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The patient was brought into the angiography suite. Conscious sedation was provided with a combination of intravenous Versed 6 mg and fentanyl 200 mcg. The patient was monitored throughout the exam by the interventional radiology nurse, whose sole responsibility was to monitor the patient following administration of conscious sedation. The patient was also monitored by the interventional radiology physician.
Procedure time: 2 hours 15 minutes. Fluoroscopic time: 43 minutes. Contrast total: 130 ml.
Procedural medications include heparin 10,000 units intravenously.
Ultrasound imaging was used to guide puncture of the right common femoral artery and an 0.018-inch wire followed easily. A coaxial dilator was passed into the artery, and the inner dilator and wire were removed. An 025 Bentson wire was then passed into the aorta, and a 5-French side-arm sheath was placed. A SOS Omni catheter was used to perform a limited aortogram. The catheter was then pulled into the origin of the left common iliac artery, and a wire followed into the superficial femoral artery. The catheter was removed, and an angled catheter was then taken into the superficial femoral artery, and a wire was exchanged for stiff angled Glide.
The catheter and sheath were removed, and a 7-French Destination sheath was then passed over the aortic bifurcation into the proximal SFA whereupon a left leg angiogram was performed.
The angled Glidewire in conjunction with the angled catheter was used to try to traverse an area of occlusion in the left superficial femoral artery. The area of occlusion was only approximately 5 cm in length at the adductor canal, but it was quite difficult getting the wire to traverse the occlusion. Eventually, a subintimal path was developed, and the catheter was passed into the region of the reconstituted portion of the proximal popliteal artery. The wire was exchanged for an 0.014-inch wire, and the catheter was removed. An Outback re-entry device was then taken over the 0.014-inch wire and re-entry was eventually achieved and the 0.014-inch wire passed into the popliteal artery. The catheter was withdrawn, and a Quick-Cross catheter was placed and a bump wire, 0.014-inch in diameter, was then passed in conjunction with a filter which was placed in the popliteal artery for distal protection.
The filter was an Abbott 7-mm filter.
A 2.0 laser catheter was then used to perform an atherectomy of the distal SFA/proximal popliteal artery. Several passes were performed. A 5-mm balloon was then used to perform balloon angioplasty of the diseased SFA distally along with the proximal popliteal artery. A 6-mm x 80-mm self-expanding stent was then placed and then further expanded with a 5-mm balloon. The filter was then retrieved. An 0.014-inch wire was then passed down the anterior tibial artery, and a 2.5-mm balloon was used to perform angioplasty of the entire anterior tibial artery. Completion angiogram was performed. The sheath was then pulled after the heparin was allowed to wear off, and his ACT was allowed to return to a near-normal level.
The patient tolerated the procedure well.
FINDINGS:
Initial angiogram shows that the proximal SFA is within normal limits. The mid to distal SFA contains a focal area of approximately 60-70% narrowing and then is occluded over an approximately 5-cm length at the adductor canal. Reconstitution of the proximal popliteal artery is seen through collaterals. There is then runoff via the peroneal and a highly diseased anterior tibial artery.
The posterior tibial artery is never seen.
Following atherectomy and angioplasty of the distal SFA/proximal popliteal artery, there is flow in the recanalized segment. There is still at least 60-70% narrowing. Following stent placement and angioplasty, there is an excellent result with really no stenosis remaining.
The focal lesion of the mid to distal SFA is improved, but still with a narrowing of at least 20-30%.
Following angioplasty of the anterior tibial artery, there is still some narrowing distally of at least 50-60%, but the proximal anterior tibial artery is quite improved with excellent flow and nothing over 20-30% narrowing where there were several areas of narrowing of at least 80%.
Peroneal artery runoff is preserved and appears without significant disease.
IMPRESSION:
Successful recanalization/atherectomy/angioplasty and stenting of an occluded distal SFA/proximal popliteal artery.
Successful angioplasty of a highly diseased anterior tibial artery
Procedure time: 2 hours 15 minutes. Fluoroscopic time: 43 minutes. Contrast total: 130 ml.
Procedural medications include heparin 10,000 units intravenously.
Ultrasound imaging was used to guide puncture of the right common femoral artery and an 0.018-inch wire followed easily. A coaxial dilator was passed into the artery, and the inner dilator and wire were removed. An 025 Bentson wire was then passed into the aorta, and a 5-French side-arm sheath was placed. A SOS Omni catheter was used to perform a limited aortogram. The catheter was then pulled into the origin of the left common iliac artery, and a wire followed into the superficial femoral artery. The catheter was removed, and an angled catheter was then taken into the superficial femoral artery, and a wire was exchanged for stiff angled Glide.
The catheter and sheath were removed, and a 7-French Destination sheath was then passed over the aortic bifurcation into the proximal SFA whereupon a left leg angiogram was performed.
The angled Glidewire in conjunction with the angled catheter was used to try to traverse an area of occlusion in the left superficial femoral artery. The area of occlusion was only approximately 5 cm in length at the adductor canal, but it was quite difficult getting the wire to traverse the occlusion. Eventually, a subintimal path was developed, and the catheter was passed into the region of the reconstituted portion of the proximal popliteal artery. The wire was exchanged for an 0.014-inch wire, and the catheter was removed. An Outback re-entry device was then taken over the 0.014-inch wire and re-entry was eventually achieved and the 0.014-inch wire passed into the popliteal artery. The catheter was withdrawn, and a Quick-Cross catheter was placed and a bump wire, 0.014-inch in diameter, was then passed in conjunction with a filter which was placed in the popliteal artery for distal protection.
The filter was an Abbott 7-mm filter.
A 2.0 laser catheter was then used to perform an atherectomy of the distal SFA/proximal popliteal artery. Several passes were performed. A 5-mm balloon was then used to perform balloon angioplasty of the diseased SFA distally along with the proximal popliteal artery. A 6-mm x 80-mm self-expanding stent was then placed and then further expanded with a 5-mm balloon. The filter was then retrieved. An 0.014-inch wire was then passed down the anterior tibial artery, and a 2.5-mm balloon was used to perform angioplasty of the entire anterior tibial artery. Completion angiogram was performed. The sheath was then pulled after the heparin was allowed to wear off, and his ACT was allowed to return to a near-normal level.
The patient tolerated the procedure well.
FINDINGS:
Initial angiogram shows that the proximal SFA is within normal limits. The mid to distal SFA contains a focal area of approximately 60-70% narrowing and then is occluded over an approximately 5-cm length at the adductor canal. Reconstitution of the proximal popliteal artery is seen through collaterals. There is then runoff via the peroneal and a highly diseased anterior tibial artery.
The posterior tibial artery is never seen.
Following atherectomy and angioplasty of the distal SFA/proximal popliteal artery, there is flow in the recanalized segment. There is still at least 60-70% narrowing. Following stent placement and angioplasty, there is an excellent result with really no stenosis remaining.
The focal lesion of the mid to distal SFA is improved, but still with a narrowing of at least 20-30%.
Following angioplasty of the anterior tibial artery, there is still some narrowing distally of at least 50-60%, but the proximal anterior tibial artery is quite improved with excellent flow and nothing over 20-30% narrowing where there were several areas of narrowing of at least 80%.
Peroneal artery runoff is preserved and appears without significant disease.
IMPRESSION:
Successful recanalization/atherectomy/angioplasty and stenting of an occluded distal SFA/proximal popliteal artery.
Successful angioplasty of a highly diseased anterior tibial artery
