bhargavi
Guru
Conclusion
70 year-old female with severe peripheral vascular disease has ongoing nonhealing ulcers in bilateral lower extremities worse on the left than the right. She was known to have severe vascular disease status post stenting to the right superficial femoral artery. Recent CT angiogram showed occlusion of the area of stenting. She was brought in for right common femoral artery. Extremity angiogram and possible intervention. 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 12:08 PM and monitoring period Ended 1:17 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 5 French sheath was inserted in the left femoral artery. A 5 French rim catheter was used to cross over from right to left over a zip wire and was advanced into the mid left superficial femoral artery for selective left lower extremity angiogram. Ultimately the 5 French system was removed over a Magic torque wire and exchanged for a 6 French destination sheath that was advanced all the way into the mid right common femoral artery
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Findings:
1 complete occlusion of the entire length of the stented portion of the right superficial femoral artery. The popliteal artery is patent and there is three-vessel distal runoff
2. The left superficial femoral artery is patent with diffuse moderate disease. The left popliteal is patent. There is three-vessel distal runoff
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Over the Rubicon catheter, a zip wire was able to cross the occlusion all the way into the popliteal artery. The Rubicon catheter was then advanced, there is a prior was removed and exchanged for a V 18 wire. The whole length of the stented portion as well as short segment distal to that was treated with a 5 mm balloon with excellent result and no residual stenosis and significant improvement in flow
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Final impression
Complete occlusion of the entire length of the stented portion of the right superficial femoral artery successfully treated with balloon angioplasty alone
Of note I did an angiogram of the left subclavian artery due to a significant pressure gradient. The left subclavian artery is occluded beyond the origin of the left internal mammary artery
i am thinking of 75710-lt, 37224-lt but confused about lft subclavian angio he mentioned 36225?
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70 year-old female with severe peripheral vascular disease has ongoing nonhealing ulcers in bilateral lower extremities worse on the left than the right. She was known to have severe vascular disease status post stenting to the right superficial femoral artery. Recent CT angiogram showed occlusion of the area of stenting. She was brought in for right common femoral artery. Extremity angiogram and possible intervention. 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 12:08 PM and monitoring period Ended 1:17 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 5 French sheath was inserted in the left femoral artery. A 5 French rim catheter was used to cross over from right to left over a zip wire and was advanced into the mid left superficial femoral artery for selective left lower extremity angiogram. Ultimately the 5 French system was removed over a Magic torque wire and exchanged for a 6 French destination sheath that was advanced all the way into the mid right common femoral artery
*
Findings:
1 complete occlusion of the entire length of the stented portion of the right superficial femoral artery. The popliteal artery is patent and there is three-vessel distal runoff
2. The left superficial femoral artery is patent with diffuse moderate disease. The left popliteal is patent. There is three-vessel distal runoff
*
Over the Rubicon catheter, a zip wire was able to cross the occlusion all the way into the popliteal artery. The Rubicon catheter was then advanced, there is a prior was removed and exchanged for a V 18 wire. The whole length of the stented portion as well as short segment distal to that was treated with a 5 mm balloon with excellent result and no residual stenosis and significant improvement in flow
*
Final impression
Complete occlusion of the entire length of the stented portion of the right superficial femoral artery successfully treated with balloon angioplasty alone
Of note I did an angiogram of the left subclavian artery due to a significant pressure gradient. The left subclavian artery is occluded beyond the origin of the left internal mammary artery
i am thinking of 75710-lt, 37224-lt but confused about lft subclavian angio he mentioned 36225?
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