PLAN OF CARE:
1. Restart anticoagulation and IV heparin in six hours, after the
sheath removal.
2. Continue to monitor the patient's circulation in both legs.
