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DIAGNOSTIC LOWER EXTREMITY ANGIOGRAM
INDICATIONS: Claudication.
PROCEDURE: Selective placement of catheter right common femoral artery. Selective placement of catheter in the aorta as well as second order left common iliac system with aortoiliofemoral angiogram with bilateral lower extremity runoff.
HISTORY OF PRESENT ILLNESS: The patient is a 71-year-old with a history of hypertension and previous CVA with identified symptoms of claudication with ambulation just over a block or two. He underwent noninvasive studies that demonstrates concern for elevated velocities in the bilateral SFA systems greater than 60% stenosis. With symptoms, 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 groins were prepped in usual sterile fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Right common femoral artery was accessed using modified Seldinger technique of which a 6 French 11 cm sheath was placed without complication. A 5 French Contra catheter was then placed into the aorta of which an aortoiliac angiogram was then performed under digital subtraction. Next, the Contra catheter was then introduced into the left common iliac and subsequently left external iliac system for selective injection and left lower extremity runoff. The Contra was then placed into the right external iliac for selective injection of the right iliofemoral system and then subsequently through the sheath. A right lower extremity runoff was then performed. At the conclusion of the procedure, manual compression was used for hemostasis.
FINDINGS: The aorta had moderate disease without obvious stenosis at the bifurcation. The common iliacs on both the left and the right had mild disease. The external and internal iliacs bilaterally had mild disease and they were tortuous in their course. The common femoral arteries bilaterally had mild disease. The left SFA had moderate adventitial calcification with diffuse 80% stenosis seen in the mid SFA extending down to a sequential 70% stenosis in the mid to distal SFA. The profunda had mild disease. Popliteal artery had mild diffuse disease. There is at least 2-vessel runoff leading to the foot with good flow in the AT and PT. The right SFA had a focal 70% stenosis seen in the mid SFA. The profunda had only mild disease. The popliteal had mild diffuse disease. There is at least 2-vessel runoff with good flow in the AT and DP.
SUMMARY: Bilateral significant SFA stenosis with high-grade sequential 80% stenosis seen in the left SFA with focal 70% stenosis seen in the right SFA.
Based on the patient's angiographic findings that these lesions are amenable to percutaneous revascularization. We will discuss options with the patient to determined risks, benefits and alternatives to percutaneous intervention for these lesions. We thank you for the opportunity to participate in the care of this fine gentleman.
I hope you can help, 1st time coding this Thanks Nancy
claudication - access artery, cath aorta, aorto-ileo fem angio with interpretation, selective 2nd order cath placement, bilateral lower extremity angiogram with interpretation
INDICATIONS: Claudication.
PROCEDURE: Selective placement of catheter right common femoral artery. Selective placement of catheter in the aorta as well as second order left common iliac system with aortoiliofemoral angiogram with bilateral lower extremity runoff.
HISTORY OF PRESENT ILLNESS: The patient is a 71-year-old with a history of hypertension and previous CVA with identified symptoms of claudication with ambulation just over a block or two. He underwent noninvasive studies that demonstrates concern for elevated velocities in the bilateral SFA systems greater than 60% stenosis. With symptoms, 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 groins were prepped in usual sterile fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Right common femoral artery was accessed using modified Seldinger technique of which a 6 French 11 cm sheath was placed without complication. A 5 French Contra catheter was then placed into the aorta of which an aortoiliac angiogram was then performed under digital subtraction. Next, the Contra catheter was then introduced into the left common iliac and subsequently left external iliac system for selective injection and left lower extremity runoff. The Contra was then placed into the right external iliac for selective injection of the right iliofemoral system and then subsequently through the sheath. A right lower extremity runoff was then performed. At the conclusion of the procedure, manual compression was used for hemostasis.
FINDINGS: The aorta had moderate disease without obvious stenosis at the bifurcation. The common iliacs on both the left and the right had mild disease. The external and internal iliacs bilaterally had mild disease and they were tortuous in their course. The common femoral arteries bilaterally had mild disease. The left SFA had moderate adventitial calcification with diffuse 80% stenosis seen in the mid SFA extending down to a sequential 70% stenosis in the mid to distal SFA. The profunda had mild disease. Popliteal artery had mild diffuse disease. There is at least 2-vessel runoff leading to the foot with good flow in the AT and PT. The right SFA had a focal 70% stenosis seen in the mid SFA. The profunda had only mild disease. The popliteal had mild diffuse disease. There is at least 2-vessel runoff with good flow in the AT and DP.
SUMMARY: Bilateral significant SFA stenosis with high-grade sequential 80% stenosis seen in the left SFA with focal 70% stenosis seen in the right SFA.
Based on the patient's angiographic findings that these lesions are amenable to percutaneous revascularization. We will discuss options with the patient to determined risks, benefits and alternatives to percutaneous intervention for these lesions. We thank you for the opportunity to participate in the care of this fine gentleman.
I hope you can help, 1st time coding this Thanks Nancy
claudication - access artery, cath aorta, aorto-ileo fem angio with interpretation, selective 2nd order cath placement, bilateral lower extremity angiogram with interpretation
