kmuerth
Networker
Can someone please guide me through this. I think the documentation is pretty bad :/ so I'm not sure what to capture.
INDICATION FOR PROCEDURE: Claudication, abnormal duplex ultrasound.
INDICATION FOR PROCEDURE: Claudication.
PROCEDURES PERFORMED: Abdominal aortic angiography.Selective angiography of the right common femoral artery with runoff to the right lower extremity. Selective angiography of the left common femoral artery with runoff to the left lower extremity. Mechanical atherectomy of the proximal and mid right superficial femoral artery. PTA of the proximal and mid right superficial femoral artery. PTA of the proximal left common iliac artery, stenting of the proximal left common iliac artery.
PROCEDURE: Informed consent was obtained from the patient. The patient was prepped and draped in the usual fashion. 1% lidocaine solution was injected in the left groin for local anesthesia. IV sedation was performed using Versed and fentanyl. A 6-French 10 cm sheath was inserted into the body of the left common femoral artery using the modified Seldinger technique without complications. Abdominal aortic angiography was performed using a 6-French straight pigtail catheter. Selective angiography of the right common femoral artery was performed using a 7-French 45 cm sheath. Selective angiography of the left common femoral artery with runoff to the left lower extremity was performed using a 7-french 45 cm sheath.The results were as follows.
HEMODYNAMICS: The aortic opening pressure was 158/50 with a mean pressure of 96. The right femoral artery opening pressure was 147/58 with a mean pressure of 91. The right femoral artery closing pressure was 182/74 with a mean pressure of 115.
PERIPHERAL ANATOMY: The abdominal aorta was a medium caliber vessel with moderate distal ectasia. It appeared to be normal in caliber. The right
renal artery was a medium caliber vessel that appeared to be widely patent.
The left renal artery was a medium caliber vessel that appeared to be widely patent. The left common iliac artery was a medium caliber with 80% ulcerative proximal stenosis. The left internal iliac artery was a small caliber vessel with 90% proximal stenosis. The left external iliac artery was a medium caliber vessel with 20-30% proximal stenosis. The left common femoral artery was a medium caliber vessel that appeared to be widely patent. The left profunda femoris artery was a medium caliber vessel that appeared to be widely patent. The left superficial femoral artery was a small to medium caliber vessel that was totally occluded in a short segment in the mid vessel with reconstitution within the mid vessel via collateral circulation from both the superficial femoral artery and the profunda femoris artery. The distal left superficial femoral artery was a medium caliber vessel that appeared to be patent. The left popliteal artery was a medium caliber vessel that was widely patent. There was excellent three vessel runoff to the left lower extremity with widely patent anterior tibial, tibioperoneal and posterior tibial arteries. The right common iliac artery was a medium caliber vessel with mild luminal irregularities. The right internal iliac artery was a medium caliber vessel with mild luminal irregularities. The right external iliac artery was a
medium caliber vessel with 20-30% proximal stenosis. The right common
femoral artery was a medium caliber vessel that was widely patent. The
right profunda femoris artery was a small to medium caliber vessel that was
widely patent. The right superficial femoral artery was a medium caliber
vessel with 80% proximal stenosis and subtotal occlusion of the mid vessel
with collaterals supplying the mid vessel from the profunda femoris artery.
The distal right superficial femoral artery was a medium caliber vessel
that was widely patent. The right popliteal artery was a medium caliber
that was widely patent. There appeared to be excellent three vessel runoff
to the right lower extremity with widely patent anterior tibial,
tibioperoneal, peroneal and posterior tibial arteries. After reviewing the
diagnostic images, the decision was made to proceed with peripheral
intervention. The patient was anticoagulated with IV heparin. A 7-French
45 cm sheath was crossed over to the right common femoral artery using a
6-French IM catheter and a 260 cm J-wire. A 0.014 Thruway guidewire was
inserted into the right popliteal artery. The patient underwent successful
mechanical atherectomy of the proximal and mid right superficial femoral
artery using a 2.1/3.0 mm Jetstream atherectomy catheter with passes
performed using the closed blade at 2.1 mm in the proximal right
superficial femoral artery and the mid right superficial femoral artery and
using the open blade at 3.0 mm with multiple passes performed in the
proximal vessel. Subsequent to this, the patient underwent balloon
dilatation of the proximal right superficial femoral artery using a 5.0 x
40 mm Sterling balloon at a maximum of 12 atmospheres and the mid right
superficial femoral artery using the same 5.0 x 40 mm Sterling balloon at a
maximum of 8 atmospheres. This resulted in the proximal lesion being
reduced from 80% to 10% residual stenosis and the mid vessel being reduced
from 100% to 10% residual stenosis with TIMI-3 flow in both segments.
There also remained excellent three vessel runoff to the right lower
extremity following the intervention. Subsequent to this, the 7-French
sheath was pulled back to the left common iliac artery. The patient
underwent successful PTA of the proximal left common iliac artery followed
by stenting using an 8.0 x 37 mm Express balloon expandable stent at 8
atmospheres. This resulted in a reduction from 80% to less than 10%
residual stenosis with TIMI-3 flow and no complications.
