calorom2
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Can anyone give some guidance here? 36252/37236/99152? Am I on the right path? If you have any resources or can direct me to any documents that would help with these it would be appreciated!
PROCEDURES:
1. Right common femoral artery access with ultrasound guidance.
2. Selective right and left renal artery angiography.
3. Drug-eluting stent, 3.5/12 mm, to the inferior right renal artery.
4. 5.0/15 mm ParaMount GPS stent to the superior right renal artery ostium.
TOTAL CONTRAST USED:
250 mL.
COMPLICATIONS:
None.
BLOOD LOSS:
Minimal.
DESCRIPTION OF PROCEDURE:
The risks and benefits of renal artery angiography and percutaneous intervention
were discussed with the patient. She is agreeable to procedure. Consent
was obtained.
Time-out was performed. The patient, physician, and procedure to be
performed were identified.
The patient was given Versed 1 mg and fentanyl 50 mcg intermittently
during the procedure for conscious sedation.
The patient was prepped and draped in the normal fashion. 1% lidocaine
was generously infiltrated into the right groin region. Ultrasound
was used to visualize the common femoral artery bifurcating into the
SFA and profundus branch. Arterial access was gained with ultrasound
guidance into the right common femoral artery without difficulty. The
6-French sheath was introduced.
Renal artery angiography was performed using our DC 6-French catheter.
The left renal artery is large, patent, and without significant stenosis.
The right renal artery had 2 arteries that arose from a separate ostium.
The superior renal artery had a 99% ostial stenosis. This artery appeared
to supply at least 50% of the right kidney. The inferior renal artery
was a moderate-sized vessel approximating 3 to 4 mm vessel that also
supplied about 50% of the renal artery. There was an ostial 90% stenosis.
A 6-French JR4 short guide catheter was used to engage the ostium of
the right renal artery. The Prowater wire was advanced to the distal
renal artery. A 3.0/15 mm noncompliant balloon was advanced over the
stenosis and inflations were made to nominal atmospheres. There was
significant recoil of the vessel. A 5.0/15 mm ParaMount GPS stent was
advanced to the ostium of the artery. The stent was deployed to nominal
atmospheres. The previous 99% stenosis had 10% stenosis. Heavy calcification
is noted at the ostium.
Our attention was directed towards the inferior renal artery. The same
Prowater wire was advanced through the stenosis and placed in the distal
artery. The 3.0/15 mm noncompliant balloon was advanced over the stenotic
segment and dilated to nominal atmospheres. There was significant recoil
of the vessel. A 3.5/15 mm Resolute stent was advanced to the ostium
of the previous angioplasty site. The stent was deployed to 10 to 12
atmospheres. The deployment balloon was withdrawn approximately halfway
and the ostium flared to 12 to 14 atmospheres. Final angiography showed
the previous 90% stenosis to have 0% stenosis.
IMPRESSION:
1. Successful PTCA and drug-eluting stent to the inferior right ostial
stenosis.
2. Successful PTCA and bare-metal stent placement to the superior
right renal artery.
At the end of the procedure, the femoral angiography showed the sheath
to be in good placement. The sheath was withdrawn and a 6-French Angio-Seal
collagen sponge was successfully deployed.
At the end of the procedure, the patient was notably severely :
Hypertension with blood pressure is 190s to 210 with systolic blood pressures
up to 190 to 210 mmHg. She was given labetalol 10 mg IV x2 and hydralazine
10 mg IV x1. She had continued persistent severe hypertension. She
was subsequently placed on IV nitroglycerin drip and the IV nitroglycerin
drip titrated up to 40 mcg/minute. The patient tolerated the procedure
well and was transferred to the CVICU in stable condition.
PROCEDURES:
1. Right common femoral artery access with ultrasound guidance.
2. Selective right and left renal artery angiography.
3. Drug-eluting stent, 3.5/12 mm, to the inferior right renal artery.
4. 5.0/15 mm ParaMount GPS stent to the superior right renal artery ostium.
TOTAL CONTRAST USED:
250 mL.
COMPLICATIONS:
None.
BLOOD LOSS:
Minimal.
DESCRIPTION OF PROCEDURE:
The risks and benefits of renal artery angiography and percutaneous intervention
were discussed with the patient. She is agreeable to procedure. Consent
was obtained.
Time-out was performed. The patient, physician, and procedure to be
performed were identified.
The patient was given Versed 1 mg and fentanyl 50 mcg intermittently
during the procedure for conscious sedation.
The patient was prepped and draped in the normal fashion. 1% lidocaine
was generously infiltrated into the right groin region. Ultrasound
was used to visualize the common femoral artery bifurcating into the
SFA and profundus branch. Arterial access was gained with ultrasound
guidance into the right common femoral artery without difficulty. The
6-French sheath was introduced.
Renal artery angiography was performed using our DC 6-French catheter.
The left renal artery is large, patent, and without significant stenosis.
The right renal artery had 2 arteries that arose from a separate ostium.
The superior renal artery had a 99% ostial stenosis. This artery appeared
to supply at least 50% of the right kidney. The inferior renal artery
was a moderate-sized vessel approximating 3 to 4 mm vessel that also
supplied about 50% of the renal artery. There was an ostial 90% stenosis.
A 6-French JR4 short guide catheter was used to engage the ostium of
the right renal artery. The Prowater wire was advanced to the distal
renal artery. A 3.0/15 mm noncompliant balloon was advanced over the
stenosis and inflations were made to nominal atmospheres. There was
significant recoil of the vessel. A 5.0/15 mm ParaMount GPS stent was
advanced to the ostium of the artery. The stent was deployed to nominal
atmospheres. The previous 99% stenosis had 10% stenosis. Heavy calcification
is noted at the ostium.
Our attention was directed towards the inferior renal artery. The same
Prowater wire was advanced through the stenosis and placed in the distal
artery. The 3.0/15 mm noncompliant balloon was advanced over the stenotic
segment and dilated to nominal atmospheres. There was significant recoil
of the vessel. A 3.5/15 mm Resolute stent was advanced to the ostium
of the previous angioplasty site. The stent was deployed to 10 to 12
atmospheres. The deployment balloon was withdrawn approximately halfway
and the ostium flared to 12 to 14 atmospheres. Final angiography showed
the previous 90% stenosis to have 0% stenosis.
IMPRESSION:
1. Successful PTCA and drug-eluting stent to the inferior right ostial
stenosis.
2. Successful PTCA and bare-metal stent placement to the superior
right renal artery.
At the end of the procedure, the femoral angiography showed the sheath
to be in good placement. The sheath was withdrawn and a 6-French Angio-Seal
collagen sponge was successfully deployed.
At the end of the procedure, the patient was notably severely :
Hypertension with blood pressure is 190s to 210 with systolic blood pressures
up to 190 to 210 mmHg. She was given labetalol 10 mg IV x2 and hydralazine
10 mg IV x1. She had continued persistent severe hypertension. She
was subsequently placed on IV nitroglycerin drip and the IV nitroglycerin
drip titrated up to 40 mcg/minute. The patient tolerated the procedure
well and was transferred to the CVICU in stable condition.