jlb102780
Guru
Good Morning Everyone,
Need some guidance on the report below:
INDICATIONS
Circumflex artery aneurysm.
OPERATORS
Dr. A
Dr. B
PROCEDURE PERFORMED
1. Right groin 6-French retrograde access with a 45 cm sheath into the mid
aorta.
2. Selective saphenous vein graft to the circumflex artery angiography.
3. Attempted coiling procedure deployment into the aneurysm.
CATHETERIZATION REPORT
After informed consent was obtained, the patient was prepped and draped in a sterile fashion on the cath lab table. After injecting 10 mL of 2% Xylocaine
in the right groin, access was obtained via Seldinger technique. Catheters
used were a 6-French short sheath. We had a significantly difficult time
getting the wire into the aortoiliac bifurcation region due to severe tortuosity. At this point, utilizing a straight glide catheter and glidewire, we were able to get the catheter placed in the mid aorta, exchange the glidewire for an 0.035 exchange wire, and at this point, a 45 cm Terumo
braided sheath was placed in the mid aorta. This provided adequate support.
At this point, multiple catheters were attempted to engage the saphenous vein graft ostium. Finally, the catheter that did engage appropriately was the JR5 catheter followed by an AL1 catheter. Both of these catheters engaged the ostium appropriately, and the intervention was started. A Choice PT floppy wire was used to wire the vessel through the SVG graft into the native vessel retrograde to provide support, and Dr. B placed a braided coiling catheter over the wire technique down to the vessel. Multiple attempts were made for the catheter. However, due to lack of support and severe tortuosity, there was a significant amount of pushback to where the catheter did come out of the artery and was not able to traverse successfully. At this point, a Guide Liner catheter was introduced through the AL1 catheter, and buddy wire position was maintained with the choice CT wire which was then changed to a ProWater Flex wire. The catheter was advanced on numerous occasions and unfortunately would not traverse down to the level of the aneurysm. After 66 minutes of fluoro time and repeated attempts, decision was made to remove all equipment and to reevaluate alternative options for the patient.
IMPRESSION
1. Unsuccessful attempt to coil and nebulize circumflex artery large
aneurysm.
2. The right groin 6-French sheath was removed with manual pressure.
3. Will discuss with Dr. Still and the cardiac team in regards to
alternative options.
COMPLICATIONS
None.
Need some guidance on the report below:
INDICATIONS
Circumflex artery aneurysm.
OPERATORS
Dr. A
Dr. B
PROCEDURE PERFORMED
1. Right groin 6-French retrograde access with a 45 cm sheath into the mid
aorta.
2. Selective saphenous vein graft to the circumflex artery angiography.
3. Attempted coiling procedure deployment into the aneurysm.
CATHETERIZATION REPORT
After informed consent was obtained, the patient was prepped and draped in a sterile fashion on the cath lab table. After injecting 10 mL of 2% Xylocaine
in the right groin, access was obtained via Seldinger technique. Catheters
used were a 6-French short sheath. We had a significantly difficult time
getting the wire into the aortoiliac bifurcation region due to severe tortuosity. At this point, utilizing a straight glide catheter and glidewire, we were able to get the catheter placed in the mid aorta, exchange the glidewire for an 0.035 exchange wire, and at this point, a 45 cm Terumo
braided sheath was placed in the mid aorta. This provided adequate support.
At this point, multiple catheters were attempted to engage the saphenous vein graft ostium. Finally, the catheter that did engage appropriately was the JR5 catheter followed by an AL1 catheter. Both of these catheters engaged the ostium appropriately, and the intervention was started. A Choice PT floppy wire was used to wire the vessel through the SVG graft into the native vessel retrograde to provide support, and Dr. B placed a braided coiling catheter over the wire technique down to the vessel. Multiple attempts were made for the catheter. However, due to lack of support and severe tortuosity, there was a significant amount of pushback to where the catheter did come out of the artery and was not able to traverse successfully. At this point, a Guide Liner catheter was introduced through the AL1 catheter, and buddy wire position was maintained with the choice CT wire which was then changed to a ProWater Flex wire. The catheter was advanced on numerous occasions and unfortunately would not traverse down to the level of the aneurysm. After 66 minutes of fluoro time and repeated attempts, decision was made to remove all equipment and to reevaluate alternative options for the patient.
IMPRESSION
1. Unsuccessful attempt to coil and nebulize circumflex artery large
aneurysm.
2. The right groin 6-French sheath was removed with manual pressure.
3. Will discuss with Dr. Still and the cardiac team in regards to
alternative options.
COMPLICATIONS
None.