37225-LT, 37228-LT, 75710-26,59, 75625-26, 99152
PROCEDURES PERFORMED:
Right common femoral artery access, catheter placement, and contralateral
posterior tibial angioplasty of posterior tibial into the plantar arch,
angioplasty, arthrectomy of the left SFA, and balloon angioplasty of
the left SFA.
CONSCIOUS SEDATION TIME:
1-1/2 hours.
Intra-Service Start Time: 1037
Intra-Service End Time: 1219
COMPLICATIONS:
No reflow of the posterior tibial, which was treated with the intra-arterial
nitroglycerin adenosine and balloon angioplasty. Final pictures showed
excellent flow.
INDICATION FOR PROCEDURE:
Gangrene threatened lower extremity.
DESCRIPTION OF PROCEDURE:
After informed consent, discussion of risks and benefits, a 5-French
sheath was placed on the right common femoral artery. Catheter was
placed up and over. Angiography was performed.
ANGIOGRAPHIC FINDINGS:
Abdominal aorta bilateral common and external iliac free of significant
disease. Left common femoral free of significant disease. Left SFA
has a 99% occlusion in the midportion, followed by 4 tandem 90% stenosis.
The popliteal has a diffuse 30% to 40% stenosis. Runoff is via the
posterior tibial, the anterior tibial terminates at the ankle and then
collateralizes to the foot.
INTERVENTION PROCEDURE:
A 6-French sheath was placed up and over. The patient was anticoagulated
to a therapeutic ACT. CSI atherectomy was performed at low medium and
high speeds. Following that, balloon angioplasty was done with 2 inflations
with a 5.0 x 150 drug-coated balloon. There was significant improvement
in the lesion. Angiography did show no reflow on the posterior tibial.
We then put a catheter and wire down into the posterior tibial, got
into the plantar arch, did a balloon angioplasty of the plantar arch
with a 1.5 balloon. Balloon angioplasty of the posterior tibial with
a 2.0 balloon. The patient was given about 1000 mcg of intra-arterial
adenosine and 600 mcg of nitroglycerin. Flow improved. The patient
was stable at the time of case completion
with good flow into the foot. The sheath will be pulled manually. The
patient was given 600 mg of Plavix. Closing ACT was 308.
DA/12287980/MODL