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Peripheral renal angiogram and angioplasty report
INDICATIONS: Secondary renovascular hypertension, uncontrolled.
HISTORY OF PRESENT ILLNESS: The patient is a 77-year-old with history of severe coronary disease, diabetes, hypertension, peripheral artery disease, previous CABG, AVR, previous renal artery stenosis with the renal artery stent on the left as well as
uncontrolled hypertension. He has been managed in concert with Dr. with challenges in obtaining effective blood pressure control. He has been maximized on multiple agents, exceeding 6 agents as well as a diuretic. He underwent renal
ultrasonography that raised concern of bilateral renal artery stenosis. In light of these findings and clinical suspicion, he is referred for angiography with possible angioplasty.
PROCEDURE: Informed consent was obtained, the patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The right femoral artery was accessed with the use of modified Seldinger technique and a 6
French sheath was placed without complication. A 5 French IMA diagnostic catheter were used for selective bilateral renal angiography. At the conclusion of the procedure, an Angio-Seal device was deployed without complication for effective hemostasis.
HEMODYNAMICS: Right renal artery was selectively engaged and injected that revealed a 20% ostial stenosis but otherwise was patent with good filling of the arcades and appropriate kidney size. Selective engagement of the left renal artery within the
previously stented segment demonstrated catheter dampening and an 80% ostial restenotic lesion. The distal arcades completely filled and the kidney was otherwise normal sinus.
SUMMARY: Critical restenosis of the left renal artery complicating renovascular hypertension.
In light of the angiographic findings, it was elected to proceed with balloon angioplasty of the focal restenotic lesion at the ostium of the left renal artery.
INTERVENTION: Angiomax was used for effective anticoagulation and a 6 French IMA guide catheter with side-holes was used to intubate the left renal artery. A Runthrough wire was placed distally and a 3.5 x 6.0 cutting balloon was deployed in multiple
episodes upwards of 12 atmospheres. There was an excellent angiographic result with only 20-30% residual restenosis, TIMI-III flow, no evidence of dissection.
SUMMARY: Successful balloon angioplasty of focal restenosis in the left renal artery.
CLINICAL PATHWAY: We will reload him on Plavix and maintain his antihypertensive regimen. He was bradycardic during the procedure, otherwise stable. We will maintain his clonidine patch at 0.3 as well as maintain his calcium antagonist and reinstitute
diuretics. He received hydration prior to the procedure with half normal saline with hopes of preservation of his renal function and reduce the chances of contrast nephropathy as his baseline creatinine was moderately elevated. Less than 25 mL of
contrast were used for the entire procedure.
I have
36252-26-59
35471
75966-26
36140
I hope these are correct? Thank you Nancy
INDICATIONS: Secondary renovascular hypertension, uncontrolled.
HISTORY OF PRESENT ILLNESS: The patient is a 77-year-old with history of severe coronary disease, diabetes, hypertension, peripheral artery disease, previous CABG, AVR, previous renal artery stenosis with the renal artery stent on the left as well as
uncontrolled hypertension. He has been managed in concert with Dr. with challenges in obtaining effective blood pressure control. He has been maximized on multiple agents, exceeding 6 agents as well as a diuretic. He underwent renal
ultrasonography that raised concern of bilateral renal artery stenosis. In light of these findings and clinical suspicion, he is referred for angiography with possible angioplasty.
PROCEDURE: Informed consent was obtained, the patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The right femoral artery was accessed with the use of modified Seldinger technique and a 6
French sheath was placed without complication. A 5 French IMA diagnostic catheter were used for selective bilateral renal angiography. At the conclusion of the procedure, an Angio-Seal device was deployed without complication for effective hemostasis.
HEMODYNAMICS: Right renal artery was selectively engaged and injected that revealed a 20% ostial stenosis but otherwise was patent with good filling of the arcades and appropriate kidney size. Selective engagement of the left renal artery within the
previously stented segment demonstrated catheter dampening and an 80% ostial restenotic lesion. The distal arcades completely filled and the kidney was otherwise normal sinus.
SUMMARY: Critical restenosis of the left renal artery complicating renovascular hypertension.
In light of the angiographic findings, it was elected to proceed with balloon angioplasty of the focal restenotic lesion at the ostium of the left renal artery.
INTERVENTION: Angiomax was used for effective anticoagulation and a 6 French IMA guide catheter with side-holes was used to intubate the left renal artery. A Runthrough wire was placed distally and a 3.5 x 6.0 cutting balloon was deployed in multiple
episodes upwards of 12 atmospheres. There was an excellent angiographic result with only 20-30% residual restenosis, TIMI-III flow, no evidence of dissection.
SUMMARY: Successful balloon angioplasty of focal restenosis in the left renal artery.
CLINICAL PATHWAY: We will reload him on Plavix and maintain his antihypertensive regimen. He was bradycardic during the procedure, otherwise stable. We will maintain his clonidine patch at 0.3 as well as maintain his calcium antagonist and reinstitute
diuretics. He received hydration prior to the procedure with half normal saline with hopes of preservation of his renal function and reduce the chances of contrast nephropathy as his baseline creatinine was moderately elevated. Less than 25 mL of
contrast were used for the entire procedure.
I have
36252-26-59
35471
75966-26
36140
I hope these are correct? Thank you Nancy