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CARDIOLOGIST:
PERIPHERAL ARTERIAL ANGIOGRAPHY PROCEDURE REPORT.
PROCEDURES PERFORMED:
1. Abdominal aortogram with bilateral lower extremity arterial angiography
with runoff.
2. Selective bilateral renal artery angiography.
INDICATIONS:
1. Claudication pain in both lower extremities.
2. Severe peripheral artery disease.
3. Severe claudication pain in the right lower extremity as well as mild
claudication pain in the left lower extremity.
4. Severe disease in the right superficial femoral artery with a previously
total occlusion of the right superficial femoral artery as well as
mild-to-moderate disease of the left superficial femoral artery.
5. Hypertension.
6. Renal artery disease and bilateral renal artery atherosclerosis.
PROCEDURE: After the informed consent was obtained, the patient was prepped
and draped in the usual sterile fashion. Lidocaine 2 percent was used for
local anesthesia in the right groin. Vascular access was obtained in the
left femoral artery and over a guidewire, a 5-French angio sheath was placed
in the left femoral artery.
A 5-French pigtail catheter was introduced into the distal abdominal aorta
and abdominal aortogram with bilateral lower extremity arterial angiography
with runoff was performed.
Then, the _____ 5-French pigtail catheter was removed and a 5-French JL4
catheter was used to engage selectively the right renal artery. Selective
right renal artery angiography was performed.
Operative Report/Procedure Note
Report Status: Transcribed
DOB: 04/13/1937
Transcribed: 08/29/2013 10:14
A 5-French JR4 catheter was used to selectively engage the left renal artery
and selective left renal artery angiography was performed.
End of the diagnostic catheterization, the guidewire and diagnostic
catheters were removed. Arterial sheath was removed and hemostasis was
obtained with application of manual pressure and a hemostatic patch. The
patient was transferred in a stable condition to the floor for further care
with no complications.
RESULTS:
HEMODYNAMIC DATA: Aortic pressure 149/66/92 mm mean.
ANATOMIC DATA:
1. Distal abdominal aorta: The distal abdominal aorta has mild
atherosclerosis without any high-grade focal stenosis. The distal
abdominal aorta bifurcates into the 2 iliac arteries.
2. Left renal artery: The left renal artery has mild atherosclerosis with
mild 10-20 percent stenosis without any high-grade focal stenosis.
3. Right renal artery: The right renal artery has mild disease with up to
20 percent stenosis.
4. Right common iliac artery: The right common iliac artery has a 60
percent stenosis in its proximal portion followed by another 50 percent
stenosis. The right common iliac artery gives rise to right internal
iliac artery. The right external iliac artery is totally occluded.
5. Left common iliac artery: Left common iliac artery has a 50-60 percent
stenosis in its proximal portion with mild-to-moderate disease the rest
of the course. It bifurcates into external and internal iliac arteries.
6. Internal iliac arteries, both right and left internal iliac arteries
have mild-to-moderate diffuse disease.
A. The right internal iliac artery gives rise to large collaterals to
the right profunda femoris artery.
B. The left internal iliac artery gives rise to several branches, which
have mild disease.
7. External iliac arteries:
A. Right external iliac artery: The right external iliac artery is
totally occluded at its origin from the right common iliac artery.
B. Left external iliac artery: The left external iliac artery has mild
disease throughout its course and _____ continues on as the left
common femoral artery. The left common femoral artery has a 40-50
percent stenosis in its proximal portion.
8. Common femoral arteries:
A. Right common femoral artery is totally occluded. The occlusion
extends from the distal right common iliac artery involving the
right external iliac artery all the way to the distal portion of the
right superficial femoral artery. The profunda femoris artery
supplies the distal portion of the right superficial femoral
arteries.
B. Left common femoral artery: The left common femoral artery has 40
percent stenosis in midportion and bifurcates into left profunda
femoris and the left superficial femoral arteries.
9. Superficial femoral arteries.
A. Right superficial femoral artery: The right superficial femoral
artery is totally occluded in its _____ the very distal portion
where it becomes the popliteal artery. Significant collaterals from
the profunda femoral arteries were noted to fill the distal portion
of the right superficial femoral arteries/popliteal arteries.
B. Left superficial femoral artery: The left superficial femoral
artery has moderate diffuse disease throughout its course. Proximal
and mid portion have mild disease and mid and distal portion have
about 40 percent diffuse stenosis as it continues on popliteal
artery.
10. Popliteal artery:
A. Right popliteal artery: It reconstitutes by profuse collaterals
from the right profunda femoris artery. Right popliteal artery
continues on and trifurcates into the peroneal trunk and the
posterior tibial arteries.
B. Left popliteal artery. Left popliteal artery has mild diffuse
disease and it continues on into trifurcation arteries and
Report
AB120 Coid: 803
Location:
Transcribed: 08/29/2013 10:14
bifurcates into the common peroneal trunk in the posterior tibial
artery.
