kimberly_sapp3
New
I need some info before going to the docs, any sugestions on how to code this? The S&I most importantly.
ROCEDURE:
1. Right femoral artery access and angiography.
2. Catheter placement into the left femoral artery through an above and over access with angiography.
3. Catheter placement in the left tibioperoneal trunk with angiography of the foot.
4. Access into the left posterior tibial under ultrasound guidance.
5. Balloon angioplasty of the left posterior tibial artery.
6. Atherectomy with a TurboHawk of the left proximal superficial femoral artery.
7. Atherectomy with a TurboHawk of the distal left superficial femoral artery.
8. Balloon angioplasty of the proximal left superficial femoral artery.
INDICATION FOR PROCEDURE: This is a 59-year-old male patient with severe peripheral vascular disease who has been having pain in his toes. The patient underwent initially balloon angioplasty of the SFA 4 weeks ago. The patient is still having difficulty with healing and was brought in for further revascularization.
DESCRIPTION OF PROCEDURE: Right femoral access was performed under ultrasound guidance. A 5-French vascular sheath was inserted. Next angiography was performed and documented a good arteriotomy site. A 4-French IMA catheter was taken and positioned into the left femoral artery. Angiography of the SFA was performed.Next the catheter was taken down into the popliteal artery and angiography of popliteal artery was performed. Next the catheter was taken down into the left tibioperoneal trunk and angiography was performed. The posterior tibial was completely occluded proximal to the ostium with no obvious cap. Over the wire the sheaths were exchanged for a 7-French 45 cm Cook catheter. This was positioned in the left common femoral artery. Next a multipurpose catheter, a 6-French, was used and advanced over the wire and positioned into the popliteal artery. Through this an Astato wire was used to attempt to cross into the posterior tibial artery proximally without any success. Next under ultrasound guidance, access into the left posterior tibial artery distally was performed. After confirming intraluminal positioning, angiography performed via sheath in PT artery, the wire was then used to cross into the tibioperoneal trunk. The wire was then externalized through the catheter all of the way out through the right femoral access. The balloon was advanced and balloon angioplasty of the posterior tibial artery was performed. Next the balloon was taken out and was re-advanced over the wire in an antegrade fashion into the posterior tibial artery. Once it was positioned in the posterior tibial artery, the wire was taken out and re-advanced in an antegrade fashion. The 4-French sheath was then taken out of the posterior tibial artery and I used gentle 2 atmosphere inflation of the balloon was performed across the artery on the side with manual pressure for 5 minutes. Repeat angiography revealed no signs of extravasation with complete sealing of the arteriotomy site. Attempts at crossing into the posterior tibial were met with difficulty and this was aborted. Next repeat balloon angioplasty of the posterior tibial artery and the tibioperoneal trunk was performed for optimal result. The balloon was taken out and a 6.0 SpiderFlex Filter was advanced and deployed into the posterior tibial artery. An LX-C TurboHawk catheter was used to perform atherectomy of the distal SFA and proximal SFA. This was performed in multiple runs, multiplanar. The catheter was taken out. Balloon angioplasty of the proximal SFA was performed using a 5.0 x 200 mm balloon. Repeat angiography revealed good optimal result with less than 20% residual stenosis. There was brisk flow all of the way into the posterior tibial artery distally and the peroneal artery distally. The catheter was exchanged to a short 7-French sheath. This will be taken out with manual pressure.
The patient received aspirin and Plavix. He was given multiple heparin injections throughout the procedure to maintain the ACT above 200. He received normal saline for hydration. Total contrast used throughout the procedure was 475 mL.
LEFT LEG: There is 30-40% stenosis of the common femoral artery just as soon as it comes off the external iliac artery. The common femoral artery otherwise is widely patent with run off in the profunda. The SFA proximally has a 50-70% stenosis eccentric lesions. The SFA in the mid segment is widely patent and then there is a 50-60% stenosis in the distal SFA. It runs down to give the popliteal artery which gives the tibioperoneal trunk . The anterior tibial artery is proximally occluded. The tibioperoneal trunk runs down to give the peroneal artery. However, the posterior tibial artery is 100% occluded with filling through collaterals to the posterior tibial artery.
LEFT PTA:
Preintervention 100% occluded.
Postintervention less than 10%.
Balloon angioplasty using a 3.0 x 80 mm balloon with an occluded distal PT just around the ankle. This is filling through collaterals into the distal arch briskly.
LEFT SFA:
Preintervention multiple 60-70% sequential lesions.
Postintervention less than 20% residual lesions.
Atherectomy with TurboHawk using an LX-C with balloon angioplasty was performed.
