Rosanat1991
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Can I get some help coding this procedure.
PROCEDURE PERFORMED:
1. Abdominal aortography at the renals
2. Abdominal aortography with limited run-offs
3. Right lower extremity runoff via left groin access
4. Left lower extremity distal runoffs via left groin access.
4. Catheter positioning in the Right SFA via the left femoral approach (4th order).
5. PTA of right SFA
6. DCB of right SFA
7. Stenting of right distal SFA
8. post dilation of stent in distal SFA
9. Manual hemostasis of left groin
PROCEDURE:
Patient brought to the catrh LAB 3 where she was prepped and draped in the usual fashion. Micropuncture technique was used to insert the 6French sheath in the left femoral artery.
A 5-French pigtail was placed at the level of the abdominal aorta to perform abdominal angiography at the renals using digital subtraction and 24 cc contrast. Then the same catheter is positioned at the distal abdominal aorta using 16 mL of contrast.
Then the pigtail was exchanged to a rim and a glidewire was positioned in the right femoral distribution. At this point we proceeded by performingright lower extremity distal runoffs using serial injections of 5 mL per view in a digital subtraction mode with serial injections.
After PTA and stent, we exchanged to a 6 French short shgeath in LFA, and performed left lower extremity runoff using a bolus chase automated method using 25 cc contrtast.
We sutured the sheath for manual closure at conclusion.
FINDINGS:
1. The abdominal aorta is patent with diffuse calcifications of the mesenterics and aorta without a focal critical lesion. There is diffuse caclfied mild to moderate aortic atheromata.
2. The disatl abdominal aorta is heavily cacified with diffuse atehromata of mild caliber in the bifrucation extenting into the iliacs. The external iliac was patent bilaterally, as was the common iliacs and the internal iliacs. The femoral arteries appeared to have mild luminal irregularities without any focal high-grade stenosis up to the level of the bifurcation. The profunda femoral was patent bilaterally.
3. The right lower extremity runoff. The iliacs are calcifed and diffusel;y disease with mild to moderate calcifed plaquing. The SFA had serial mild to moderate luminal irregularities. The distal SFA has a 90% diffuse calcfiedi plaque noted. The popliteral is patent with mild diffuse calcified plaque and intact trifurcation with at least 1-vessel distal runoff.
4. The left lower extremity showed iliacs are calcifed and diffusely diseased with mild to moderate calcifed plaquing. The SFA had serial mild to moderate luminal irregularities. There was a 70% prxoimal SFA lesion and then a 90% mid SFA calcified plaque noted. The popliteral is patent with mild diffuse calcified plaque and intact trifurcation with at least 1-vessel distal runoff. The AT is occluded with distal reconstitution.
INTERVENTION:
We exchanged to glide cathter from the rim and then used a Wholey wire across the right SFA lesion and then placed a Pinnacle Destination 6 Fr sheath into the right CFA. We used heparin 2000 units, then 2000 more units and the ACT was 191. We then gave 2000 more untis after ACT was 191. We then used a 4.0x20mm Evercross ballloon at 8 ATM and noted poor yielding and increaeed to 12ATM and then serially to 20 ATM when it yielded. Post angio did not show any perforation.
We then used a 5.0x40mm DCB across the lesion and deployed for 160 seconds at 10 ATM. We then used a 6x40mm Everflex self-expanding stent across the lesion and deployed across the leison. We then used a 5x40mm balloon to post dilate at 12 ATM distal x2 and then 12 ATM in teh mid x2 and then 10 and 12 ATM proximally.
We had excellent angiographic results. We used added Plavix to ASA after the procedure.