11. Profunda femoris artery:
A. Right profunda femoris artery: Right profunda femoris artery is
reconstituted by very large collaterals from the distal portion of
the right common iliac artery and subsequent to this, the right
profunda femoris artery _____ in its entirety and then gives rise to
collaterals to supply the right popliteal artery.
B. Left profunda femoris artery: Left profunda femoris artery has mild
diffuse disease.
12. Trifurcation arteries: The trifurcation arteries bilaterally have mild
plaquing with good runoff in the left side with mild-to-moderate diffuse
disease in the proximal portion.
A. Right common peroneal trunk: The right common peroneal truck
divides into right _____ artery and right common peroneal artery and
both of these have mild disease and extend up to the ankles.
13. Right posterior tibial artery has mild diffuse disease.
14. Trifurcation arteries on the left side.
15. The left anterior tibial artery is moderate to severely diseased
diffusely, but it does have flow up to the ankle.
16. The left common peroneal artery has mild disease.
17. Left posterior tibial artery has mild disease.
18. Ankle arteries. Ankle arteries are not well visualized in the
right-side. Ankle arteries on the left side are also not well
visualized because of technical reasons.
IMPRESSION:
1. Severe peripheral vascular disease involving the right lower extremity
with total occlusion of the right external iliac artery, right common
femoral artery, and proximal to the mid portion of the right superficial
femoral artery as well as the right common femoral artery.
2. Collateral fluid to the distal portion of the right superficial femoral
artery/right popliteal artery through profunda femoris artery as well as
through the internal iliac artery.
3. Moderate disease of both the common iliac arteries bilaterally with 50
Discharge: 08/29/2013 15:30
Location:
Transcribed: 08/29/2013 10:14
to 60 percent stenosis of the right common iliac artery and a 50 to 60
percent stenosis of the left common iliac artery.
4. Patent renal arteries bilaterally with mild diffuse atherosclerosis.
5. Patent left superficial femoral artery with 40 percent diffuse stenosis
in its mid distal portion and patent bilateral trifurcation arteries
with severe disease of the left anterior tibial artery and mild disease
of the trifurcation arteries on the right side.
RECOMMENDATIONS:
1. Recommend medical management.
2. Surgical intervention may be considered only if the claudication
symptoms are more severe. This would involve applying a bypass graft in
the right popliteal artery.
___________________________________
WE HAVE CHOSEN FOR PROVIDER B 75630/26 ANY INPUT?
PERIPHERAL ARTERIAL ANGIOGRAPHY PROCEDURE REPORT.
PROCEDURES PERFORMED:
1. Abdominal aortogram with bilateral lower extremity arterial angiography
with runoff.
2. Selective bilateral renal artery angiography.
INDICATIONS:
1. Claudication pain in both lower extremities.
2. Severe peripheral artery disease.
3. Severe claudication pain in the right lower extremity as well as mild
claudication pain in the left lower extremity.
4. Severe disease in the right superficial femoral artery with a previously
total occlusion of the right superficial femoral artery as well as
mild-to-moderate disease of the left superficial femoral artery.
5. Hypertension.
6. Renal artery disease and bilateral renal artery atherosclerosis.
PROCEDURE: After the informed consent was obtained, the patient was prepped
and draped in the usual sterile fashion. Lidocaine 2 percent was used for
local anesthesia in the right groin. Vascular access was obtained in the
left femoral artery and over a guidewire, a 5-French angio sheath was placed
in the left femoral artery.
A 5-French pigtail catheter was introduced into the distal abdominal aorta
and abdominal aortogram with bilateral lower extremity arterial angiography
with runoff was performed.
Then, the _____ 5-French pigtail catheter was removed and a 5-French JL4
catheter was used to engage selectively the right renal artery. Selective
right renal artery angiography was performed.
Operative Report/Procedure Note
Report Status: Transcribed
DOB: 04/13/1937
Transcribed: 08/29/2013 10:14
A 5-French JR4 catheter was used to selectively engage the left renal artery
and selective left renal artery angiography was performed.
End of the diagnostic catheterization, the guidewire and diagnostic
catheters were removed. Arterial sheath was removed and hemostasis was
obtained with application of manual pressure and a hemostatic patch. The
patient was transferred in a stable condition to the floor for further care
with no complications.
RESULTS:
HEMODYNAMIC DATA: Aortic pressure 149/66/92 mm mean.
ANATOMIC DATA:
1. Distal abdominal aorta: The distal abdominal aorta has mild
atherosclerosis without any high-grade focal stenosis. The distal
abdominal aorta bifurcates into the 2 iliac arteries.
2. Left renal artery: The left renal artery has mild atherosclerosis with
mild 10-20 percent stenosis without any high-grade focal stenosis.
3. Right renal artery: The right renal artery has mild disease with up to
20 percent stenosis.
