INDICATIONS:
Left lower extremity claudication and evidence of severe femoral and external iliac artery stenosis on
Doppler ultrasound.
PROCEDURES PERFORMED:
1. Abdominal flush aortic angiogram.
2. Fluoroscopy.
3. Selective cannulation of the left common iliac artery.
4. Selective left lower extremity runoff angiogram.
5. Selective right lower extremity runoff angiogram.
6. Fluoroscopy.
PROCEDURE:
After the informed consent was obtained, the patient was brought to the cardiac catheterization laboratory,
and prepped and draped in usual sterile fashion. The right femoral area was anesthetized with 10 mL of
0.5% Sensorcaine, and the right femoral artery was cannulated with a 5-French sheath using modified
Seldinger technique. The 5-French Omni Flush catheter was advanced into the proximal abdominal aorta.
An abdominal flush angiogram was performed. The catheter was then pulled back and together with a
Glidewire was advanced into the left iliac artery. The left lower extremity runoff angiogram was then
performed. The catheter was then withdrawn over a guidewire and the right femoral angiogram runoff was
performed. The sheath was then pulled and hemostasis was obtained using manual compression. There
were no complications. Upon completion of the procedure, the patient was transferred to her room in stable
condition.
ANATOMY: 1. Abdominal aorta: The abdominal aorta appears to be moderately calcified without evidence of
aneurysmal dilatation.
2. Right renal artery: The right renal artery is single and patent.
3. Left renal artery: The left renal artery is single and patent.
4. The right common iliac artery is mildly diseased but patent.
5. The left common iliac artery is mildly diseased but patent.
6. The right external iliac artery is patent.
7. The left external iliac artery is totally occluded at the ostium. A large collateral is noted to then
connected into the distal common femoral artery just prior to bifurcation.
8. Left lower extremity angiogram: Left lower extremity angiogram demonstrated the occluded
common femoral artery. The left SFA and profunda were filling via large collateral. The remainder of
the SFA was widely patent.
9. Left popliteal artery was patent.
10. A 2-vessel below-knee runoff was noted. The left anterior tibial artery was subtotally occluded.
11. Right lower extremity angiogram: Right lower extremity angiogram demonstrated a widely patent
common femoral artery, SFA, and profunda.
12. The popliteal artery was patent.
13. The anterior tibial and posterior tibial arteries were patent. The peroneal artery was totally
occluded.
IMPRESSION:
1. Total occlusion of the left external iliac artery with a large collateral noted.
2. 2-vessel below-the-knee runoff bilaterally.
--------------
36245 -lt
36245-rt
75716-26-59
???
Left lower extremity claudication and evidence of severe femoral and external iliac artery stenosis on
Doppler ultrasound.
PROCEDURES PERFORMED:
1. Abdominal flush aortic angiogram.
2. Fluoroscopy.
3. Selective cannulation of the left common iliac artery.
4. Selective left lower extremity runoff angiogram.
5. Selective right lower extremity runoff angiogram.
6. Fluoroscopy.
PROCEDURE:
After the informed consent was obtained, the patient was brought to the cardiac catheterization laboratory,
and prepped and draped in usual sterile fashion. The right femoral area was anesthetized with 10 mL of
0.5% Sensorcaine, and the right femoral artery was cannulated with a 5-French sheath using modified
Seldinger technique. The 5-French Omni Flush catheter was advanced into the proximal abdominal aorta.
An abdominal flush angiogram was performed. The catheter was then pulled back and together with a
Glidewire was advanced into the left iliac artery. The left lower extremity runoff angiogram was then
performed. The catheter was then withdrawn over a guidewire and the right femoral angiogram runoff was
performed. The sheath was then pulled and hemostasis was obtained using manual compression. There
were no complications. Upon completion of the procedure, the patient was transferred to her room in stable
condition.
ANATOMY: 1. Abdominal aorta: The abdominal aorta appears to be moderately calcified without evidence of
aneurysmal dilatation.
2. Right renal artery: The right renal artery is single and patent.
3. Left renal artery: The left renal artery is single and patent.
4. The right common iliac artery is mildly diseased but patent.
5. The left common iliac artery is mildly diseased but patent.
6. The right external iliac artery is patent.
7. The left external iliac artery is totally occluded at the ostium. A large collateral is noted to then
connected into the distal common femoral artery just prior to bifurcation.
8. Left lower extremity angiogram: Left lower extremity angiogram demonstrated the occluded
common femoral artery. The left SFA and profunda were filling via large collateral. The remainder of
the SFA was widely patent.
9. Left popliteal artery was patent.
10. A 2-vessel below-knee runoff was noted. The left anterior tibial artery was subtotally occluded.
11. Right lower extremity angiogram: Right lower extremity angiogram demonstrated a widely patent
common femoral artery, SFA, and profunda.
12. The popliteal artery was patent.
13. The anterior tibial and posterior tibial arteries were patent. The peroneal artery was totally
occluded.
IMPRESSION:
1. Total occlusion of the left external iliac artery with a large collateral noted.
2. 2-vessel below-the-knee runoff bilaterally.
--------------
36245 -lt
36245-rt
75716-26-59
???
