Here is the report.
After informed consent was obtained from the patient and his family, he is brought to the cath lab whre his right femoral region was prepped, draped and infiltrated with Xylocaine. A 5-French sheath was placed in the right femoral artery via the modified Seldinger technique. A 5-French pigtail catheter was position in the lower portion of the abdominal aorta. Abdominal aortography with iliofemoral runoff was was performed in the PA view. This catheter was then used to advance an angled Glidewire into the left superficial femoral artery. The catheter was exchanged over the wire for a 5-French angled glide catheter, which was positioned in the left SFA. Left leg angiography with distal vessel runoff was performed in the PA view. This catheter was brought back and angled views of the femoral bifurcations were made bilaterally. Right leg angiography with distal vessel runoff was then performed in 2 views. This catheter was removed.
Heparin 3000 units was given intravenously. The 5-French pigtail catheter was used to advance the angled Glidewire into the left SFA. The angled glide catheter was then posisioned in the left SFA. A 6-French sheath was then placed over the Amplatz wire into the left SFA.
An excahange length Journey guidewire was used to advance into the anterior tibial artery beyond the 2 areas of stenosis. A 2.5 x 40 mm balloon was used to dilate both stenoses at 7 and 8 atmospheres. The balloon was brought back. Nitroglycerin was given down the artery and final angiography was performed. The balloon and guidewire were removed from the sheath.
Using its introducer and the Amplatz wire, the long sheath was taken back across the aortic bifurcation. It was then removed and hemostasis was achieved using a StarClose closure device.