DIAGNOSTIC APPROPRIATENESS CRITERIA: 63A
HISTORY:
68 y/o M with PMH of ESRD on HD, PVD without reported claudications, prior TIA, Ogilvie’s syndrome s/p partial colectomy who is for cardiac cath as a part of pre-kidney transplant evaluation. *Pt has fatigue (Anginal equivalent).
Also she has PVD and plan for peripheral angiography
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ACCESS SITE(S): left radial artery
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PROCEDURAL OVERVIEW:
After obtaining informed consent and positioning the patient on the catheterization table, a timeout was performed to confirm the patient’s name, date of birth, and procedure. Sedation was initiated and the patient was prepped and draped using standard sterile technique. Lidocaine was used for local anesthesia over the access site, after which the vessel was accessed and a sheath was placed using the modified Seldinger technique. Access was uncomplicated. The right coronary system was engaged by using FR4 Boston Scientific Diagnostic and left coronary system by using FL4 Boston Scientific Diagnostic. At the conclusion of the procedure, hemostasis was achieved using a radial compression device after removal of all catheters, wires, and sheaths.
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SEDATION:
Moderate sedation on this adult patient was ordered by Dr. ******, administered intravenously in their presence, and monitored by the procedure nurse as an independent trained observer who was present throughout the procedure. The following parameters were monitored: oxygen saturation, heart rate, blood pressure, and response to care. Intra-service sedation start time was 1137 and end time was 1308 during which the attending was present. Total physician intra-service sedation time was 89 minutes. For details on pre-moderate sedation and post-moderate sedation patient evaluation, please review the evaluation forms in Epic. For details on monitored clinical parameters during the intra-service sedation time, please review the procedure nurse documentation in Epic. Total sedation administered as follows: 50 mcg IV fentanyl, 1 mg IV midazolam, and 50 mg IV benadryl. 3 ml of 1% lidocaine was administered subcutaneously at the access site.
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COMPLICATIONS: None
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HEMODYNAMIC FINDINGS:
AO: 194/49/86
LVEDP: 20 mmHg
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ANGIOGRAPHY:
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i. * *Left main: Short vessel that bifurcates into LAD and LCx.
ii.* *LAD: large caliber with luminal irregularities in proximal segment and 40% stenosis in mid segment. 1st diagonal has 30% stenosis in the ostium and luminal irregularities in mid segment.
iii. * LCx: Non-dominant large caliber with luminal irregularities in proximal segment. OM2 is a large branching caliber with 20% stenosis in proximal segment, otherwise mild luminal irregularities.
iv. * RCA: Dominant vessel without angiographic evidence of disease. PDA and rPL without angiographic evidence of disease.
DOMINANCE: Right
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Peripheral angiography:
Same access for coronary angiography was used which was left radial access. Peripheral angiography was performed by using Pigtail Straight and MPA2 Boston Scientific Diagnostic 125cm.
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RIGHT
The Common Iliac artery had a non obstructive disease..
The Internal Iliac artery had non obstructive disease.
The External Iliac artery had non obstructive disease.
The Common Femoral Artery had non obstructive disease.
The Profunda femoris artery had non obstructive disease.
The Superficial Femoral artery had non obstructive disease.
The Popliteal Artery had non obstructive disease.
The Post tibial artery had a non obstructive disease.
The Anterior tibial artery had non obstructive disease.
The Peroneal artery had non obstructive disease.
There was a 3 vessel distal run off
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LEFT
The Common Iliac artery had a non obstructive disease..
The Internal Iliac artery had non obstructive disease.
The External Iliac artery had non obstructive disease.
The Common Femoral Artery had non obstructive disease.
The Profunda femoris artery had non obstructive disease.
The Superficial Femoral artery had non obstructive disease.
The Popliteal Artery had non obstructive disease.
The Post tibial artery had a non obstructive disease.
The Anterior tibial artery had non obstructive disease.
The Peroneal artery had non obstructive disease.
There was a 3 vessel distal run off
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DIAGNOSTIC INTERPRETATIONS:
– Non-obstructive CAD.
– Peripheral angiography shows calcified vessel without evidence of obstruction.
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RECOMMENDATIONS AFTER DIAGNOSTIC CATHETERIZATION:
Medical management of nonobstructive CAD.
Aggressive modification of atherosclerotic risk factors.
TR band to be taken off after 2 hours

Thank you
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