IMPRESSION:
1. Severe peripheral vascular disease.
2. Success atherectomy of the proximal superficial femoral artery.
3. Successful atherectomy of the distal superficial femoral artery.
4. Successful balloon angioplasty of the posterior tibial artery.
ROCEDURE:
1. Right femoral artery access and angiography.
2. Catheter placement into the left femoral artery through an above and over access with angiography.
3. Catheter placement in the left tibioperoneal trunk with angiography of the foot.
4. Access into the left posterior tibial under ultrasound guidance.
5. Balloon angioplasty of the left posterior tibial artery.
6. Atherectomy with a TurboHawk of the left proximal superficial femoral artery.
7. Atherectomy with a TurboHawk of the distal left superficial femoral artery.
8. Balloon angioplasty of the proximal left superficial femoral artery.
INDICATION FOR PROCEDURE: This is a 59-year-old male patient with severe peripheral vascular disease who has been having pain in his toes. The patient underwent initially balloon angioplasty of the SFA 4 weeks ago. The patient is still having difficulty with healing and was brought in for further revascularization.
DESCRIPTION OF PROCEDURE: Right femoral access was performed under ultrasound guidance. A 5-French vascular sheath was inserted. Next angiography was performed and documented a good arteriotomy site. A 4-French IMA catheter was taken and positioned into the left femoral artery. Angiography of the SFA was performed.Next the catheter was taken down into the popliteal artery and angiography of popliteal artery was performed. Next the catheter was taken down into the left tibioperoneal trunk and angiography was performed. The posterior tibial was completely occluded proximal to the ostium with no obvious cap. Over the wire the sheaths were exchanged for a 7-French 45 cm Cook catheter. This was positioned in the left common femoral artery. Next a multipurpose catheter, a 6-French, was used and advanced over the wire and positioned into the popliteal artery. Through this an Astato wire was used to attempt to cross into the posterior tibial artery proximally without any success. Next under ultrasound guidance, access into the left posterior tibial artery distally was performed. After confirming intraluminal positioning, angiography performed via sheath in PT artery, the wire was then used to cross into the tibioperoneal trunk. The wire was then externalized through the catheter all of the way out through the right femoral access. The balloon was advanced and balloon angioplasty of the posterior tibial artery was performed. Next the balloon was taken out and was re-advanced over the wire in an antegrade fashion into the posterior tibial artery. Once it was positioned in the posterior tibial artery, the wire was taken out and re-advanced in an antegrade fashion. The 4-French sheath was then taken out of the posterior tibial artery and I used gentle 2 atmosphere inflation of the balloon was performed across the artery on the side with manual pressure for 5 minutes. Repeat angiography revealed no signs of extravasation with complete sealing of the arteriotomy site. Attempts at crossing into the posterior tibial were met with difficulty and this was aborted. Next repeat balloon angioplasty of the posterior tibial artery and the tibioperoneal trunk was performed for optimal result. The balloon was taken out and a 6.0 SpiderFlex Filter was advanced and deployed into the posterior tibial artery. An LX-C TurboHawk catheter was used to perform atherectomy of the distal SFA and proximal SFA. This was performed in multiple runs, multiplanar. The catheter was taken out. Balloon angioplasty of the proximal SFA was performed using a 5.0 x 200 mm balloon. Repeat angiography revealed good optimal result with less than 20% residual stenosis. There was brisk flow all of the way into the posterior tibial artery distally and the peroneal artery distally. The catheter was exchanged to a short 7-French sheath. This will be taken out with manual pressure.
The patient received aspirin and Plavix. He was given multiple heparin injections throughout the procedure to maintain the ACT above 200. He received normal saline for hydration. Total contrast used throughout the procedure was 475 mL.
LEFT LEG: There is 30-40% stenosis of the common femoral artery just as soon as it comes off the external iliac artery. The common femoral artery otherwise is widely patent with run off in the profunda. The SFA proximally has a 50-70% stenosis eccentric lesions. The SFA in the mid segment is widely patent and then there is a 50-60% stenosis in the distal SFA. It runs down to give the popliteal artery which gives the tibioperoneal trunk . The anterior tibial artery is proximally occluded. The tibioperoneal trunk runs down to give the peroneal artery. However, the posterior tibial artery is 100% occluded with filling through collaterals to the posterior tibial artery.
LEFT PTA:
Preintervention 100% occluded.
Postintervention less than 10%.
Balloon angioplasty using a 3.0 x 80 mm balloon with an occluded distal PT just around the ankle. This is filling through collaterals into the distal arch briskly.
LEFT SFA:
Preintervention multiple 60-70% sequential lesions.
Postintervention less than 20% residual lesions.
Atherectomy with TurboHawk using an LX-C with balloon angioplasty was performed.
IMPRESSION:
1. Severe peripheral vascular disease.
2. Success atherectomy of the proximal superficial femoral artery.
3. Successful atherectomy of the distal superficial femoral artery.
4. Successful balloon angioplasty of the posterior tibial artery.