csorensen21@yahoo.com
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Procedure: Left Femoral Angiogram with distal runoff as well as left femoral CSI atherectomy of the left common femoral artery and the left superficial femoral artery as well as PTA of the left common femoral and left superficial femoral artery.
Description of procedure: The patient was taken the to the cath lab. The right groin was prepped and draped in the usual manner and was anesthetized with 1% lidocaine. A 6-french LIMA catheter, accessed. A 0.035 stiff angled Glidewire was advanced to the infrapopliteal vessels across the iliac femoral, superficial femoral and popliteal vessels. The 6-french sheath was then replaced with a 7-french long sheath, the tip of which was lodged at the mid left common femoral artery, popliteal and infrapopliteal vessels was then performed in a sequential using digital subtraction angiography.
Initial angiography revealed evidences of 90% stenosis involving the distal left common femoral artery extending into the origin of the left superficial femoral artery and the left profunda artery. The femoral bifurcation was calcified. There was also a long calcified lesion casuing 80% stenosis involving the distal left superficial femoral artery. The popliteal artery was patent. The posterior tibial artery was occluded and there was moderate disease involving the proximal portion of the left peroneal artery. The left anterior tibial artery was widely patent and there was 2 vessel runoff to the foot with anterior tibial and peroneal with collateralization to the distal portion of the left posterior tibial artery.
I proceeded with CSI atherectomy of the left common femoral and distal left superficial femoral artery. The CSI wire was advanced to the infrapopliteal vessels. CSI atherectomy was performed at low, medium and high speeds using 2.0 mm device. Repeat angio revealed evidence of significant improvement of the lumen, although there was a least 60% residual stenosis in the common femoral artery at the bifurcation as well as the distal superficial femoral artery. At this point, using a trailblazer I replaced the CSI wire with a spider wire for distal protection and I then performed FoxHollow atherectomy of the left common femoral artery extending into the ostium of the left superficial femoral artery. I used a larger device (4 to 7mm) I used the device with 30-degree bends along the femoral bifurcation. I then used the same device along the distal superficial femoral artery using 32 to 90 degree bends and 5 passes. I then used a 6.0 x 100mm ballon catheter dilated at 2 atmospheres along the distal lesion and an 8.0x 20mm balloon inflated at 1 atmospheres for the proximal lesion at the bifurcation. Final angiography revealed evidence of no residual stensosis along the common femoral artery and the ostium of the left superficial femoral artery. There was 20% residual stenosis along the distal superficial femoral artery. There was a slight dissection distally, which had no flow limiting characteristics.
Heparin IV was given during the procedure and intra-arterial nitroglycerin and Cardizem also instilled through the sheath. The patient also received hydralazine 30mg IV to keep the systolic blood pressure less than 160 along with Lopressor 5mg IV.
There was no evidence of distal emboliztion. The spider distal protection device was pulled without any problems.
At the end of the procedure, the 7 French long sheath was replaced with a 7-french short sheath. The right femoral artery revealed evidence of patency of the right femoral artery at the bifurcation with patency of the vessel all the way into the popliteal artery.
Someone please help me!!!!!!!!!!!
Description of procedure: The patient was taken the to the cath lab. The right groin was prepped and draped in the usual manner and was anesthetized with 1% lidocaine. A 6-french LIMA catheter, accessed. A 0.035 stiff angled Glidewire was advanced to the infrapopliteal vessels across the iliac femoral, superficial femoral and popliteal vessels. The 6-french sheath was then replaced with a 7-french long sheath, the tip of which was lodged at the mid left common femoral artery, popliteal and infrapopliteal vessels was then performed in a sequential using digital subtraction angiography.
Initial angiography revealed evidences of 90% stenosis involving the distal left common femoral artery extending into the origin of the left superficial femoral artery and the left profunda artery. The femoral bifurcation was calcified. There was also a long calcified lesion casuing 80% stenosis involving the distal left superficial femoral artery. The popliteal artery was patent. The posterior tibial artery was occluded and there was moderate disease involving the proximal portion of the left peroneal artery. The left anterior tibial artery was widely patent and there was 2 vessel runoff to the foot with anterior tibial and peroneal with collateralization to the distal portion of the left posterior tibial artery.
I proceeded with CSI atherectomy of the left common femoral and distal left superficial femoral artery. The CSI wire was advanced to the infrapopliteal vessels. CSI atherectomy was performed at low, medium and high speeds using 2.0 mm device. Repeat angio revealed evidence of significant improvement of the lumen, although there was a least 60% residual stenosis in the common femoral artery at the bifurcation as well as the distal superficial femoral artery. At this point, using a trailblazer I replaced the CSI wire with a spider wire for distal protection and I then performed FoxHollow atherectomy of the left common femoral artery extending into the ostium of the left superficial femoral artery. I used a larger device (4 to 7mm) I used the device with 30-degree bends along the femoral bifurcation. I then used the same device along the distal superficial femoral artery using 32 to 90 degree bends and 5 passes. I then used a 6.0 x 100mm ballon catheter dilated at 2 atmospheres along the distal lesion and an 8.0x 20mm balloon inflated at 1 atmospheres for the proximal lesion at the bifurcation. Final angiography revealed evidence of no residual stensosis along the common femoral artery and the ostium of the left superficial femoral artery. There was 20% residual stenosis along the distal superficial femoral artery. There was a slight dissection distally, which had no flow limiting characteristics.
Heparin IV was given during the procedure and intra-arterial nitroglycerin and Cardizem also instilled through the sheath. The patient also received hydralazine 30mg IV to keep the systolic blood pressure less than 160 along with Lopressor 5mg IV.
There was no evidence of distal emboliztion. The spider distal protection device was pulled without any problems.
At the end of the procedure, the 7 French long sheath was replaced with a 7-french short sheath. The right femoral artery revealed evidence of patency of the right femoral artery at the bifurcation with patency of the vessel all the way into the popliteal artery.
Someone please help me!!!!!!!!!!!