INDICATIONS FOR STUDY: History of coronary artery disease, abnormal echo, attempt to cardiac catheterization and peripheral vascular disease.
STUDIES PERFORMED: Selective left and right external iliac angiogram.
PROCEDURE DATA: Left groin was anesthetized with 2% Lidocaine. Subsequently, a needle was punctured into the left common femoral artery due to being unable to advance the guidewire. Then, selective left iliac angiogram was performed with the injections through the puncture needle. It demonstrates total occlusion of the left external iliac artery at its distal portion. After that, the needle was removed and a prolonged manual hold was performed. After that, the right groin was anesthetized with 2% Lidocaine. Subsequently, a 6-French sheath was able to advance to the distal portion of the right external iliac artery. Due to being unable to pass the wire through the iliac artery, then a right external iliac angiogram was performed with 6 Fr Sheath with the tip in the right external iliac artery. It demonstrated extremely calcified, tortuous, iliac artery. There is a patent renal artery to transplant a kidney at his right psoas area. Proximal to that, the right common iliac artery is extensively calcified and tortuous. After that, a TigerWire was not able to pass into the abdominal aorta. Then, with difficulty, the soft angle Glidewire was able to pass into the abdominal aorta. However, the 5-French JR4 or 5-French angled Glide catheter was not able to pass into the aorta due to extreme tortuosity, calcification of the iliac artery. After that, the stiff, straight Glidewire was placed into the distal abdominal aorta and then advancement of the angled Glide catheter was attempted and it was successful. However, attempt to place a 6-French 45 cm sheath was unsuccessful into the abdominal aorta due to lesion calcifications and tortuosity. After that, a 6-French JR4 was not able to pass into the abdominal aorta. Then, attempt to pass a 5-French JR4 was not able to pass into the abdominal aorta and then, further attempt was abandoned. Then, the sheath initially was attempted to close with a Mynx device; however, the balloon was lacerated by the calcium in the vessel. Subsequently, a prolonged manual holder was performed.
CONCLUSIONS:
1. Chronic total occlusion of left external iliac artery.
2. Extremely calcified and tortuous right iliac artery system.
3. Patent transplanted renal artery into the right external iliac artery.
Right now I would do the following. Anyone agree, disagree?
36140
36140.59
75716.26
Jessica CPC, CCC
STUDIES PERFORMED: Selective left and right external iliac angiogram.
PROCEDURE DATA: Left groin was anesthetized with 2% Lidocaine. Subsequently, a needle was punctured into the left common femoral artery due to being unable to advance the guidewire. Then, selective left iliac angiogram was performed with the injections through the puncture needle. It demonstrates total occlusion of the left external iliac artery at its distal portion. After that, the needle was removed and a prolonged manual hold was performed. After that, the right groin was anesthetized with 2% Lidocaine. Subsequently, a 6-French sheath was able to advance to the distal portion of the right external iliac artery. Due to being unable to pass the wire through the iliac artery, then a right external iliac angiogram was performed with 6 Fr Sheath with the tip in the right external iliac artery. It demonstrated extremely calcified, tortuous, iliac artery. There is a patent renal artery to transplant a kidney at his right psoas area. Proximal to that, the right common iliac artery is extensively calcified and tortuous. After that, a TigerWire was not able to pass into the abdominal aorta. Then, with difficulty, the soft angle Glidewire was able to pass into the abdominal aorta. However, the 5-French JR4 or 5-French angled Glide catheter was not able to pass into the aorta due to extreme tortuosity, calcification of the iliac artery. After that, the stiff, straight Glidewire was placed into the distal abdominal aorta and then advancement of the angled Glide catheter was attempted and it was successful. However, attempt to place a 6-French 45 cm sheath was unsuccessful into the abdominal aorta due to lesion calcifications and tortuosity. After that, a 6-French JR4 was not able to pass into the abdominal aorta. Then, attempt to pass a 5-French JR4 was not able to pass into the abdominal aorta and then, further attempt was abandoned. Then, the sheath initially was attempted to close with a Mynx device; however, the balloon was lacerated by the calcium in the vessel. Subsequently, a prolonged manual holder was performed.
CONCLUSIONS:
1. Chronic total occlusion of left external iliac artery.
2. Extremely calcified and tortuous right iliac artery system.
3. Patent transplanted renal artery into the right external iliac artery.
Right now I would do the following. Anyone agree, disagree?
36140
36140.59
75716.26
Jessica CPC, CCC