REFERRING PHYSICIAN: Jane Doe, MD
PREOPERATIVE DIAGNOSIS: Peripheral vascular disease with claudication.
POSTOPERATIVE DIAGNOSIS: Successful revascularization to the left common femoral artery and bilateral internal iliac artery occlusions.
PROCEDURE PERFORMED:
1. Aortogram with runoff.
2. Selective iliac artery injection.
3. Selective common femoral artery injection.
4. Percutaneous revascularization to the left common femoral artery.
OPERATOR: John Doe, MD
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: Following routine sterile preparation of both groins, the right groin was anesthetized with 2% lidocaine. The right femoral artery was then entered percutaneously and 6-French arterial sheath was placed. An angled pigtail catheter was used to perform abdominal aortography with runoff to the iliacs. Subsequently, an injection was performed to the right common femoral arterial sheath and then also with the internal mammary artery catheter in the more proximal vessels to fully delineate the course of the iliacs with runoffs to the foot. Subsequently, this same catheter was used with an angled glide catheter wire to cross over the aortic bifurcation. An injection was then performed in the left common iliac artery and the left common femoral artery with runoffs through the foot. After completion of diagnostic angiography, it was decided to proceed with percutaneous revascularization. A 7-French Destination sheath was placed over the guidewire and into the left external iliac artery. The Mailman guidewire was then placed down the vessel after systemic anticoagulation was performed with heparin. SilverHawk atherectomy catheter was used to perform atherectomy and post-balloon dilatation was performed with a 7 x 20 mm Powerflex balloon at 6 atmospheres. Excellent results were obtained, the procedure was terminated, and the patient was transferred to the holding area for line removal.
ANGIOGRAPHIC RESULTS: The previous aortobiiliac bypass graft appeared to be intact and without significant blockage or obstruction.
RIGHT LOWER EXTREMITY: The right internal iliac artery was noted to be obstructed at its ostium and filled by collaterals. The proximal portion of the right common femoral artery had diffuse 40% narrowing. The SFA was largely unobstructed. The posterior tibial artery was about 50% mid distal narrowing.
LEFT LOWER EXTREMITY: The left internal iliac artery was noted to be obstructed at its ostium with distal collateral filling. The left proximal common femoral artery had a focal 70% obstruction. The remainder of the vessels, including the runoff at the ankles, was unobstructed. Following revascularization, the left common femoral artery obstruction was 0%. No attempts were made to reopen the chronically occluded bilateral internal iliac arteries.
IMPRESSION:
1. Wide patency of the previous aortobiiliac bypass graft repair.
2. Bilateral internal iliac artery occlusions with collateral filling.
3. Proximal right common femoral artery obstruction of 40%.
4. Proximal left common femoral artery obstruction of 70%.
5. Fifty percent obstruction in the mid portion of the posterior tibial artery on the right.
