rgander
New
I was wondering if anyone can help me with this peripheral procedure. 
PROCEDURES:
Abdominal aortogram with runoff, subselective left and right
renal artery angiograms, selective right superficial femoral
artery angiogram, left iliac artery angiogram, and Perclose of
left common femoral artery.
COMPLICATIONS:
None.
INDICATIONS:
Peripheral vascular disease, claudication, old myocardial
infarction, ischemic cardiomyopathy, recurrent claudication.
DESCRIPTION OF PROCEDURE:
After informed consent outlined in detail to the patient of
risks, benefits, alternatives of endovascular intervention
including the risks of MI, CVA, bleeding, infection, arrhythmia,
death, blood transfusion, urgent vascular surgery, and loss of
limb, the patient is prepped and draped under local anesthesia
with a Seldinger technique. The left common femoral artery is
accessed and over a 0.035-inch guidewire, a 6-French 10 cm Cordis
sheath is placed retrograde in the left common femoral artery. A
pigtail was then passed retrograde to the level of the abdominal
aorta and subselective renal angiograms are performed. Nonionic
contrast, 20 mL DSA power injection. The pigtail is then taken
to the bifurcation and upon injection 35 mL nonionic contrast
with runoff down both legs performed. Thereafter, intravenous
Angiomax Factor 2 inhibitor is commenced and a 6-French flexor 45
cm sheath is placed contralateral across to the right external
iliac artery for subselective angiograms of the right leg.
Utilizing an 0.035 with Glidewire support, the chronic occlusion
of the right SFA is intervened, however, it is not suitable for
total cross due to chronic occlusion of at least 40 cm proximal,
mid, distal, with reconstitution of the right SFA at the adductor
canal. Perclose of the left common femoral artery is performed
after removing the sheath with excellent hemostasis. Small Track ooze
pressure FemoStop placed. The Perclose is performed with
excellent hemostasis.
DIAGNOSTIC FINDINGS:
Noted as follows: Normal left and right renal arteries. Mild
plaque of the distal aorta. Left common iliac artery, external
and internal arteries, mild plaque, left common femoral artery
30% lesion noted, diffuse, proximal to mid 60% left SFA stenoses
noted with chronic occlusion of distal SFA, short 5 cm to 10 cm
long area of occlusion is noted at the distal SFA with
reconstitution to the popliteal artery with 3-vessel runoff down
the left leg. The profunda on the left is large and normal. On
the right, the right common iliac, external iliac, internal iliac
patent with mild plaque, right common femoral artery mild plaque,
patent profunda femoris with flow down in collaterals to the
occluded right SFA distally, proximal to mid SFA 100% occlusion
at least 40 cm in length, 3-vessel runoff down infrapopliteal to
dorsalis pedis, posterior tibial and peroneal vessels of the
right leg.
FINAL IMPRESSION:
Chronic occlusions of the right proximal mid distal SFA, chronic
occlusion of left distal SFA with profunda collaterals down both
legs.
PROCEDURES:
Abdominal aortogram with runoff, subselective left and right
renal artery angiograms, selective right superficial femoral
artery angiogram, left iliac artery angiogram, and Perclose of
left common femoral artery.
COMPLICATIONS:
None.
INDICATIONS:
Peripheral vascular disease, claudication, old myocardial
infarction, ischemic cardiomyopathy, recurrent claudication.
DESCRIPTION OF PROCEDURE:
After informed consent outlined in detail to the patient of
risks, benefits, alternatives of endovascular intervention
including the risks of MI, CVA, bleeding, infection, arrhythmia,
death, blood transfusion, urgent vascular surgery, and loss of
limb, the patient is prepped and draped under local anesthesia
with a Seldinger technique. The left common femoral artery is
accessed and over a 0.035-inch guidewire, a 6-French 10 cm Cordis
sheath is placed retrograde in the left common femoral artery. A
pigtail was then passed retrograde to the level of the abdominal
aorta and subselective renal angiograms are performed. Nonionic
contrast, 20 mL DSA power injection. The pigtail is then taken
to the bifurcation and upon injection 35 mL nonionic contrast
with runoff down both legs performed. Thereafter, intravenous
Angiomax Factor 2 inhibitor is commenced and a 6-French flexor 45
cm sheath is placed contralateral across to the right external
iliac artery for subselective angiograms of the right leg.
Utilizing an 0.035 with Glidewire support, the chronic occlusion
of the right SFA is intervened, however, it is not suitable for
total cross due to chronic occlusion of at least 40 cm proximal,
mid, distal, with reconstitution of the right SFA at the adductor
canal. Perclose of the left common femoral artery is performed
after removing the sheath with excellent hemostasis. Small Track ooze
pressure FemoStop placed. The Perclose is performed with
excellent hemostasis.
DIAGNOSTIC FINDINGS:
Noted as follows: Normal left and right renal arteries. Mild
plaque of the distal aorta. Left common iliac artery, external
and internal arteries, mild plaque, left common femoral artery
30% lesion noted, diffuse, proximal to mid 60% left SFA stenoses
noted with chronic occlusion of distal SFA, short 5 cm to 10 cm
long area of occlusion is noted at the distal SFA with
reconstitution to the popliteal artery with 3-vessel runoff down
the left leg. The profunda on the left is large and normal. On
the right, the right common iliac, external iliac, internal iliac
patent with mild plaque, right common femoral artery mild plaque,
patent profunda femoris with flow down in collaterals to the
occluded right SFA distally, proximal to mid SFA 100% occlusion
at least 40 cm in length, 3-vessel runoff down infrapopliteal to
dorsalis pedis, posterior tibial and peroneal vessels of the
right leg.
FINAL IMPRESSION:
Chronic occlusions of the right proximal mid distal SFA, chronic
occlusion of left distal SFA with profunda collaterals down both
legs.