bhargavi
Guru
Conclusion
PROCEDURES
1. Abdominal aortogram
2. Bilateral lower extremity angiogram with runoff
3. Percutaneous intervention of right popliteal, posterior tibial, anterior tibial arteries. Status post stenting of proximal posterior tibial artery.
4. 6 French Mynx vascular closure for left femoral artery access.
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Left groin was draped and prepped in the sterile fashion. Patient was premedicated with fentanyl and Versed. After injecting 2% lidocaine in the left groin, left common femoral artery was accessed using micropuncture needle and a 5 French sheath was inserted without any difficulty. 5 French contra imager catheter was advanced and abdominal aortogram was performed. With the help of 0.035 zip wire bifurcation of the aorta was successfully crossed. Right lower extremity angiogram was performed. Patient was proceeded with intervention of the right popliteal, anterior tibial, TPT trunk, and posterior tibial arteries. Patient remained hemodynamically stable and tolerated procedure well. Patient was stable without any discomfort at the procedure.
After obtaining informed consent, the patient was prepped and draped in sterile fashion. A 6 French glide sheath/sheath was inserted in the right radial artery/right common femoral artery. A 6 French Tiger catheter/Judkins left and right coronary catheters was used for left and right coronary angiography. Iliofemoral angiography revealed presence of sheath in the common femoral artery. A minx closure device was used to close the right common femoral artery access site.
I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient. Start time 14:07 p.m. and end time was 15:40 PM. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.
ABDOMINAL AORTOGRAM
Abdominal aorta was patent without aneurysm or dilatation..
RIGHT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Right external iliac artery was patent. Internal iliac was patent. Common femoral artery was patent. Superficial femoral artery was patent. Popliteal artery was occluded. Tibioperoneal trunk was occluded. Anterior tibial artery was occluded in the proximal segment with distal faint filling. Posterior tibial artery was occluded with distal faint filling. Peroneal artery was was occluded with distal faint filling.
LEFT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Left external iliac artery was patent. Internal iliac was patent. Common femoral artery was patent. Superficial femoral artery was patent in the proximal mid segment with distal focal 40 to 50% stenosis. Popliteal artery was patent. Infrapopliteal runoff was not performed to limit IV contrast and radiation exposure.
PERCUTANEOUS INTERVENTION OF
6 French 65 cm destination sheath was advanced over a Magic torque wire and the proximal end of the sheath was placed in the right mid to distal superficial femoral artery. 60 units/kg heparin was used for anticoagulation. Run-through wire was advanced into distal posterior tibial artery through a 0.018 Rubicon catheter. AngioJet thrombectomy catheter was used to perform thrombectomy. Subsequent angiogram revealed significant improvement in the flow of the popliteal artery and TPT trunk. There was still residual thrombus left in the TP trunk into popliteal artery and peroneal arteries. Anterior tibial artery had TIMI-3 flow at this time. tPA was infused through the AngioJet catheter which was continued for 20 minutes. Thrombectomy was repeated for another 50 to 60 seconds. Subsequent angiogram revealed significant improvement in the lesion of the popliteal artery, TPT trunk, and posterior tibial artery without perforation or significant dissection and a brisk antegrade flow. There was a residual stenosis at the ostium of posterior tibial artery. Balloon angioplasty was performed using 2.5 x 40 mm and then 3.0 x 20 mm balloon. This lesion was resistant to balloon angioplasty. Decision was made to deploy a resolute Onyx 3.0 x 22 mm drug-eluting stent. Stent was postdilated using stent balloon under high atmospheric pressure. Subsequent angiogram revealed TIMI-3 flow without evidence of dissection perforation and two-vessel runoff. Final ACT was measured at 211. Patient was loaded with 600 mg of Plavix.
IMPRESSION
1. Acute thrombotic occlusion of popliteal artery, TPT trunk, anterior tibial artery, and posterior tibial and peroneal arteries.
