sslater
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Help- CV Surgery is very new to me. Can someone help me with this?? I have the 37221 for the iliac stenting..
OPERATIVE PROCEDURE: Abdominal aortogram, pelvic arteriogram,
bilateral lower extremity arteriogram and runoff from the femoral
artery level, right common iliac artery stent angioplasty.
Pelvic arteriogram: The pelvic vessels were patent with internal and
external iliac arteries patent with calcified walls but no high-grade
disease other than the high-grade calcific plaque at the inflow the
right common iliac artery. Left lower extremity arteriogram and
runoff, left common femoral artery, superficial femoral artery,
profunda femorus were patent with calcifications in the walls and
luminal irregularities. Left popliteal artery was patent. There was
luminal irregularities in the tibial vessels; however, she had
2-vessel runoff to the left foot.
DESCRIPTION OF OPERATION:
Right lower extremity arteriogram and runoff: Right common femoral
artery, profunda femorus and superficial femoral arteries were patent.
However, there was calcification and luminal irregularities. The
right superficial femoral artery had multiple areas of calcification
and 40-50 in some areas of 60% diffuse stenotic areas in the mid to
distal right superficial femoral artery. Popliteal artery was patent.
Tibial vessels have calcified plaque but were patent to the foot.
DESCRIPTION OF OPERATION: The patient was taken to the operating room
and placed in a supine position. General endotracheal anesthesia was
administered. Lower abdomen, groins and legs were prepped and draped
in the usual sterile manner. Using the CT angiogram for guidance, we
accessed the left common femoral artery and a Glidewire was advanced
into the thoracic aorta. All wire manipulation was done under
continuous fluoroscopic guidance. A 4-French sheath was placed. An
oblique angiogram done of the puncture site documenting common femoral
artery puncture site. The pelvic angiogram was performed and left
lower extremity arteriogram was performed. We accessed the right
common femoral artery and noted approximately 40 mmHg difference
between the radial artery pressure in the right common femoral artery.
We advanced the Glidewire through the lesion and into the thoracic
aorta. We heparinized the patient with a total of 10,000 units of
intravenous Heparin and activated clotting time was approximately 300
seconds. I placed a 6-French x 30 cm Raabe sheath on the right wire
through the lesion with the tip in the lower abdominal aorta. The
image intensifier and the bed were locked and flush aortography was
performed and the lesion was visualized and measured. We placed a 7
mm x 30 mm stent through the Raabe sheath and then withdrew the Raabe
sheath positioning it in the common iliac artery extending into the
aorta approximately 1 cm. We inflated this to 8-1/2 atmospheres and
had good profiling. This stent material, because of the small
diameter of the aorta and its protruding into the aorta, was in the
blood flow track to the left common iliac artery. I had the up on the
left side and decided to not place a stent in the left common iliac
artery as this would have required an 8 mm stent because of the
relative larger diameter and no stenosis on the left side. My concern
with been to then in that deployment to crush the right-sided stent
against the lateral aortic wall plaque which would then more an
obstruction to flow than a widely open stent from the right side
alone. We measured pressures and found approximately a 4 mmHg
difference between the two legs and angiogram showed no evidence of
extravasation or dissection. I used a StarClose device for hemostasis
on the right side since a 4-French sheath was placed on the left we
used digital pressure for hemostasis. Lower extremity perfusion was
judged at the completion and found to have excellent flow with the
right side, commensurate with the superficial femoral artery stenotic
disease noted. Sterile dressings were applied and the patient was
awakened and transported to the intensive care unit having tolerated
the procedure well. All needles and wires, sharps and sponge count
were correct x2.
OPERATIVE PROCEDURE: Abdominal aortogram, pelvic arteriogram,
bilateral lower extremity arteriogram and runoff from the femoral
artery level, right common iliac artery stent angioplasty.
Pelvic arteriogram: The pelvic vessels were patent with internal and
external iliac arteries patent with calcified walls but no high-grade
disease other than the high-grade calcific plaque at the inflow the
right common iliac artery. Left lower extremity arteriogram and
runoff, left common femoral artery, superficial femoral artery,
profunda femorus were patent with calcifications in the walls and
luminal irregularities. Left popliteal artery was patent. There was
luminal irregularities in the tibial vessels; however, she had
2-vessel runoff to the left foot.
DESCRIPTION OF OPERATION:
Right lower extremity arteriogram and runoff: Right common femoral
artery, profunda femorus and superficial femoral arteries were patent.
However, there was calcification and luminal irregularities. The
right superficial femoral artery had multiple areas of calcification
and 40-50 in some areas of 60% diffuse stenotic areas in the mid to
distal right superficial femoral artery. Popliteal artery was patent.
Tibial vessels have calcified plaque but were patent to the foot.
DESCRIPTION OF OPERATION: The patient was taken to the operating room
and placed in a supine position. General endotracheal anesthesia was
administered. Lower abdomen, groins and legs were prepped and draped
in the usual sterile manner. Using the CT angiogram for guidance, we
accessed the left common femoral artery and a Glidewire was advanced
into the thoracic aorta. All wire manipulation was done under
continuous fluoroscopic guidance. A 4-French sheath was placed. An
oblique angiogram done of the puncture site documenting common femoral
artery puncture site. The pelvic angiogram was performed and left
lower extremity arteriogram was performed. We accessed the right
common femoral artery and noted approximately 40 mmHg difference
between the radial artery pressure in the right common femoral artery.
We advanced the Glidewire through the lesion and into the thoracic
aorta. We heparinized the patient with a total of 10,000 units of
intravenous Heparin and activated clotting time was approximately 300
seconds. I placed a 6-French x 30 cm Raabe sheath on the right wire
through the lesion with the tip in the lower abdominal aorta. The
image intensifier and the bed were locked and flush aortography was
performed and the lesion was visualized and measured. We placed a 7
mm x 30 mm stent through the Raabe sheath and then withdrew the Raabe
sheath positioning it in the common iliac artery extending into the
aorta approximately 1 cm. We inflated this to 8-1/2 atmospheres and
had good profiling. This stent material, because of the small
diameter of the aorta and its protruding into the aorta, was in the
blood flow track to the left common iliac artery. I had the up on the
left side and decided to not place a stent in the left common iliac
artery as this would have required an 8 mm stent because of the
relative larger diameter and no stenosis on the left side. My concern
with been to then in that deployment to crush the right-sided stent
against the lateral aortic wall plaque which would then more an
obstruction to flow than a widely open stent from the right side
alone. We measured pressures and found approximately a 4 mmHg
difference between the two legs and angiogram showed no evidence of
extravasation or dissection. I used a StarClose device for hemostasis
on the right side since a 4-French sheath was placed on the left we
used digital pressure for hemostasis. Lower extremity perfusion was
judged at the completion and found to have excellent flow with the
right side, commensurate with the superficial femoral artery stenotic
disease noted. Sterile dressings were applied and the patient was
awakened and transported to the intensive care unit having tolerated
the procedure well. All needles and wires, sharps and sponge count
were correct x2.
