Carmen7414
Contributor
PROCEDURES:
1. Insertion of sheath in the left femoral artery.
2. Advancement of the catheter across the bifurcation into the right common iliac artery and angiogram with runoff.
3. PTA and stent of 100% occluded distal right external iliac artery and proximal common femoral artery. This was done using a Viabahn stent 7 mm x 10 cm.
4. PTA and stent of the proximal right external iliac artery using a 7 x 57 EV3 balloon expandable stent.
5. Increased technical difficulty because of 100% occlusion, which was difficult to cross.
INDICATIONS: This is a young patient, who after cath and Angio-Seal developed claudication and was found to have total occlusion of the distal external iliac artery with collaterals reconstituting the common femoral artery via the internal iliac artery.
DETAILS OF PROCEDURE: Informed consent was obtained. The patient was brought to the cath lab. Left groin was prepped and draped in the usual fashion. Xylocaine 2% was infiltrated to obtain local anesthesia. Cannulization of the left femoral artery was obtained using modified Seldinger's technique on first attempt and size 6 sheath was introduced. A 6-French internal mammary artery catheter was then advanced across the bifurcation and angiogram was done. The patient was documented to have 100% occlusion of the distal external iliac artery and the entire external iliac artery had very diffuse narrowing.
The internal iliac artery was giving collaterals and reconstituted the common femoral artery.
Interventional procedure was started. The patient was given 5000 units of heparin intra-arterially and a 6-French crossover sheath was used. Then, a 5-French glide catheter was used and the occlusion was attempted to cross first with a 0.018 V18 wire. It did not cross. We then used a 5-French glide catheter and tried the Storq wire, which did not cross the occlusion. Then, used a Miracle Bros 6 guidewire and that was able to cross the occlusion. The glide catheter was then advanced over the wire and angiography done to make sure that I was in the true lumen. The PTA procedure was started. The occluded segment was dilated with a 5 x 6 balloon. Angiography was done and showed improvement. After careful review of the film, it was decided to stent the proximal CFA and external iliac artery with a 7 mm x 10 cm Viabahn stent .The 6 F cross over sheath was exchanged with 7 F sheath Wire was exchanged with 0.18 wire. Viahban stent was advanced and very carefully positioned and deployed. The proximal external iliac artery was stented using a 7 x 57 balloon expandable stent and both stents were overlapped. The stented segment was then dilated with the same balloon. Balloon was removed. Angiography revealed very good result with no residual stenosis. The patient had no complications. The 7-French crossover sheath was then exchanged with a 7-French short sheath, Procedure was completed. The patient was sent to recovery area in stable condition for sheath to be removed once ACT down. She had no complications
is it:
36140
37221
37223-22,51,XU
75716
thanks!!!
1. Insertion of sheath in the left femoral artery.
2. Advancement of the catheter across the bifurcation into the right common iliac artery and angiogram with runoff.
3. PTA and stent of 100% occluded distal right external iliac artery and proximal common femoral artery. This was done using a Viabahn stent 7 mm x 10 cm.
4. PTA and stent of the proximal right external iliac artery using a 7 x 57 EV3 balloon expandable stent.
5. Increased technical difficulty because of 100% occlusion, which was difficult to cross.
INDICATIONS: This is a young patient, who after cath and Angio-Seal developed claudication and was found to have total occlusion of the distal external iliac artery with collaterals reconstituting the common femoral artery via the internal iliac artery.
DETAILS OF PROCEDURE: Informed consent was obtained. The patient was brought to the cath lab. Left groin was prepped and draped in the usual fashion. Xylocaine 2% was infiltrated to obtain local anesthesia. Cannulization of the left femoral artery was obtained using modified Seldinger's technique on first attempt and size 6 sheath was introduced. A 6-French internal mammary artery catheter was then advanced across the bifurcation and angiogram was done. The patient was documented to have 100% occlusion of the distal external iliac artery and the entire external iliac artery had very diffuse narrowing.
The internal iliac artery was giving collaterals and reconstituted the common femoral artery.
Interventional procedure was started. The patient was given 5000 units of heparin intra-arterially and a 6-French crossover sheath was used. Then, a 5-French glide catheter was used and the occlusion was attempted to cross first with a 0.018 V18 wire. It did not cross. We then used a 5-French glide catheter and tried the Storq wire, which did not cross the occlusion. Then, used a Miracle Bros 6 guidewire and that was able to cross the occlusion. The glide catheter was then advanced over the wire and angiography done to make sure that I was in the true lumen. The PTA procedure was started. The occluded segment was dilated with a 5 x 6 balloon. Angiography was done and showed improvement. After careful review of the film, it was decided to stent the proximal CFA and external iliac artery with a 7 mm x 10 cm Viabahn stent .The 6 F cross over sheath was exchanged with 7 F sheath Wire was exchanged with 0.18 wire. Viahban stent was advanced and very carefully positioned and deployed. The proximal external iliac artery was stented using a 7 x 57 balloon expandable stent and both stents were overlapped. The stented segment was then dilated with the same balloon. Balloon was removed. Angiography revealed very good result with no residual stenosis. The patient had no complications. The 7-French crossover sheath was then exchanged with a 7-French short sheath, Procedure was completed. The patient was sent to recovery area in stable condition for sheath to be removed once ACT down. She had no complications
is it:
36140
37221
37223-22,51,XU
75716
thanks!!!