AgnieszkaLakritz
Networker
PROCEDURE: Aortogram, bilateral leg angiogram via left brachial approach.
PREOPERATIVE DIAGNOSIS: Limiting claudication right leg.
POSTOPERATIVE DIAGNOSIS: Limiting claudication right leg.
DESCRIPTION OF PROCEDURE: The patient was brought to Angiogram Suite and prepped and draped
in the usual fashion. After infiltration of 10 mL 1% Lidocaine, using ultrasound guidance,
the left common femoral artery was insinuated but found to be totally occluded. There was a
palpable pulse on the right side and again the right groin was anesthetized with 1%
Lidocaine and using ultrasound guidance, the right distal external iliac artery was
cannulated using a micropuncture needle. A micropuncture wire was introduced. The needle
was exchanged eventually for a #4 French Brite-tip sheath. Unfortunately, it was not
possible using Glidewire and Glide-catheter to navigate up through the chronically diseased
right common iliac artery.
Therefore, it was decided to access the left brachial artery.
After infiltration of 5 to 6 mL of 1% Lidocaine, using ultrasound guidance the left
brachial artery was accessed using a micropuncture needle. A micropuncture wire was
introduced. The needle was exchanged for a #4 French Brite-tip sheath. Eventually using a
Cobra II catheter, the descending thoracic aorta was cannulated. The Universal flush
catheter was exchanged and placed in the infrarenal abdominal aorta.
The abdominal aortogram showed a patent left renal artery. The right renal artery was not
visualized. The infrarenal abdominal aorta was patent. Following this, the catheter was
positioned at the aortic bifurcation and standard RAO and LAO views were performed. These
showed severely diseased right common iliac artery with patent right common and external
iliac arteries. The left common iliac artery was patent. The left external iliac artery was
patent.
Bilateral leg angiogram was performed. The right common femoral artery was totally
occluded.
There was reconstitution of the right profunda femoris and superficial femoral artery via
collaterals. The right profunda femoris artery was patent. The right superficial femoral
artery was occluded. There was reconstitution right above the popliteal artery via
collaterals. The right above and below knee popliteal arteries were patent. The right
anterior tibial artery was patent but the right tibioperoneal trunk and peroneal arteries
were occluded.
Left leg angiogram showed a totally occluded left common femoral artery; reconstitution
left profunda femoris and superficial femoral artery via collaterals. The left superficial
femoral artery above and below knee popliteal arteries were patent. The left anterior
tibial artery was occluded. The left tibioperoneal trunk, peroneal and posterior tibial
arteries were patent.
Following this, all catheters and wires were removed and pressure was held on the left
branchial artery to achieve hemostasis.
The patient tolerated the procedure well and was brought back to recovery in stable
condition.
IMPRESSIONS:
1. Left renal artery visualized. Right renal artery not visualized. Infrarenal abdominal
aorta patent. Severe disease right common iliac artery with patent right external iliac
artery. Patent left common iliac and external iliac arteries. Patent bilateral
hypogastric arteries.
2. Totally occluded right common femoral artery with reconstitution right profunda femoris
artery via collaterals. Totally occluded right superficial femoral artery with
reconstitution of above knee popliteal artery via collaterals. Patent right above and
below knee popliteal arteries. Single vessel to the right foot via the anterior tibial
artery.
3. Totally occluded left common femoral and distal external iliac artery. Left profunda and
superficial femoral artery reconstituted via collaterals. Patent left superficial
femoral artery above and below knee popliteal arteries with two-vessel run-off to the
left foot via left peroneal and posterior tibial arteries.
36200,75625,75716 ?
PREOPERATIVE DIAGNOSIS: Limiting claudication right leg.
POSTOPERATIVE DIAGNOSIS: Limiting claudication right leg.
DESCRIPTION OF PROCEDURE: The patient was brought to Angiogram Suite and prepped and draped
in the usual fashion. After infiltration of 10 mL 1% Lidocaine, using ultrasound guidance,
the left common femoral artery was insinuated but found to be totally occluded. There was a
palpable pulse on the right side and again the right groin was anesthetized with 1%
Lidocaine and using ultrasound guidance, the right distal external iliac artery was
cannulated using a micropuncture needle. A micropuncture wire was introduced. The needle
was exchanged eventually for a #4 French Brite-tip sheath. Unfortunately, it was not
possible using Glidewire and Glide-catheter to navigate up through the chronically diseased
right common iliac artery.
Therefore, it was decided to access the left brachial artery.
After infiltration of 5 to 6 mL of 1% Lidocaine, using ultrasound guidance the left
brachial artery was accessed using a micropuncture needle. A micropuncture wire was
introduced. The needle was exchanged for a #4 French Brite-tip sheath. Eventually using a
Cobra II catheter, the descending thoracic aorta was cannulated. The Universal flush
catheter was exchanged and placed in the infrarenal abdominal aorta.
The abdominal aortogram showed a patent left renal artery. The right renal artery was not
visualized. The infrarenal abdominal aorta was patent. Following this, the catheter was
positioned at the aortic bifurcation and standard RAO and LAO views were performed. These
showed severely diseased right common iliac artery with patent right common and external
iliac arteries. The left common iliac artery was patent. The left external iliac artery was
patent.
Bilateral leg angiogram was performed. The right common femoral artery was totally
occluded.
There was reconstitution of the right profunda femoris and superficial femoral artery via
collaterals. The right profunda femoris artery was patent. The right superficial femoral
artery was occluded. There was reconstitution right above the popliteal artery via
collaterals. The right above and below knee popliteal arteries were patent. The right
anterior tibial artery was patent but the right tibioperoneal trunk and peroneal arteries
were occluded.
Left leg angiogram showed a totally occluded left common femoral artery; reconstitution
left profunda femoris and superficial femoral artery via collaterals. The left superficial
femoral artery above and below knee popliteal arteries were patent. The left anterior
tibial artery was occluded. The left tibioperoneal trunk, peroneal and posterior tibial
arteries were patent.
Following this, all catheters and wires were removed and pressure was held on the left
branchial artery to achieve hemostasis.
The patient tolerated the procedure well and was brought back to recovery in stable
condition.
IMPRESSIONS:
1. Left renal artery visualized. Right renal artery not visualized. Infrarenal abdominal
aorta patent. Severe disease right common iliac artery with patent right external iliac
artery. Patent left common iliac and external iliac arteries. Patent bilateral
hypogastric arteries.
2. Totally occluded right common femoral artery with reconstitution right profunda femoris
artery via collaterals. Totally occluded right superficial femoral artery with
reconstitution of above knee popliteal artery via collaterals. Patent right above and
below knee popliteal arteries. Single vessel to the right foot via the anterior tibial
artery.
3. Totally occluded left common femoral and distal external iliac artery. Left profunda and
superficial femoral artery reconstituted via collaterals. Patent left superficial
femoral artery above and below knee popliteal arteries with two-vessel run-off to the
left foot via left peroneal and posterior tibial arteries.
36200,75625,75716 ?