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Can someone help me out with this case?
Left lower extremity Angiogram
L SFA PTA (Ipsilateral approach)
INDICATIONS
Patient was referred for cardiac catheterization to assess the LLE anatomy . Indications for the procedure include: CLI L leg with evidence of occluded L SFA and popliteal
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. Patient was further sedated with fentanyl and versed. Patient was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 6 French sheath was placed in the right femoral artery.Angiography of the left ileaofemoral graft to the femoral bifurcation was performed using 6F LIMA catheter. I attempted several times to get access into the L femoral system using 0.035 (Glide Advantage and Standard Glide) wires as well as 0.014 (BMW and Spartacore) wires, without being able to get even a Trailblazer (0.014) exchange catheter around the horn.
At this point I proceeded with getting access to the L SFA through an antegrade stick close to the femoral bifurcation, and a 6F sheath was placed. Heparin IA There was a 10 mm Hg gradient compared to the brachial pressure that improved with IA NTG. Initial angiography revealed evidence of occlusion of the mid and distal SFA as well as the left popliteal with minimal flow to the infrapopliteal vessels.
I used a 0.035 Stiff angled Glide wire to cross the occlusion into the infrapopliteal vessels. Multiple subtotal occlusions in the SFA were uncovered. All lesions were predilated with a 3.0x40mm Balloon at 10-14 atm with multiople inflations. The entire lesions were then postdilated with a 4.0x150mm Lutonix Drug Eluting baloon at 4 atm. Final angiography revealed evidence of minimla residual stenosis along the entire mid and distal SFA as well as the popliteal with stable nonflow limiting short dissections, The poplital was patent as well as the tibioperoneal trunk. The AT was occluded proximally, while the peroneal had severe proximal disease and the PT had severe diffuse disease in the mid and distal portions.
The sheaths were sutured in place and will be removed when ACT<150.
Moderate conscious sedation was administered by a qualified nursing professional under Continuous hemodynamic monitoring starting at 7:40 AM , and ending at 9:53 AM
Total IV Fentanyl: 175 mcg
Total IV Versed: 3.75 mg
Impression:
CLI L leg
S/P successful recanalization and PTA (using DE balloon) of totally occluded SFA and politeal vessels.with an excellent result.
Treatment:
ASA
Plavix
Statins
Continue current medical therapy
Thank you so much!
Left lower extremity Angiogram
L SFA PTA (Ipsilateral approach)
INDICATIONS
Patient was referred for cardiac catheterization to assess the LLE anatomy . Indications for the procedure include: CLI L leg with evidence of occluded L SFA and popliteal
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. Patient was further sedated with fentanyl and versed. Patient was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 6 French sheath was placed in the right femoral artery.Angiography of the left ileaofemoral graft to the femoral bifurcation was performed using 6F LIMA catheter. I attempted several times to get access into the L femoral system using 0.035 (Glide Advantage and Standard Glide) wires as well as 0.014 (BMW and Spartacore) wires, without being able to get even a Trailblazer (0.014) exchange catheter around the horn.
At this point I proceeded with getting access to the L SFA through an antegrade stick close to the femoral bifurcation, and a 6F sheath was placed. Heparin IA There was a 10 mm Hg gradient compared to the brachial pressure that improved with IA NTG. Initial angiography revealed evidence of occlusion of the mid and distal SFA as well as the left popliteal with minimal flow to the infrapopliteal vessels.
I used a 0.035 Stiff angled Glide wire to cross the occlusion into the infrapopliteal vessels. Multiple subtotal occlusions in the SFA were uncovered. All lesions were predilated with a 3.0x40mm Balloon at 10-14 atm with multiople inflations. The entire lesions were then postdilated with a 4.0x150mm Lutonix Drug Eluting baloon at 4 atm. Final angiography revealed evidence of minimla residual stenosis along the entire mid and distal SFA as well as the popliteal with stable nonflow limiting short dissections, The poplital was patent as well as the tibioperoneal trunk. The AT was occluded proximally, while the peroneal had severe proximal disease and the PT had severe diffuse disease in the mid and distal portions.
The sheaths were sutured in place and will be removed when ACT<150.
Moderate conscious sedation was administered by a qualified nursing professional under Continuous hemodynamic monitoring starting at 7:40 AM , and ending at 9:53 AM
Total IV Fentanyl: 175 mcg
Total IV Versed: 3.75 mg
Impression:
CLI L leg
S/P successful recanalization and PTA (using DE balloon) of totally occluded SFA and politeal vessels.with an excellent result.
Treatment:
ASA
Plavix
Statins
Continue current medical therapy
Thank you so much!