2. Status post AngioJet thrombectomy and thrombolysis. Status post balloon angioplasty and stenting of posterior tibial artery.
i am looking at 37230-rt, 37228-rt,37184, should i add 37211? and 37224?popliteal
PROCEDURES
1. Abdominal aortogram
2. Bilateral lower extremity angiogram with runoff
3. Percutaneous intervention of right popliteal, posterior tibial, anterior tibial arteries. Status post stenting of proximal posterior tibial artery.
4. 6 French Mynx vascular closure for left femoral artery access.
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Left groin was draped and prepped in the sterile fashion. Patient was premedicated with fentanyl and Versed. After injecting 2% lidocaine in the left groin, left common femoral artery was accessed using micropuncture needle and a 5 French sheath was inserted without any difficulty. 5 French contra imager catheter was advanced and abdominal aortogram was performed. With the help of 0.035 zip wire bifurcation of the aorta was successfully crossed. Right lower extremity angiogram was performed. Patient was proceeded with intervention of the right popliteal, anterior tibial, TPT trunk, and posterior tibial arteries. Patient remained hemodynamically stable and tolerated procedure well. Patient was stable without any discomfort at the procedure.
After obtaining informed consent, the patient was prepped and draped in sterile fashion. A 6 French glide sheath/sheath was inserted in the right radial artery/right common femoral artery. A 6 French Tiger catheter/Judkins left and right coronary catheters was used for left and right coronary angiography. Iliofemoral angiography revealed presence of sheath in the common femoral artery. A minx closure device was used to close the right common femoral artery access site.
I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient. Start time 14:07 p.m. and end time was 15:40 PM. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.
ABDOMINAL AORTOGRAM
Abdominal aorta was patent without aneurysm or dilatation..
RIGHT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Right external iliac artery was patent. Internal iliac was patent. Common femoral artery was patent. Superficial femoral artery was patent. Popliteal artery was occluded. Tibioperoneal trunk was occluded. Anterior tibial artery was occluded in the proximal segment with distal faint filling. Posterior tibial artery was occluded with distal faint filling. Peroneal artery was was occluded with distal faint filling.
LEFT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Left external iliac artery was patent. Internal iliac was patent. Common femoral artery was patent. Superficial femoral artery was patent in the proximal mid segment with distal focal 40 to 50% stenosis. Popliteal artery was patent. Infrapopliteal runoff was not performed to limit IV contrast and radiation exposure.
PERCUTANEOUS INTERVENTION OF
6 French 65 cm destination sheath was advanced over a Magic torque wire and the proximal end of the sheath was placed in the right mid to distal superficial femoral artery. 60 units/kg heparin was used for anticoagulation. Run-through wire was advanced into distal posterior tibial artery through a 0.018 Rubicon catheter. AngioJet thrombectomy catheter was used to perform thrombectomy. Subsequent angiogram revealed significant improvement in the flow of the popliteal artery and TPT trunk. There was still residual thrombus left in the TP trunk into popliteal artery and peroneal arteries. Anterior tibial artery had TIMI-3 flow at this time. tPA was infused through the AngioJet catheter which was continued for 20 minutes. Thrombectomy was repeated for another 50 to 60 seconds. Subsequent angiogram revealed significant improvement in the lesion of the popliteal artery, TPT trunk, and posterior tibial artery without perforation or significant dissection and a brisk antegrade flow. There was a residual stenosis at the ostium of posterior tibial artery. Balloon angioplasty was performed using 2.5 x 40 mm and then 3.0 x 20 mm balloon. This lesion was resistant to balloon angioplasty. Decision was made to deploy a resolute Onyx 3.0 x 22 mm drug-eluting stent. Stent was postdilated using stent balloon under high atmospheric pressure. Subsequent angiogram revealed TIMI-3 flow without evidence of dissection perforation and two-vessel runoff. Final ACT was measured at 211. Patient was loaded with 600 mg of Plavix.
IMPRESSION
1. Acute thrombotic occlusion of popliteal artery, TPT trunk, anterior tibial artery, and posterior tibial and peroneal arteries.
2. Status post AngioJet thrombectomy and thrombolysis. Status post balloon angioplasty and stenting of posterior tibial artery.
i am looking at 37230-rt, 37228-rt,37184, should i add 37211? and 37224?popliteal