bhargavi
Guru
After obtaining informed consent for the patient a 5 French sheath was placed under fluoroscopic guidance into the left common femoral artery and aortoiliac digital subtraction angiogram was performed. After identification of the significant disease in the proximal nonostial left common iliac and the distal right common iliac and proximal and mid right external iliac, detailed DSA was performed of the right common femoral, although calcified with some eccentric plaque this was nonflow limiting. Therefore under direct visualization the right common femoral artery was entered and a 6 French sheath was placed. This was a 6 French by 24 cm and the original 5 French sheath and contra catheter on the left were replaced with a 6 French by 24 cm sheath. Initially balloon angioplasty was performed of the right external and distal common iliac stenosis with a 5 mm balloon, a single short Boston Scientific balloon expandable stent 6 mm x 17 mm was deployed in the mid right external iliac to high pressure excellent angiographic result with resolution of gradient a larger longer 7 x 27 mm stent was then deployed extending from the distal right common iliac across the internal iliac origin into the proximal right external iliac. This was postdilated ultimately with an 8 mm balloon. Thereafter kissing balloon angioplasty was performed of the common iliac proximal stenoses and region with a 6 mm balloon followed by placement of two 7 mm stents initially, on the left a Boston Scientific Express LD 7 x 57 mm stent, and on the right a 7 x 27 mm stent. After deployment the stents were postdilated to high pressure with 8 mm balloon. Final angiographic result was excellent with no residual gradient. Both sheaths were documented to be placed in the common femoral arteries and closure was then obtained with manual compression, no closure device was utilized.
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Patient was given initially 3000 units of heparin at the initiation of the intervention there no complications.
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Hemodynamics:
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Aortic pressure 115/70.
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Diagnostic digital subtraction aortoiliac angiogram.
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Abdominal aorta without apparent aneurysm, minimal plaque, patent bilateral renal arteries celiac SMA and IMA.
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Distal aorta tapers slightly, there was very proximal but not ostial disease on the left common femoral artery up to 70%, 60% in the proximal to mid vessel but the distal one third was widely patent left internal and external iliac vessels were patent. Left common femoral vessel was patent.
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Right common iliac with mild proximal disease of 30-40%, mid vessel patent, at the very distal segment at the bifurcation there was 70% stenosis, right internal iliac was patent with ostial stenosis of 50-60%, proximal right external iliac 70% stenosis. Finally the mid right external iliac had a discrete stenosis of 75%. This was the major gradient. The distal external iliac common femoral vessel was patent on the right.
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Angiography and angulated views of the right common femoral artery revealed moderate eccentric plaque with calcification on the medial aspect predominantly, in the angled RAO view no luminal narrowing was noted however in the AP view less than 30% narrowing was noted. This appeared non-flow-limiting, and right common femoral access today was above this site.
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Intervention:
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As detailed above bilateral common iliac angioplasty and stenting was performed and right external iliac angioplasty and stenting was performed.
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Summary conclusion:
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Bilateral iliac disease, with bilateral common iliac proximal balloon angioplasty and stenting, not kissing stent application, future crossover will be feasible following this proximal common iliac stent placement bilaterally
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Right external iliac stenosis treated with balloon expandable stent placement
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Nonobstructive right common femoral calcified plaque
*thank you in advance
I am thinking of 37221-50,37223
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Patient was given initially 3000 units of heparin at the initiation of the intervention there no complications.
*
*
Hemodynamics:
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Aortic pressure 115/70.
*
*
Diagnostic digital subtraction aortoiliac angiogram.
*
Abdominal aorta without apparent aneurysm, minimal plaque, patent bilateral renal arteries celiac SMA and IMA.
*
Distal aorta tapers slightly, there was very proximal but not ostial disease on the left common femoral artery up to 70%, 60% in the proximal to mid vessel but the distal one third was widely patent left internal and external iliac vessels were patent. Left common femoral vessel was patent.
*
Right common iliac with mild proximal disease of 30-40%, mid vessel patent, at the very distal segment at the bifurcation there was 70% stenosis, right internal iliac was patent with ostial stenosis of 50-60%, proximal right external iliac 70% stenosis. Finally the mid right external iliac had a discrete stenosis of 75%. This was the major gradient. The distal external iliac common femoral vessel was patent on the right.
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Angiography and angulated views of the right common femoral artery revealed moderate eccentric plaque with calcification on the medial aspect predominantly, in the angled RAO view no luminal narrowing was noted however in the AP view less than 30% narrowing was noted. This appeared non-flow-limiting, and right common femoral access today was above this site.
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Intervention:
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As detailed above bilateral common iliac angioplasty and stenting was performed and right external iliac angioplasty and stenting was performed.
*
*
Summary conclusion:
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Bilateral iliac disease, with bilateral common iliac proximal balloon angioplasty and stenting, not kissing stent application, future crossover will be feasible following this proximal common iliac stent placement bilaterally
*
Right external iliac stenosis treated with balloon expandable stent placement
*
Nonobstructive right common femoral calcified plaque
*thank you in advance
I am thinking of 37221-50,37223
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