Hello! I need help on this case... Can anyone please help me.
Thank you so much in advance.
Reason for Evaluation: Claudication
Procedure: The patient was brought to the catheterization lab and prepped and draped in a sterile fashion. Lidocaine was placed to the left common femoral area. Using micropuncture technique, a 6 French sheath was placed in the left common femoral artery. Next, an angiography was performed down the leg via thr sheath site. Next, over the wire, a 6-French JR4 was used to selectively engage the left renal artery. Angiography was performed. Selective angiography of the right renal artery was also performed.
At this point, over the Glidewire, a 6- French LIMA catheter was placed in the right common femoral artery, and femoral arterial angiography was performed down the right leg. As we were performing this, we saw significant pressure difference between the right leg and the brachial pressures. Thus, we brought the LIMA catheter up to the proximal portion of the right iliac. There was still significant pressure gradient, and we did angiography down the right side. We brought the catheter back up and over to the left proximal common femoral artery. There was still a significant yet midly improved gradient. Angiography was performed at this site.
Next, over the wire, we placed the catheter to the distal abdominal aorta, infrarenal, and angiography was performed,showing evidence of a small dissection. Above this dissection plane, there was no significant brachial aortic pressure gradient. Wire was placed. We placed the pigtail cathetered higher at the level above the renal arteries. Angiography again down showed narrowing of the distal abdominal aorta and heavily calcified lesion and no significant dissection.
The pigtail catheter was brought back slowly, again measuring a significant pressure gradient. The pigtail catheter was removed. Manual pressure was held at the left common femoral artery. There was good groin hemostasis and no evidence of oozing, bruising, or hematoma.
Impression:
1. At the distal abdominal aorta the angiography appears heavily calcified with a focal stenosis. It is narrowed. However, with focal angiography, there is evedince of an dissection plane that is infrarenal and extending to the lesion. This is somewhat isolated, but does cause a significant pressure gradient. The distal abdominal aorta is also significantly calcified at the bifurcation to the iliac.
2. At the bilateral iliac arteries at the ostial segment, the right iliac shows moderate disease. It is heavily calcified. The left iliac is patent. Again there is approximately greater than 40-60 mmHG gradient from the infrarenal aorta into the iliac arteries. Otherwise the bilateral iliac arteries are widely patent.
3. The common femoral arteries and superficial femoral arteries bilaterally are widely patent. The popliteal arteries bilaterally are widely patent. There is 3-vessel flow into the foot.
4. Selective renal angiography. The right renal artery is large and widely patent. The left renal artery is much smaller. There is a 30% to 50% ostial/proximal stenosis of such.
Thank you so much in advance.
Reason for Evaluation: Claudication
Procedure: The patient was brought to the catheterization lab and prepped and draped in a sterile fashion. Lidocaine was placed to the left common femoral area. Using micropuncture technique, a 6 French sheath was placed in the left common femoral artery. Next, an angiography was performed down the leg via thr sheath site. Next, over the wire, a 6-French JR4 was used to selectively engage the left renal artery. Angiography was performed. Selective angiography of the right renal artery was also performed.
At this point, over the Glidewire, a 6- French LIMA catheter was placed in the right common femoral artery, and femoral arterial angiography was performed down the right leg. As we were performing this, we saw significant pressure difference between the right leg and the brachial pressures. Thus, we brought the LIMA catheter up to the proximal portion of the right iliac. There was still significant pressure gradient, and we did angiography down the right side. We brought the catheter back up and over to the left proximal common femoral artery. There was still a significant yet midly improved gradient. Angiography was performed at this site.
Next, over the wire, we placed the catheter to the distal abdominal aorta, infrarenal, and angiography was performed,showing evidence of a small dissection. Above this dissection plane, there was no significant brachial aortic pressure gradient. Wire was placed. We placed the pigtail cathetered higher at the level above the renal arteries. Angiography again down showed narrowing of the distal abdominal aorta and heavily calcified lesion and no significant dissection.
The pigtail catheter was brought back slowly, again measuring a significant pressure gradient. The pigtail catheter was removed. Manual pressure was held at the left common femoral artery. There was good groin hemostasis and no evidence of oozing, bruising, or hematoma.
Impression:
1. At the distal abdominal aorta the angiography appears heavily calcified with a focal stenosis. It is narrowed. However, with focal angiography, there is evedince of an dissection plane that is infrarenal and extending to the lesion. This is somewhat isolated, but does cause a significant pressure gradient. The distal abdominal aorta is also significantly calcified at the bifurcation to the iliac.
2. At the bilateral iliac arteries at the ostial segment, the right iliac shows moderate disease. It is heavily calcified. The left iliac is patent. Again there is approximately greater than 40-60 mmHG gradient from the infrarenal aorta into the iliac arteries. Otherwise the bilateral iliac arteries are widely patent.
3. The common femoral arteries and superficial femoral arteries bilaterally are widely patent. The popliteal arteries bilaterally are widely patent. There is 3-vessel flow into the foot.
4. Selective renal angiography. The right renal artery is large and widely patent. The left renal artery is much smaller. There is a 30% to 50% ostial/proximal stenosis of such.