Following this, the 7-French sheath was exchanged out for a 7-French 10 cm
sheath.
INDICATION FOR PROCEDURE: Claudication, abnormal duplex ultrasound.
INDICATION FOR PROCEDURE: Claudication.
PROCEDURES PERFORMED: Abdominal aortic angiography.Selective angiography of the right common femoral artery with runoff to the right lower extremity. Selective angiography of the left common femoral artery with runoff to the left lower extremity. Mechanical atherectomy of the proximal and mid right superficial femoral artery. PTA of the proximal and mid right superficial femoral artery. PTA of the proximal left common iliac artery, stenting of the proximal left common iliac artery.
PROCEDURE: Informed consent was obtained from the patient. The patient was prepped and draped in the usual fashion. 1% lidocaine solution was injected in the left groin for local anesthesia. IV sedation was performed using Versed and fentanyl. A 6-French 10 cm sheath was inserted into the body of the left common femoral artery using the modified Seldinger technique without complications. Abdominal aortic angiography was performed using a 6-French straight pigtail catheter. Selective angiography of the right common femoral artery was performed using a 7-French 45 cm sheath. Selective angiography of the left common femoral artery with runoff to the left lower extremity was performed using a 7-french 45 cm sheath.The results were as follows.
HEMODYNAMICS: The aortic opening pressure was 158/50 with a mean pressure of 96. The right femoral artery opening pressure was 147/58 with a mean pressure of 91. The right femoral artery closing pressure was 182/74 with a mean pressure of 115.
PERIPHERAL ANATOMY: The abdominal aorta was a medium caliber vessel with moderate distal ectasia. It appeared to be normal in caliber. The right
renal artery was a medium caliber vessel that appeared to be widely patent.
The left renal artery was a medium caliber vessel that appeared to be widely patent. The left common iliac artery was a medium caliber with 80% ulcerative proximal stenosis. The left internal iliac artery was a small caliber vessel with 90% proximal stenosis. The left external iliac artery was a medium caliber vessel with 20-30% proximal stenosis. The left common femoral artery was a medium caliber vessel that appeared to be widely patent. The left profunda femoris artery was a medium caliber vessel that appeared to be widely patent. The left superficial femoral artery was a small to medium caliber vessel that was totally occluded in a short segment in the mid vessel with reconstitution within the mid vessel via collateral circulation from both the superficial femoral artery and the profunda femoris artery. The distal left superficial femoral artery was a medium caliber vessel that appeared to be patent. The left popliteal artery was a medium caliber vessel that was widely patent. There was excellent three vessel runoff to the left lower extremity with widely patent anterior tibial, tibioperoneal and posterior tibial arteries. The right common iliac artery was a medium caliber vessel with mild luminal irregularities. The right internal iliac artery was a medium caliber vessel with mild luminal irregularities. The right external iliac artery was a
medium caliber vessel with 20-30% proximal stenosis. The right common
femoral artery was a medium caliber vessel that was widely patent. The
right profunda femoris artery was a small to medium caliber vessel that was
widely patent. The right superficial femoral artery was a medium caliber
vessel with 80% proximal stenosis and subtotal occlusion of the mid vessel
with collaterals supplying the mid vessel from the profunda femoris artery.
The distal right superficial femoral artery was a medium caliber vessel
that was widely patent. The right popliteal artery was a medium caliber
that was widely patent. There appeared to be excellent three vessel runoff
to the right lower extremity with widely patent anterior tibial,
tibioperoneal, peroneal and posterior tibial arteries. After reviewing the
diagnostic images, the decision was made to proceed with peripheral
intervention. The patient was anticoagulated with IV heparin. A 7-French
45 cm sheath was crossed over to the right common femoral artery using a
6-French IM catheter and a 260 cm J-wire. A 0.014 Thruway guidewire was
inserted into the right popliteal artery. The patient underwent successful
mechanical atherectomy of the proximal and mid right superficial femoral
artery using a 2.1/3.0 mm Jetstream atherectomy catheter with passes
performed using the closed blade at 2.1 mm in the proximal right
superficial femoral artery and the mid right superficial femoral artery and
using the open blade at 3.0 mm with multiple passes performed in the
proximal vessel. Subsequent to this, the patient underwent balloon
dilatation of the proximal right superficial femoral artery using a 5.0 x
40 mm Sterling balloon at a maximum of 12 atmospheres and the mid right
superficial femoral artery using the same 5.0 x 40 mm Sterling balloon at a
maximum of 8 atmospheres. This resulted in the proximal lesion being
reduced from 80% to 10% residual stenosis and the mid vessel being reduced
from 100% to 10% residual stenosis with TIMI-3 flow in both segments.
There also remained excellent three vessel runoff to the right lower
extremity following the intervention. Subsequent to this, the 7-French
sheath was pulled back to the left common iliac artery. The patient
underwent successful PTA of the proximal left common iliac artery followed
by stenting using an 8.0 x 37 mm Express balloon expandable stent at 8
atmospheres. This resulted in a reduction from 80% to less than 10%
residual stenosis with TIMI-3 flow and no complications.
Following this, the 7-French sheath was exchanged out for a 7-French 10 cm
sheath.