4. Right common iliac artery: The right common iliac artery has a 60
percent stenosis in its proximal portion followed by another 50 percent
stenosis. The right common iliac artery gives rise to right internal
iliac artery. The right external iliac artery is totally occluded.
5. Left common iliac artery: Left common iliac artery has a 50-60 percent
stenosis in its proximal portion with mild-to-moderate disease the rest
of the course. It bifurcates into external and internal iliac arteries.
6. Internal iliac arteries, both right and left internal iliac arteries
have mild-to-moderate diffuse disease.
A. The right internal iliac artery gives rise to large collaterals to
the right profunda femoris artery.
B. The left internal iliac artery gives rise to several branches, which
have mild disease.
7. External iliac arteries:
A. Right external iliac artery: The right external iliac artery is
totally occluded at its origin from the right common iliac artery.
B. Left external iliac artery: The left external iliac artery has mild
disease throughout its course and _____ continues on as the left
common femoral artery. The left common femoral artery has a 40-50
percent stenosis in its proximal portion.
8. Common femoral arteries:
A. Right common femoral artery is totally occluded. The occlusion
extends from the distal right common iliac artery involving the
right external iliac artery all the way to the distal portion of the
right superficial femoral artery. The profunda femoris artery
supplies the distal portion of the right superficial femoral
arteries.
B. Left common femoral artery: The left common femoral artery has 40
percent stenosis in midportion and bifurcates into left profunda
femoris and the left superficial femoral arteries.
9. Superficial femoral arteries.
A. Right superficial femoral artery: The right superficial femoral
artery is totally occluded in its _____ the very distal portion
where it becomes the popliteal artery. Significant collaterals from
the profunda femoral arteries were noted to fill the distal portion
of the right superficial femoral arteries/popliteal arteries.
B. Left superficial femoral artery: The left superficial femoral
artery has moderate diffuse disease throughout its course. Proximal
and mid portion have mild disease and mid and distal portion have
about 40 percent diffuse stenosis as it continues on popliteal
artery.
10. Popliteal artery:
A. Right popliteal artery: It reconstitutes by profuse collaterals
from the right profunda femoris artery. Right popliteal artery
continues on and trifurcates into the peroneal trunk and the
posterior tibial arteries.
B. Left popliteal artery. Left popliteal artery has mild diffuse
disease and it continues on into trifurcation arteries and
Report
AB120 Coid: 803Location:
Transcribed: 08/29/2013 10:14
bifurcates into the common peroneal trunk in the posterior tibial
artery.
11. Profunda femoris artery:
A. Right profunda femoris artery: Right profunda femoris artery is
reconstituted by very large collaterals from the distal portion of
the right common iliac artery and subsequent to this, the right
profunda femoris artery _____ in its entirety and then gives rise to
collaterals to supply the right popliteal artery.
B. Left profunda femoris artery: Left profunda femoris artery has mild
diffuse disease.
12. Trifurcation arteries: The trifurcation arteries bilaterally have mild
plaquing with good runoff in the left side with mild-to-moderate diffuse
disease in the proximal portion.
A. Right common peroneal trunk: The right common peroneal truck
divides into right _____ artery and right common peroneal artery and
both of these have mild disease and extend up to the ankles.
13. Right posterior tibial artery has mild diffuse disease.
14. Trifurcation arteries on the left side.
15. The left anterior tibial artery is moderate to severely diseased
diffusely, but it does have flow up to the ankle.
16. The left common peroneal artery has mild disease.
17. Left posterior tibial artery has mild disease.
18. Ankle arteries. Ankle arteries are not well visualized in the
right-side. Ankle arteries on the left side are also not well
visualized because of technical reasons.
IMPRESSION:
1. Severe peripheral vascular disease involving the right lower extremity
with total occlusion of the right external iliac artery, right common
femoral artery, and proximal to the mid portion of the right superficial
femoral artery as well as the right common femoral artery.
2. Collateral fluid to the distal portion of the right superficial femoral
artery/right popliteal artery through profunda femoris artery as well as
through the internal iliac artery.
3. Moderate disease of both the common iliac arteries bilaterally with 50
Discharge: 08/29/2013 15:30
Location:
Transcribed: 08/29/2013 10:14
to 60 percent stenosis of the right common iliac artery and a 50 to 60
percent stenosis of the left common iliac artery.
4. Patent renal arteries bilaterally with mild diffuse atherosclerosis.
5. Patent left superficial femoral artery with 40 percent diffuse stenosis
in its mid distal portion and patent bilateral trifurcation arteries
with severe disease of the left anterior tibial artery and mild disease
of the trifurcation arteries on the right side.
RECOMMENDATIONS:
1. Recommend medical management.
2. Surgical intervention may be considered only if the claudication
symptoms are more severe. This would involve applying a bypass graft in
the right popliteal artery.
___________________________________
WE HAVE CHOSEN FOR PROVIDER B 75630/26 ANY INPUT?