keesh0103
New
Should I use 37221-50, 37224,75625-26,75710-26??
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PREOPERATIVE DIAGNOSIS: Left lower extremity claudication, lifestyle
limiting.
POSTOPERATIVE DIAGNOSIS: Left lower extremity claudication, lifestyle
limiting.
PROCEDURES:
1. Ultrasound-guided access of bilateral common femoral artery.
2. Aortogram with pelvic runoff.
3. Left lower extremity angiogram.
4. Selective angiogram of the left tibial vessels.
5. Left popliteal artery angioplasty using VascuTrak 4 x 40 and 5 x 40.
6. Bilateral kissing iliac stents using a 9 x 38 kissing iliac stent.
7. Closure of right common femoral artery access site and ProGlide closure
of the left common femoral artery access site.
ANGIOGRAPHIC FINDINGS:
1. Patent aorta with some calcification and mild ectasia just above the
bifurcation with patent bilateral renal arteries.
2. Patent bilateral common iliac.
3. High-grade stenosis of right common iliac artery of about 90%.
4. Right hypogastric is patent with severe disease. Left hypogastric is
occluded.
5. Bilateral profunda is open.
6. Left superficial femoral artery is patent with mild disease.
7. Left popliteal artery in the mid segment has a severe stenosis of about
80%.
8. The tibioperoneal trunk is open and the anterior tibial artery is open.
The anterior tibial was open all the way down to the foot. The posterior
tibial is chronically occluded .
INDICATIONS FOR PROCEDURE: This is a patient who was referred to vascular
surgery for lifestyle-limiting claudication and possible left foot surgery.
Risks and benefits of the procedure were discussed with the patient and the
patient wishes to proceed with the procedure.
PROCEDURE IN DETAIL: The patient was taken to the cath lab after operative
informed consent was obtained. The patient was put in the supine position.
Monitored anesthesia care was made without complication. Bilateral groins
were prepped and draped in sterile fashion. Ultrasound-guided access of the
right common femoral artery was done using Mini Stick needle, Mini Stick
wire, and Mini Stick sheath. A 6-French sheath was inserted. An angiogram
Operative Report
was done, which showed that we stuck the common femoral artery. There was
high-grade stenosis in the right common iliac artery of about 90%stenosis
close bifurcation. Afterwards, a Glidewire was inserted and an Omni Flush
catheter was inserted. Aortogram was done, which showed bilateral renals
patent. There is ectasia in the lower aorta with moderate calcification.
There is right high-grade iliac artery stenosis, patent left iliac system
with some stenosis, moderate disease in the left external iliac. Afterwards
Omni Flush was used to access the left iliac system and selective angiogram
was done, which showed patent profunda, patent SFA with mild disease. The
left popliteal artery had severe disease in the mid segment with focal
stenosis of about 80%.
Afterwards, heparin 5000 units was given. A 6-French, 55 cm sheath was
inserted all the way into the SFA. The left popliteal artery was
angioplastied using VascuTrak 4 x 40 and 5 x 40 balloon. Afterwards,
angiogram showed excellent angiographic result. Afterwards, a 6-French, 55
cm sheath was replaced by a 7-French, 23 cm radiopaque-tip sheath. The left
common femoral artery was accessed using Mini stick needle, Mini stick
wire, and Mini stick sheath. A Glidewire was inserted, and a 7-French, 22
cm sheath was inserted. An angiogram was done which showed the 90%
high-grade stenosis of the right common iliac artery near the
aortic bifurcation. A kissing iliac stent was done using iCAST 9 x 38 at the
same level. Completion angiogram showed excellent angiographic result. The
right common femoral artery was closed using Mynx grip and the left common
femoral access site was closed using a ProGlide. The patient tolerated the
procedure well and was taken back to the PACU in satisfactory condition.
The patient had allergic reaction intraoperatively with the use of the
contrast and has some hives, but she does not have any shortness of breath.
Besides the hives, nothing else. She was given Benadryl 50 mg and
Solu-Medrol 125 and has responded. The patient will need to be premedicated
the next time she gets an angiogram.
