1. Infra renal aortogram.
2. Selective left and right lower extremity angiograms with run-offs.
3. Percutaneous vascular intervention with angioplasty and balloon expandable stentx2 placement to the left common iliac artery.
After obtaining informed consent, the patient was prepped and draped in sterile fashion. After obtaining moderate sedation and local anesthesia with s.c. lidocaine, a 6 French glide sheath was inserted in the right radial artery.
Infra-renal aortogram was obtained using a 6 French long pig-tail catheter. After identifying the lesion, under ultrasound guidance a right common femoral arteriotomy was obtained and a 6 French sheath was inserted. After obtaining systemic anticoagulation with Heparin, the lesion was successfully crossed with a 0.035' glidewire. The lesion was then managed with balloon angioplasty with a 6.0x40 mm Mustang balloon. The LCFA 6 French sheath was then up-sized to a 7 French long sheath followed by successful stenting with overlapping 8.0x57mm and 8.0x17mm balloon expandable stents with excellent result and excellent distal flow. A left lower extremity angiography with run-offs was then performed. Using a long 4 French glide catheter via right radial artery, the right common femoral artery was successfully selectively engaged and a right lower extremity angiogram was performed.
A transradial band was then used for hemostasis of the right radial arteriotomy at the end of the procedure. Manual pressure was used for hemostasis of the left common femoral arteriotomy.
I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 25 mcg of fentanyl to sedate the patient. Start time 09:05 am and end time was 11:05 am for a total of 120 minutes. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.
No significant infra-renal aortic stenosis in the visualized segment.
Severe stenosis involving left common iliac artery in it's entire length.
No significant stenosis involving right common iliac artery bilateral external iliac, bilateral internal iliac and bilateral common femoral arteries.
LEFT LOWER EXTREMITY ANGIOGRAPHY
No significant stenosis left superficial femoral, popliteal arteries.
A three vessel runoff with no significant stenosis involving anterior tibial, posterior tibial and peroneal arteries.
RIGHT LOWER EXTREMITY ANGIOGRAPHY
No significant stenosis right superficial femoral, popliteal arteries.
A one vessel runoff with no significant stenosis involving posterior tibial artery but occluded anterior tibial and peroneal arteries in their proximal aspect. Distally, the anterior tibial artery re-constitutes via collaterals from posterior tibial artery.
1. Severe left common iliac stenosis s/p angioplasty with 6.0mm balloon and successful overlapping 8.0x57 and 8.0x17mm stent placement.
2. Chronically proximally occluded right anterior tibial and right peroneal arteries with distal reconstitution.
1. Coumadin+Plavix for 1-3 months.
2. GDMT, risk factor modification, exercise therapy.
thanks in advance
I can only come up with 37221-lt