TWilliam2019
Guru
Procedure list in detail:
Ultrasound guided right common femoral artery access
Arch aortogram
Left carotid artery catheterization and arteriogram
Left internal to common carotid artery stent placement with a 7 mm x 50 mm Viabahn stent over a 6 mm spider filter
Completion carotid arteriogram
Left cerebral arteriogram
?37215
?36222
Procedure Details:
After consent was obtained the patient was taken to the operative suite and laid in the supine position. General anesthesia was induced and endotracheal tube placed. The left neck and upper chest were prepped and draped in usual sterile fashion along with bilateral groins. A proper timeout was performed and agreed upon by all parties present. Antibiotics were addressed. The ultrasound was used to gain access to the right common femoral artery. Ultrasound-guided puncture was performed of the right common femoral artery using a micropuncture technique. Duplex was used to survey the site for vessel selection and puncture was performed under real-time ultrasound imaging. Imaging was documented of the guidance and placed in the patient's record. A 5 French sheath was placed and flushed with heparinized saline. Systemic heparin was given and allowed to circulate. The universal flush catheter was guided over a Glidewire into the arch of the aorta and an arch aortogram was performed in the LAO position. The aortic arch is patent. The innominate artery right subclavian, and right proximal common carotid artery are patent. The left common carotid artery origin has heavy calcifications within the arch that appears patent. The left subclavian artery proximally appears patent. The universal flush catheter was removed and the 5 French sheath was exchanged for a 7 French by 90 cm sheath and flushed with heparinized saline. A Glidewire and VTK catheter were used to gain access to the proximal common left common carotid artery and catheter was advanced into the proximal common carotid artery. A selected left carotid arteriogram was performed which showed patency of the proximal common carotid artery and carotid bulb. The external common carotid and internal carotid artery are patent without stenosis. There are 2 pseudoaneurysms identified in the area of the carotid bulb. The wire was exchanged for an Amplatz wire which was guided into the proximal common carotid artery and the sheath was advanced into the proximal common carotid artery. A 6 mm spider filter was then guided over a 014 victory wire and deployed in good position in the distal internal carotid artery. A 7 mm x 50 mm Viabahn stent was then guided over the spider filter wire and deployed from the internal carotid artery to the common carotid artery excluding both pseudoaneurysms successfully. This was confirmed on final carotid artery arteriogram. I then performed a left cerebral arteriogram which showed patency of the left intracranial internal carotid artery, patent anterior cerebral, middle cerebral and posterior cerebral arteries without filling defect. The spider filter was recaptured and removed. The sheath was pulled back into the right external iliac artery and arteriogram at this location showed no access site complications. The sheath was exchanged for a 7 French by 10 cm sheath and flushed with heparinized saline. The access site was closed with a 7 French XO seal and direct pressure held until hemostasis is achieved. The patient tolerated the procedure well was awakened from general anesthesia neurologically stable from preoperative exam.
Ultrasound guided right common femoral artery access
Arch aortogram
Left carotid artery catheterization and arteriogram
Left internal to common carotid artery stent placement with a 7 mm x 50 mm Viabahn stent over a 6 mm spider filter
Completion carotid arteriogram
Left cerebral arteriogram
?37215
?36222
Procedure Details:
After consent was obtained the patient was taken to the operative suite and laid in the supine position. General anesthesia was induced and endotracheal tube placed. The left neck and upper chest were prepped and draped in usual sterile fashion along with bilateral groins. A proper timeout was performed and agreed upon by all parties present. Antibiotics were addressed. The ultrasound was used to gain access to the right common femoral artery. Ultrasound-guided puncture was performed of the right common femoral artery using a micropuncture technique. Duplex was used to survey the site for vessel selection and puncture was performed under real-time ultrasound imaging. Imaging was documented of the guidance and placed in the patient's record. A 5 French sheath was placed and flushed with heparinized saline. Systemic heparin was given and allowed to circulate. The universal flush catheter was guided over a Glidewire into the arch of the aorta and an arch aortogram was performed in the LAO position. The aortic arch is patent. The innominate artery right subclavian, and right proximal common carotid artery are patent. The left common carotid artery origin has heavy calcifications within the arch that appears patent. The left subclavian artery proximally appears patent. The universal flush catheter was removed and the 5 French sheath was exchanged for a 7 French by 90 cm sheath and flushed with heparinized saline. A Glidewire and VTK catheter were used to gain access to the proximal common left common carotid artery and catheter was advanced into the proximal common carotid artery. A selected left carotid arteriogram was performed which showed patency of the proximal common carotid artery and carotid bulb. The external common carotid and internal carotid artery are patent without stenosis. There are 2 pseudoaneurysms identified in the area of the carotid bulb. The wire was exchanged for an Amplatz wire which was guided into the proximal common carotid artery and the sheath was advanced into the proximal common carotid artery. A 6 mm spider filter was then guided over a 014 victory wire and deployed in good position in the distal internal carotid artery. A 7 mm x 50 mm Viabahn stent was then guided over the spider filter wire and deployed from the internal carotid artery to the common carotid artery excluding both pseudoaneurysms successfully. This was confirmed on final carotid artery arteriogram. I then performed a left cerebral arteriogram which showed patency of the left intracranial internal carotid artery, patent anterior cerebral, middle cerebral and posterior cerebral arteries without filling defect. The spider filter was recaptured and removed. The sheath was pulled back into the right external iliac artery and arteriogram at this location showed no access site complications. The sheath was exchanged for a 7 French by 10 cm sheath and flushed with heparinized saline. The access site was closed with a 7 French XO seal and direct pressure held until hemostasis is achieved. The patient tolerated the procedure well was awakened from general anesthesia neurologically stable from preoperative exam.