Thanks for your help!
--------------------------------------------------------------------------------------------------
PREOPERATIVE DIAGNOSIS: Left lower extremity claudication, lifestyle
limiting.
POSTOPERATIVE DIAGNOSIS: Left lower extremity claudication, lifestyle
limiting.
PROCEDURES:
1. Ultrasound-guided access of bilateral common femoral artery.
2. Aortogram with pelvic runoff.
3. Left lower extremity angiogram.
4. Selective angiogram of the left tibial vessels.
5. Left popliteal artery angioplasty using VascuTrak 4 x 40 and 5 x 40.
6. Bilateral kissing iliac stents using a 9 x 38 kissing iliac stent.
7. Closure of right common femoral artery access site and ProGlide closure
of the left common femoral artery access site.
ANGIOGRAPHIC FINDINGS:
1. Patent aorta with some calcification and mild ectasia just above the
bifurcation with patent bilateral renal arteries.
2. Patent bilateral common iliac.
3. High-grade stenosis of right common iliac artery of about 90%.
4. Right hypogastric is patent with severe disease. Left hypogastric is
occluded.
5. Bilateral profunda is open.
6. Left superficial femoral artery is patent with mild disease.
7. Left popliteal artery in the mid segment has a severe stenosis of about
80%.
8. The tibioperoneal trunk is open and the anterior tibial artery is open.
The anterior tibial was open all the way down to the foot. The posterior
tibial is chronically occluded .
INDICATIONS FOR PROCEDURE: This is a patient who was referred to vascular
surgery for lifestyle-limiting claudication and possible left foot surgery.
Risks and benefits of the procedure were discussed with the patient and the
patient wishes to proceed with the procedure.
PROCEDURE IN DETAIL: The patient was taken to the cath lab after operative
informed consent was obtained. The patient was put in the supine position.
Monitored anesthesia care was made without complication. Bilateral groins
were prepped and draped in sterile fashion. Ultrasound-guided access of the
right common femoral artery was done using Mini Stick needle, Mini Stick
wire, and Mini Stick sheath. A 6-French sheath was inserted. An angiogram
Operative Report
was done, which showed that we stuck the common femoral artery. There was
high-grade stenosis in the right common iliac artery of about 90%stenosis
close bifurcation. Afterwards, a Glidewire was inserted and an Omni Flush
catheter was inserted. Aortogram was done, which showed bilateral renals
patent. There is ectasia in the lower aorta with moderate calcification.
There is right high-grade iliac artery stenosis, patent left iliac system
with some stenosis, moderate disease in the left external iliac. Afterwards
Omni Flush was used to access the left iliac system and selective angiogram
was done, which showed patent profunda, patent SFA with mild disease. The
left popliteal artery had severe disease in the mid segment with focal
stenosis of about 80%.
Afterwards, heparin 5000 units was given. A 6-French, 55 cm sheath was
inserted all the way into the SFA. The left popliteal artery was
angioplastied using VascuTrak 4 x 40 and 5 x 40 balloon. Afterwards,
angiogram showed excellent angiographic result. Afterwards, a 6-French, 55
cm sheath was replaced by a 7-French, 23 cm radiopaque-tip sheath. The left
common femoral artery was accessed using Mini stick needle, Mini stick
wire, and Mini stick sheath. A Glidewire was inserted, and a 7-French, 22
cm sheath was inserted. An angiogram was done which showed the 90%
high-grade stenosis of the right common iliac artery near the
aortic bifurcation. A kissing iliac stent was done using iCAST 9 x 38 at the
same level. Completion angiogram showed excellent angiographic result. The
right common femoral artery was closed using Mynx grip and the left common
femoral access site was closed using a ProGlide. The patient tolerated the
procedure well and was taken back to the PACU in satisfactory condition.
The patient had allergic reaction intraoperatively with the use of the
contrast and has some hives, but she does not have any shortness of breath.
Besides the hives, nothing else. She was given Benadryl 50 mg and
Solu-Medrol 125 and has responded. The patient will need to be premedicated
the next time she gets an angiogram.
Thanks for your help!