em2177
Expert
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REASON FOR EVALUATION: Peripheral arterial disease, limiting claudication.
HISTORY OF PRESENT ILLNESS: The patient has a history of coronary artery
disease, hypertension, and hyperlipidemia with progressive intermittent
claudication, which is lifestyle limiting. The patient has had an ultrasound
showing common femoral arterial disease on the right side, moderate, as well as
severe left SFA. His left leg hurts more than his right. The patient thus has
been explained the risks, benefits, and alternatives of peripheral angiography
plus/minus angioplasty and stenting and agrees to proceed.
PROCEDURE: The patient was brought to the catheterization lab and prepped and
draped in a sterile fashion. Lidocaine was placed to the right common femoral
area.
Using a micropuncture technique, we were able to gain access to the vessel;
however, the micropuncture wire would not cross the distal external iliac
portion. There was concern regarding severe disease or perhaps a total
occlusion. Thus, at this time, we held manual pressure to the right common
femoral area. There was no hematoma, and there was good groin hemostasis.
Thus, lidocaine was placed to the left common femoral area. Micropuncture
technique was able to place a 6-French sheath. Angiography down the left leg
was then performed. At this point, a Glidewire was placed into the abdominal
aorta, and a 6-French LIMA catheter was placed in the distal abdominal aorta.
The wire was pulled back and then placed into the right external iliac artery.
Again the wire would not pass in a retrograde fashion. The 6F LIMA catheter
was placed to the common iliac vessel, and angiography down the right leg was
performed. There was a near subtotal occlusion of the right external iliac,
which was focal.
At this time, the wire was able to cross, and we placed it into the right SFA.
The LIMA catheter was removed. The short sheath was exchanged for a 6-French
Ansel sheath, which was placed to the right common iliac. Over the Glidewire,
a 5.0 Fox Plus balloon was used for angioplasty of the right common femoral
artery as well as then pulled back into the right external iliac near subtotal
occlusion, and angioplasty was performed to 12 atmospheres. The balloon was
removed at this point. In the external iliac, we placed a 7.0 x 40 Absolute
Pro self-expanding stent, and then post dilatation was done with a 7.0 Fox Plus
balloon. Repeat angiography down the right leg showed 0% residual stenosis of
the external iliac, 30% stenosis of the common femoral artery, which
< > angioplasty due to need for access in the future, and the SFA
had significant improvement in flow. The wire was removed. The catheter under
fluoroscopic guidance was removed, and manual pressure was held with good groin
hemostasis and no evidence of oozing, bruising, or hematoma.
REASON FOR EVALUATION: Peripheral arterial disease, limiting claudication.
HISTORY OF PRESENT ILLNESS: The patient has a history of coronary artery
disease, hypertension, and hyperlipidemia with progressive intermittent
claudication, which is lifestyle limiting. The patient has had an ultrasound
showing common femoral arterial disease on the right side, moderate, as well as
severe left SFA. His left leg hurts more than his right. The patient thus has
been explained the risks, benefits, and alternatives of peripheral angiography
plus/minus angioplasty and stenting and agrees to proceed.
PROCEDURE: The patient was brought to the catheterization lab and prepped and
draped in a sterile fashion. Lidocaine was placed to the right common femoral
area.
Using a micropuncture technique, we were able to gain access to the vessel;
however, the micropuncture wire would not cross the distal external iliac
portion. There was concern regarding severe disease or perhaps a total
occlusion. Thus, at this time, we held manual pressure to the right common
femoral area. There was no hematoma, and there was good groin hemostasis.
Thus, lidocaine was placed to the left common femoral area. Micropuncture
technique was able to place a 6-French sheath. Angiography down the left leg
was then performed. At this point, a Glidewire was placed into the abdominal
aorta, and a 6-French LIMA catheter was placed in the distal abdominal aorta.
The wire was pulled back and then placed into the right external iliac artery.
Again the wire would not pass in a retrograde fashion. The 6F LIMA catheter
was placed to the common iliac vessel, and angiography down the right leg was
performed. There was a near subtotal occlusion of the right external iliac,
which was focal.
At this time, the wire was able to cross, and we placed it into the right SFA.
The LIMA catheter was removed. The short sheath was exchanged for a 6-French
Ansel sheath, which was placed to the right common iliac. Over the Glidewire,
a 5.0 Fox Plus balloon was used for angioplasty of the right common femoral
artery as well as then pulled back into the right external iliac near subtotal
occlusion, and angioplasty was performed to 12 atmospheres. The balloon was
removed at this point. In the external iliac, we placed a 7.0 x 40 Absolute
Pro self-expanding stent, and then post dilatation was done with a 7.0 Fox Plus
balloon. Repeat angiography down the right leg showed 0% residual stenosis of
the external iliac, 30% stenosis of the common femoral artery, which
< > angioplasty due to need for access in the future, and the SFA
had significant improvement in flow. The wire was removed. The catheter under
fluoroscopic guidance was removed, and manual pressure was held with good groin
hemostasis and no evidence of oozing, bruising, or hematoma.