IMPRESSION:
1. High grade SFA lesion on the right with significant tibial occlusive disease and non-healing ulcer in the right foot
2. Residual disease in left SFA and bilateral tibials
3. s/p PTA and DCB and stenting with self expanding stent of right SFA
PLAN:
1. We will admit for overnight observation given frailty and comorbidities
2. We will continue aggressive medical treatment. Emphasize smoking cessation and to continue medical treatment.
3. DAPT with ASA and Plavix
4. Will plan left SFA intervention in near future.
PROCEDURE PERFORMED:
1. Abdominal aortography at the renals
2. Abdominal aortography with limited run-offs
3. Right lower extremity runoff via left groin access
4. Left lower extremity distal runoffs via left groin access.
4. Catheter positioning in the Right SFA via the left femoral approach (4th order).
5. PTA of right SFA
6. DCB of right SFA
7. Stenting of right distal SFA
8. post dilation of stent in distal SFA
9. Manual hemostasis of left groin
PROCEDURE:
Patient brought to the catrh LAB 3 where she was prepped and draped in the usual fashion. Micropuncture technique was used to insert the 6French sheath in the left femoral artery.
A 5-French pigtail was placed at the level of the abdominal aorta to perform abdominal angiography at the renals using digital subtraction and 24 cc contrast. Then the same catheter is positioned at the distal abdominal aorta using 16 mL of contrast.
Then the pigtail was exchanged to a rim and a glidewire was positioned in the right femoral distribution. At this point we proceeded by performingright lower extremity distal runoffs using serial injections of 5 mL per view in a digital subtraction mode with serial injections.
After PTA and stent, we exchanged to a 6 French short shgeath in LFA, and performed left lower extremity runoff using a bolus chase automated method using 25 cc contrtast.
We sutured the sheath for manual closure at conclusion.
FINDINGS:
1. The abdominal aorta is patent with diffuse calcifications of the mesenterics and aorta without a focal critical lesion. There is diffuse caclfied mild to moderate aortic atheromata.
2. The disatl abdominal aorta is heavily cacified with diffuse atehromata of mild caliber in the bifrucation extenting into the iliacs. The external iliac was patent bilaterally, as was the common iliacs and the internal iliacs. The femoral arteries appeared to have mild luminal irregularities without any focal high-grade stenosis up to the level of the bifurcation. The profunda femoral was patent bilaterally.
3. The right lower extremity runoff. The iliacs are calcifed and diffusel;y disease with mild to moderate calcifed plaquing. The SFA had serial mild to moderate luminal irregularities. The distal SFA has a 90% diffuse calcfiedi plaque noted. The popliteral is patent with mild diffuse calcified plaque and intact trifurcation with at least 1-vessel distal runoff.
4. The left lower extremity showed iliacs are calcifed and diffusely diseased with mild to moderate calcifed plaquing. The SFA had serial mild to moderate luminal irregularities. There was a 70% prxoimal SFA lesion and then a 90% mid SFA calcified plaque noted. The popliteral is patent with mild diffuse calcified plaque and intact trifurcation with at least 1-vessel distal runoff. The AT is occluded with distal reconstitution.
INTERVENTION:
We exchanged to glide cathter from the rim and then used a Wholey wire across the right SFA lesion and then placed a Pinnacle Destination 6 Fr sheath into the right CFA. We used heparin 2000 units, then 2000 more units and the ACT was 191. We then gave 2000 more untis after ACT was 191. We then used a 4.0x20mm Evercross ballloon at 8 ATM and noted poor yielding and increaeed to 12ATM and then serially to 20 ATM when it yielded. Post angio did not show any perforation.
We then used a 5.0x40mm DCB across the lesion and deployed for 160 seconds at 10 ATM. We then used a 6x40mm Everflex self-expanding stent across the lesion and deployed across the leison. We then used a 5x40mm balloon to post dilate at 12 ATM distal x2 and then 12 ATM in teh mid x2 and then 10 and 12 ATM proximally.
We had excellent angiographic results. We used added Plavix to ASA after the procedure.
IMPRESSION:
1. High grade SFA lesion on the right with significant tibial occlusive disease and non-healing ulcer in the right foot
2. Residual disease in left SFA and bilateral tibials
3. s/p PTA and DCB and stenting with self expanding stent of right SFA
PLAN:
1. We will admit for overnight observation given frailty and comorbidities
2. We will continue aggressive medical treatment. Emphasize smoking cessation and to continue medical treatment.
3. DAPT with ASA and Plavix
4. Will plan left SFA intervention in near future.