Pelvic angiogram with bilateral lower extremity run-off.

AgnieszkaMarek

Networker
Messages
60
Location
Saratoga Springs, NY
Best answers
0
EXAMINATION:

1. Pelvic Angiogram
2. Bilateral lower extremity run-off.
3. US and fluoroscopy guided left radial artery access.
4. Left radial artery arteriotomy closure with radial band compression
device.

PREOPERATIVE DIAGNOSIS:
Possible AV fistula in the lower extremity.

POSTOPERATIVE DIAGNOSIS:
No arteriovenous fistula identified on angiography

FINDINGS/TECHNIQUE:

The risks, benefits and alternatives of the procedure were discussed
with the patient, and informed written consent was obtained. The
patient was brought to the angiography suite, and the left wrist was
prepped and draped in sterile fashion. All elements of maximal sterile
barrier technique were followed including cap and mask, sterile gown,
sterile gloves, large sterile sheet, hand hygiene and 2% chlorhexidine
for cutaneous antisepsis.

Barbeau test was performed, and left radial artery size was measured
on ultrasound to document that there is no contraindication for left
radial access.

Next, left radial artery was accessed under ultrasound and fluoroscopy
guidance. 5 French radial sheath was placed. Radial arterial access
cocktail, mixture of 200 mcg nitroglycerin and 2.5 mg verapamil, was
given through the sheath. Next, 4000 unit IV heparin was given.

Next, the aortic arch was crossed with a combination of 120 cm 4
French angled glide catheter and 035 Benson wire under fluoroscopy
guidance. The angled catheter was advanced just above the aortic
bifurcation, bilateral pelvic angiography performed demonstrating Wide
patency of the distal abdominal aorta, common, internal and external
iliac arteries. Tortuous bilateral common iliac artery..

Next, with a combination of catheter and wire, right common femoral
artery was subselected, followed by angiography
. Right lower extremity
runoff was performed in overlapping fashion
Next, in similar fashion, left common femoral artery was subselected
followed by angiography.
Left lower extremity runoff was performed in
overlapping fashion.

Wires, catheters and sheaths were removed. The left radial artery
hemostasis was achieved with radial band.

The patient tolerated the procedure well and there were no
complications.


IMPRESSION:
1. Pelvic Angiogram. Significant focal stenosis. No aneurysm
dilatation. Tortuous bilateral common iliac artery.
2. Bilateral lower extremity run-off. Right lower extremity: Common
femoral, femoral bifurcation. Patent SFA and popliteal artery.
Arteriovenous fistula identified. Venous aneurysm not identified from
a arterial injection. Patent anterior tibial and posterior tibial
peroneal trunk bifurcation. Patent 3 vessel runoff. Left lower
extremity: Common femoral, femoral bifurcation. Patent SFA and
popliteal artery. Arteriovenous fistula identified. Venous aneurysm
not identified from a arterial injection. Patent trifurcation. Patent
3 vessel runoff.
3. US and fluoroscopy guided left radial artery access.
4. Left radial artery arteriotomy closure with radial band compression
device.


36246,75625,75716?
 
Last edited:

suchang78

Guru
Messages
138
Location
Baldwin Park, CA
Best answers
0
EXAMINATION:

1. Pelvic Angiogram
2. Bilateral lower extremity run-off.
3. US and fluoroscopy guided left radial artery access.
4. Left radial artery arteriotomy closure with radial band compression
device.

PREOPERATIVE DIAGNOSIS:
Possible AV fistula in the lower extremity.

POSTOPERATIVE DIAGNOSIS:
No arteriovenous fistula identified on angiography

FINDINGS/TECHNIQUE:

The risks, benefits and alternatives of the procedure were discussed
with the patient, and informed written consent was obtained. The
patient was brought to the angiography suite, and the left wrist was
prepped and draped in sterile fashion. All elements of maximal sterile
barrier technique were followed including cap and mask, sterile gown,
sterile gloves, large sterile sheet, hand hygiene and 2% chlorhexidine
for cutaneous antisepsis.

Barbeau test was performed, and left radial artery size was measured
on ultrasound to document that there is no contraindication for left
radial access.

Next, left radial artery was accessed under ultrasound and fluoroscopy
guidance. 5 French radial sheath was placed. Radial arterial access
cocktail, mixture of 200 mcg nitroglycerin and 2.5 mg verapamil, was
given through the sheath. Next, 4000 unit IV heparin was given.

Next, the aortic arch was crossed with a combination of 120 cm 4
French angled glide catheter and 035 Benson wire under fluoroscopy
guidance. The angled catheter was advanced just above the aortic
bifurcation, bilateral pelvic angiography performed demonstrating Wide
patency of the distal abdominal aorta, common, internal and external
iliac arteries. Tortuous bilateral common iliac artery..

Next, with a combination of catheter and wire, right common femoral
artery was subselected, followed by angiography
. Right lower extremity
runoff was performed in overlapping fashion
Next, in similar fashion, left common femoral artery was subselected
followed by angiography.
Left lower extremity runoff was performed in
overlapping fashion.

Wires, catheters and sheaths were removed. The left radial artery
hemostasis was achieved with radial band.

The patient tolerated the procedure well and there were no
complications.


IMPRESSION:
1. Pelvic Angiogram. Significant focal stenosis. No aneurysm
dilatation. Tortuous bilateral common iliac artery.
2. Bilateral lower extremity run-off. Right lower extremity: Common
femoral, femoral bifurcation. Patent SFA and popliteal artery.
Arteriovenous fistula identified. Venous aneurysm not identified from
a arterial injection. Patent anterior tibial and posterior tibial
peroneal trunk bifurcation. Patent 3 vessel runoff. Left lower
extremity: Common femoral, femoral bifurcation. Patent SFA and
popliteal artery. Arteriovenous fistula identified. Venous aneurysm
not identified from a arterial injection. Patent trifurcation. Patent
3 vessel runoff.
3. US and fluoroscopy guided left radial artery access.
4. Left radial artery arteriotomy closure with radial band compression
device.


36246,75625,75716?

36246 - right common femoral artery catheterization
36246 -59 (X code) - left common femoral artery catheterization
75716 - bilateral lower extremity angiogram
 
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