TWilliam2019
Guru
1. Aortogram
2. Bilateral renal angiogram
3. Selective catheterization of the bilateral renal arteries
4. Drug-coated balloon angioplasty right renal artery
5. Stent angioplasty of the left renal artery
6. Ultrasound-guided puncture of the right common femoral artery
Patient was placed in supine position. Femoral areas were prepped and draped with ChloraPrep. Timeouts performed. The right common femoral artery was imaged using duplex imaging. The artery is patent and was accessed with micropuncture technique. Digital images are recorded. The initial 5 French sheath was upsized to a 6 French sheath. Universal flush catheter was positioned in the suprarenal aorta.
Aortogram was performed. Findings: The aorta is widely patent. In order to provide optimal renal artery imaging the catheter was positioned below the mesenteric vessel origins. the right renal artery has previously been stented. There is moderate to severe stenosis within the stent. The left renal artery is stenotic with severe stenosis in its proximal third. The left renal artery appears to have progressed in degree of stenosis compared to previous arteriogram.
Selective catheterization was performed the right renal artery and enteral renal arterial injection confirm the degree and extent of stenosis. A 6 French sheath was advanced into the ostium of the renal artery and a drug-coated balloon advanced over a wire across the stent. The in-stent stenosis was then treated with a drug-coated balloon 6 mm diameter. The patient was systemically heparinized prior to inflation of the balloon. Follow-up arteriogram showed good result with residual stenosis less than 25% and no evidence of dissection.
Selective catheterization was then performed the left renal artery and selective renal artery injection demonstrated the extent of the left renal artery stenosis seen on the initial aortogram. A 018 wire was placed across the stenosis and primary stent angioplasty performed with a 5 mm x 15 mm balloon mounted stent. The follow-up arteriogram showed excellent result with no residual stenosis dissection or contrast extravasation.
The long sheath was removed and replaced with a standard 6 French sheath. A minx closure was performed of the right common femoral artery puncture site.
Summary of radiographic findings:
1. Recurrent right renal artery in-stent stenosis successfully treated with drug-coated balloon angioplasty
2. Left renal artery stenosis successfully treated with stent angioplasty
Views of the distal aorta and pelvis demonstrated bilateral common iliac artery stents which remain patent without significant recurrent stenosis.
2. Bilateral renal angiogram
3. Selective catheterization of the bilateral renal arteries
4. Drug-coated balloon angioplasty right renal artery
5. Stent angioplasty of the left renal artery
6. Ultrasound-guided puncture of the right common femoral artery
Patient was placed in supine position. Femoral areas were prepped and draped with ChloraPrep. Timeouts performed. The right common femoral artery was imaged using duplex imaging. The artery is patent and was accessed with micropuncture technique. Digital images are recorded. The initial 5 French sheath was upsized to a 6 French sheath. Universal flush catheter was positioned in the suprarenal aorta.
Aortogram was performed. Findings: The aorta is widely patent. In order to provide optimal renal artery imaging the catheter was positioned below the mesenteric vessel origins. the right renal artery has previously been stented. There is moderate to severe stenosis within the stent. The left renal artery is stenotic with severe stenosis in its proximal third. The left renal artery appears to have progressed in degree of stenosis compared to previous arteriogram.
Selective catheterization was performed the right renal artery and enteral renal arterial injection confirm the degree and extent of stenosis. A 6 French sheath was advanced into the ostium of the renal artery and a drug-coated balloon advanced over a wire across the stent. The in-stent stenosis was then treated with a drug-coated balloon 6 mm diameter. The patient was systemically heparinized prior to inflation of the balloon. Follow-up arteriogram showed good result with residual stenosis less than 25% and no evidence of dissection.
Selective catheterization was then performed the left renal artery and selective renal artery injection demonstrated the extent of the left renal artery stenosis seen on the initial aortogram. A 018 wire was placed across the stenosis and primary stent angioplasty performed with a 5 mm x 15 mm balloon mounted stent. The follow-up arteriogram showed excellent result with no residual stenosis dissection or contrast extravasation.
The long sheath was removed and replaced with a standard 6 French sheath. A minx closure was performed of the right common femoral artery puncture site.
Summary of radiographic findings:
1. Recurrent right renal artery in-stent stenosis successfully treated with drug-coated balloon angioplasty
2. Left renal artery stenosis successfully treated with stent angioplasty
Views of the distal aorta and pelvis demonstrated bilateral common iliac artery stents which remain patent without significant recurrent stenosis.