Procedures:
1. Suprarenal aortogram
2. Bilateral LE Angiogram
3. 3rd order catheter placement (Selective L LE angiogram from L SFA)
4. Laser Artherectomy with 2.0 laser catheter of the mid-distal Left SFA
5. Angioplasty of the left popliteal artery with 5.0x120mm DCB Spectranetics
6. Stenting of the mid-distal left SFA with 6.0x120mm DES Zilver
7. Moderate sedation supervision
Anesthesia: lidocaine 2% Sedati on: Versed and Fentanyl
Moderate Conscious sedation was provided under my direct supervision with the sedation trained nurse using 2 mg of IV Versed and SO mcg of IV Fentanyl.
Start time was 0935 and end time was 1145 . There were no complications. See hospital trained nurses sedation sheet I signed and dated for the completed procedure
Access Site: Right femoral artery 6F
DESCRIPTION OF PROCEDURE: Using micropuncture needle and ultrasound guidance, we placed a 6-French sheath via Seldinger technique to the left common femoral artery. A catheter was inserted into the aorta and an aortogram was performed. The Omni Flush catheter was then pulled down to the aortic bifurcation and a bilateral runoff was performed. The results of the angiogram are listed below. Next, the Omni Flush catheter was selectively placed in the proximalright SFA and contrast injections of the right leg were performed to further evaluate the infrapopliteal disease.
Findings:
Aortogram
– Patent b/I renal arteries
– Mild distal aortic disease
Right Lower Extremity
1. Common Iliac artery patent
2. Internal Iliac artery patent
3. External Iliac artery patent
4. CFA patent
5. Profunda patent
6. SFA patent
7. Popliteal patent
8. TP trunk patent
9. AT artery patent
10. PT artery patent
11. Peroneal artery 100% occluded ostially
Left Lower Extremity
1. Common iliac artery patent
2. Internal Iliac artery patent
3. External Iliac artery patent
4. CFA patent
5. Profunda patent
6. SFA Mid 70-80% disease; Distal 100% occluded
7. Popliteal proximal 100% occluded; Mid 80% disease
8. TP trunk patent
9. AT artery patent
10. PT patent
11. Peroneal artery severely diseased
Intervention:
Given disease in the left superficial femoral artery and popliteal artery, the decision was made to Intervene on that vessel. The short 6 French sheath was exchanged for a long 6 French sheath and placed into the proximal superficial femoral artery.
Once the sheath was in the proximal superficial femoral artery a run-through wire was used to circumvent the lesions In the superficial femoral artery and popliteal artery. The wire was placed distally into the TP trunk. Laser arthrectomy was decided upon in origin debulk the lesion. A Spectranetics 2.0 laser catheter was used to to laser arthrectomy of the mid to distal left superficial femoral artery. After multiple runs, an angiogram was done which showed significant improvement
in disease and improvement in flow. A 5.0 x 120 mm drug-coated balloon was then used to angioplasty of the superficial femoral artery and popliteal artery. Once that was completed, an anglogram was done which showed good flow in the vessel; however there appeared to be a small dissection in the mid to distal left superficial femoral artery. A 6.0 x 120 mm Zllver was placed In the mid to distal portion and an angiogram was done showing no perforations or dissections and good flow in the vessel.
The long 6 French sheath was then exchanged for a short 6 French straight over a J-wire. Groin shots were done which showed that we are above the bifurcation and noted there was no significant calcification at the site of entry. Angio·Seal was deployed with good hemostasis.
Oosure Device: Angioseal
EBL: less than 25 ml Complications: None lines: None Specimens: None Condition: Stable
NP:
Critical limb ischemia of the left foot
– ASA, plavix and lipitor
– Monitor and bedrest for 3 hours. D/C Home at 630pm
– IVF