bhargavi
Guru
Indications
Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs (CMS-HCC) [I70.213 (ICD-10-CM)]
Conclusion
51-year-old male presenting with severe left lower extremity claudication and finding on CT angiogram of distal aortic as well as left common iliac disease was referred for angiogram. Procedure, risks, benefits, alternative options were explained. Risks including bleeding, infection, cerebrovascular accident, myocardial infarction, death, and arrhythmia were all explained patient was agreeable. He was brought into the cardiac cath lab where conscious sedation (moderate sedation) was performed by myself using Versed and fentanyl. Conscious sedation was started 1:21 PM and monitoring period Ended 2:35 PM. I was present throughout this whole entire period With the patient. Both groins were prepped and draped in the usual fashion. 2% lidocaine was used to anesthesize the skin. Using modified Seldinger technique, a 5R and exchanged for a 7 French sheath was inserted in the bilateral femoral artery. A 5 French pigtail was used to perform abdominal aortogram
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finding:
1: Dominant aortogram showed patent bilateral renal arteries as well as infrarenal abdominal aorta. The distal aorta has a 50% eccentric lesion. There is severe stenosis in the origin of the left common iliac artery and mild to moderate stenosis in the origin of the right common iliac artery.
2: Bilateral internal iliac arteries, external iliac arteries and common femoral arteries are normal
*
Intervention:
Over a Magic torque wire, I was able to cross bilaterally to the proximal aorta. Given the presence of disease in the distal aorta and the involvement of the ostia of both iliac arteries even though more severe on the left than the right, I decided to proceed ahead with a kissing technique. In a kissing fashion, the distal aorta and the proximal common iliac arteries were treated with an 8 x 40 mm balloon followed by the insertion of 9 x 37 mm balloon expandable stents with excellent results and no residual stenosis
*
Impression: Distal aortic as well as common iliac artery disease bilaterally successfully treated with kissing stents from the distal aorta into the proximal common iliac artery with a 9 x 37 mm balloon expandable stent
*
Plan: Continue medical treatment. Start the patient on dual antiplatelet therapy. Smoking cessation strongly advised
thanks in advance
I am coming up with 37236
Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs (CMS-HCC) [I70.213 (ICD-10-CM)]
Conclusion
51-year-old male presenting with severe left lower extremity claudication and finding on CT angiogram of distal aortic as well as left common iliac disease was referred for angiogram. Procedure, risks, benefits, alternative options were explained. Risks including bleeding, infection, cerebrovascular accident, myocardial infarction, death, and arrhythmia were all explained patient was agreeable. He was brought into the cardiac cath lab where conscious sedation (moderate sedation) was performed by myself using Versed and fentanyl. Conscious sedation was started 1:21 PM and monitoring period Ended 2:35 PM. I was present throughout this whole entire period With the patient. Both groins were prepped and draped in the usual fashion. 2% lidocaine was used to anesthesize the skin. Using modified Seldinger technique, a 5R and exchanged for a 7 French sheath was inserted in the bilateral femoral artery. A 5 French pigtail was used to perform abdominal aortogram
*
finding:
1: Dominant aortogram showed patent bilateral renal arteries as well as infrarenal abdominal aorta. The distal aorta has a 50% eccentric lesion. There is severe stenosis in the origin of the left common iliac artery and mild to moderate stenosis in the origin of the right common iliac artery.
2: Bilateral internal iliac arteries, external iliac arteries and common femoral arteries are normal
*
Intervention:
Over a Magic torque wire, I was able to cross bilaterally to the proximal aorta. Given the presence of disease in the distal aorta and the involvement of the ostia of both iliac arteries even though more severe on the left than the right, I decided to proceed ahead with a kissing technique. In a kissing fashion, the distal aorta and the proximal common iliac arteries were treated with an 8 x 40 mm balloon followed by the insertion of 9 x 37 mm balloon expandable stents with excellent results and no residual stenosis
*
Impression: Distal aortic as well as common iliac artery disease bilaterally successfully treated with kissing stents from the distal aorta into the proximal common iliac artery with a 9 x 37 mm balloon expandable stent
*
Plan: Continue medical treatment. Start the patient on dual antiplatelet therapy. Smoking cessation strongly advised
thanks in advance
I am coming up with 37236