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INDICATION: Intermittent claudication.
PROCEDURE: Access of the aorta with selective placement of catheter, femoral artery with selective catheter placement in the contralateral common femoral artery third order with selective injection and interpretation of bilateral iliofemoral angiogram as well as bilateral lower extremity runoff.
HISTORY OF PRESENT ILLNESS: The patient is an 85-year-old with history of paroxysmal atrial fibrillation, hypertension and dyslipidemia describing bilateral leg pain with limited ambulation. He had noninvasive studies that suggested diminished API in his right lower extremity concerning for severe occlusive disease. As such, he is referred for angiography.
PROCEDURE: Informed consent was obtained; the patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The left groin was prepped and draped in the usual sterile fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. The common femoral artery was accessed using modified Seldinger technique of which a 5-French sheath was placed without complication. A Contra catheter was then placed in the abdominal aorta with aortography and a bilateral iliofemoral angiography was then performed. Next, using a Terumo Glidewire, the Contra was then introduced into the right iliac system and subsequently exchanged for a 4-French glide catheter. This was then placed into the right common femoral artery. Selective injection of the right lower extremity was then done through this catheter. The ipsilateral sheath was then used to perform a left lower extremity runoff. At the conclusion of the procedure, manual compression was used for hemostasis.
FINDINGS: The abdominal aorta had mild calcification; it was ectatic and tortuous with mild aneurysm. The right common iliac system had mild disease, was tortuous in its course entering into the internal iliac which had moderate disease. The external iliac had mild disease; leading into the common femoral artery it had moderate disease. The superficial femoral artery had moderate disease. The deep profunda had mild disease. Popliteal had moderate disease and there was 3-vessel runoff. Attention was then drawn to the left system which the common iliac had a moderate aneurysmal segment seen proximally. The internal iliac had mild disease. The external iliac had mild disease, common femoral had mild disease. The SFA had mild disease. Profunda had mild disease. Popliteal had mild disease with 3-vessel runoff.
SUMMARY: Mild nonobstructive lower extremity disease with mild left common iliac aneurysm, mild abdominal aortic aneurysm.
CLINICAL PATHWAY: We reassured that the patient does not have critical obstructive lower extremity disease. He did have slow flow indicative of his bradycardia. Of note, he is undergoing electrophysiology workup for potential pacemaker placement. We will await expectantly and focus on medical therapy. Alternatively spinal stenosis can present in a similar fashion as far as his symptoms and workup could be considered.
I have 75635
36247
36140
75625 Is this correct Thank you Nancy
PROCEDURE: Access of the aorta with selective placement of catheter, femoral artery with selective catheter placement in the contralateral common femoral artery third order with selective injection and interpretation of bilateral iliofemoral angiogram as well as bilateral lower extremity runoff.
HISTORY OF PRESENT ILLNESS: The patient is an 85-year-old with history of paroxysmal atrial fibrillation, hypertension and dyslipidemia describing bilateral leg pain with limited ambulation. He had noninvasive studies that suggested diminished API in his right lower extremity concerning for severe occlusive disease. As such, he is referred for angiography.
PROCEDURE: Informed consent was obtained; the patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The left groin was prepped and draped in the usual sterile fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. The common femoral artery was accessed using modified Seldinger technique of which a 5-French sheath was placed without complication. A Contra catheter was then placed in the abdominal aorta with aortography and a bilateral iliofemoral angiography was then performed. Next, using a Terumo Glidewire, the Contra was then introduced into the right iliac system and subsequently exchanged for a 4-French glide catheter. This was then placed into the right common femoral artery. Selective injection of the right lower extremity was then done through this catheter. The ipsilateral sheath was then used to perform a left lower extremity runoff. At the conclusion of the procedure, manual compression was used for hemostasis.
FINDINGS: The abdominal aorta had mild calcification; it was ectatic and tortuous with mild aneurysm. The right common iliac system had mild disease, was tortuous in its course entering into the internal iliac which had moderate disease. The external iliac had mild disease; leading into the common femoral artery it had moderate disease. The superficial femoral artery had moderate disease. The deep profunda had mild disease. Popliteal had moderate disease and there was 3-vessel runoff. Attention was then drawn to the left system which the common iliac had a moderate aneurysmal segment seen proximally. The internal iliac had mild disease. The external iliac had mild disease, common femoral had mild disease. The SFA had mild disease. Profunda had mild disease. Popliteal had mild disease with 3-vessel runoff.
SUMMARY: Mild nonobstructive lower extremity disease with mild left common iliac aneurysm, mild abdominal aortic aneurysm.
CLINICAL PATHWAY: We reassured that the patient does not have critical obstructive lower extremity disease. He did have slow flow indicative of his bradycardia. Of note, he is undergoing electrophysiology workup for potential pacemaker placement. We will await expectantly and focus on medical therapy. Alternatively spinal stenosis can present in a similar fashion as far as his symptoms and workup could be considered.
I have 75635
36247
36140
75625 Is this correct Thank you Nancy