reneedanielle22
Networker
1. Radiological guidance and interpretation.
2. Ultrasound-guided access of the right common femoral artery.
3. Aortogram with third order subselect of the mesenteric vessels.
4. Successful coil embolization of a left gastric aneurysm
Procedure:
Consent for aortogram with mesenteric subselect as well as coiling of aneurysm is obtained from the patient and/or family members. Advised of risks
regarding infection, bleeding, vascular injury and recurrence/rupture of aneurysm versus benefit of diagnosis and coil embolization of the aneurysm. The patient is placed supine on the angiographic
table. Sterile gloves, gowns, drapes, chlorhexidine prep along with hat mask were used throughout
the procedure.
Utilizing sterile technique and ultrasound guidance, the right common femoral artery was accessed with
a micropuncture needle following approximately 10 cc of 2% lidocaine. Ultrasound is initially used to
confirm the patency of the common femoral artery. Utilizing microwire exchange, 5 French
micropuncture dilator was inserted. Next, utilizing J-wire exchange and serial dilatation, a 6 short vascular sheath is advanced. With the help of a Glidewire, a Simmons 1 catheter is advanced into the aorta where a flush aortogram is obtained.
Aortogram:
An aortogram was performed. Findings: The celiac axis and superior mesenteric artery as well as bilateral renal arteries are identified. The celiac axis extends off of a left anterior oblique orientation with heavy calcifications near the origin.
Next, with the help of a 4 French Simmons 1 catheter, a Glidewire was used to subselect the celiac axis. Next, utilizing a 2.4 merit microcatheter with the help of a true form wire, the left gastric artery is subselected with the microcatheter advanced into the right gastric artery and right hepatic artery. Subselective angiography was performed and the 9 mm
aneurysm is localized.
At this point, coiling of the aneurysm is initiated. Two 6 x 10 mm interlock coils are advanced and deployed in the aneurysm. There is still a small amount of filling within the aneurysm noted. At this point, 3 additional 6 x 10 mm appreciable coils are advanced and deployed within the aneurysm. The last demonstrates somewhat of a tight fit at which point a repeat angiogram is obtained which demonstrates paucity of filling of the aneurysm however there is still some filling noted in the distal branches.
At this point, decision is made to terminate the procedure. All catheter and sheaths are withdrawn. A 6 French Celt device is deployed under ultrasound guidance. Adequate hemostasis is achieved. No immediate complication is noted
37242, 36247, 36245,59, 36246,59, 75726, 75774, 76937 ?
2. Ultrasound-guided access of the right common femoral artery.
3. Aortogram with third order subselect of the mesenteric vessels.
4. Successful coil embolization of a left gastric aneurysm
Procedure:
Consent for aortogram with mesenteric subselect as well as coiling of aneurysm is obtained from the patient and/or family members. Advised of risks
regarding infection, bleeding, vascular injury and recurrence/rupture of aneurysm versus benefit of diagnosis and coil embolization of the aneurysm. The patient is placed supine on the angiographic
table. Sterile gloves, gowns, drapes, chlorhexidine prep along with hat mask were used throughout
the procedure.
Utilizing sterile technique and ultrasound guidance, the right common femoral artery was accessed with
a micropuncture needle following approximately 10 cc of 2% lidocaine. Ultrasound is initially used to
confirm the patency of the common femoral artery. Utilizing microwire exchange, 5 French
micropuncture dilator was inserted. Next, utilizing J-wire exchange and serial dilatation, a 6 short vascular sheath is advanced. With the help of a Glidewire, a Simmons 1 catheter is advanced into the aorta where a flush aortogram is obtained.
Aortogram:
An aortogram was performed. Findings: The celiac axis and superior mesenteric artery as well as bilateral renal arteries are identified. The celiac axis extends off of a left anterior oblique orientation with heavy calcifications near the origin.
Next, with the help of a 4 French Simmons 1 catheter, a Glidewire was used to subselect the celiac axis. Next, utilizing a 2.4 merit microcatheter with the help of a true form wire, the left gastric artery is subselected with the microcatheter advanced into the right gastric artery and right hepatic artery. Subselective angiography was performed and the 9 mm
aneurysm is localized.
At this point, coiling of the aneurysm is initiated. Two 6 x 10 mm interlock coils are advanced and deployed in the aneurysm. There is still a small amount of filling within the aneurysm noted. At this point, 3 additional 6 x 10 mm appreciable coils are advanced and deployed within the aneurysm. The last demonstrates somewhat of a tight fit at which point a repeat angiogram is obtained which demonstrates paucity of filling of the aneurysm however there is still some filling noted in the distal branches.
At this point, decision is made to terminate the procedure. All catheter and sheaths are withdrawn. A 6 French Celt device is deployed under ultrasound guidance. Adequate hemostasis is achieved. No immediate complication is noted
37242, 36247, 36245,59, 36246,59, 75726, 75774, 76937 ?