DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Possible right renal artery stenosis.
2. Claudication, lower extremities.
PROCEDURES PERFORMED:
1. Abdominal aortography.
2. Bilateral lower extremity angiography.
ANESTHESIA: Local anesthesia with IV sedation.
DESCRIPTION OF PROCEDURE: The patient was brought to the angio suite and was placed in the supine position. Both groins were prepped and draped in the usual sterile manner. Xylocaine 1% was infiltrated into the left groin and local anesthesia was obtained. Then, a percutaneous stick was made into the left common femoral artery using 18-gauge needle. Once the blood flow was seen, we introduced a 0.035 J-wire. This was advanced into the abdominal aorta using fluoroscopy. Then, a 5-French sheath was placed and the 5-French pigtail catheter was threaded over the guidewire. This was placed in the proximal abdominal aorta and injection of dye was made and aortogram pictures were obtained.
Then, the catheter was pulled down to the distal aorta and multiple injections were made, and bilateral lower extremity angiography was accomplished. These films were then reviewed and then the pigtail catheter was straightened out with the guidewire and removed. Then, we closed the arterial puncture site in the left groin using StarClose device. The patient was next transferred out of the angio suite in stable condition.
ANGIOGRAPHY FINDINGS:
1. Abdominal aorta: Right and left renal arteries were identified and were felt to be widely patent without any stenosis. Right and left common iliac, internal and external iliac arteries likewise were widely patent.
2. Right lower extremity. In the right leg, common femoral and deep femoral arteries were patent. There was a high-grade 80% stenosis of a short segment of proximal right superficial femoral artery. As we went distally, popliteal artery was patent. Below-the-knee popliteal trifurcation had plaque formation with patent anterior tibial artery. Tibioperoneal trunk was patent, but posterior tibial and peroneal arteries were occluded. The anterior tibial artery was the main artery that goes all the way down to the ankle; however, this artery had an area of near total stenosis in the midcalf area.
3. Left lower extremity. In the left leg, again common femoral, deep femoral, and superficial femoral arteries were filled with plaque material but were patent. As we went distally, the popliteal artery was patent. Below the popliteal trifurcation, however, there was only diseased peroneal artery that was patent to the ankle. This artery had several areas of plaque formation causing high-grade stenosis. Left posterior tibial and anterior tibial arteries were occluded.
FINAL IMPRESSION:
1. There is a short-segment 80% stenosis of right mid superficial femoral artery.
2. There is a high-grade 80% stenosis of mid right anterior tibial artery.
3. Right posterior tibial and peroneal arteries are occluded.
4. Left posterior tibial and anterior tibial arteries are occluded. There is a highly diseased left peroneal artery that is patent to the ankle. This artery has several areas of high-grade stenosis.
