DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left leg claudication, greater than right.
POSTOPERATIVE DIAGNOSIS: Left leg claudication, greater than right.
PROCEDURE PERFORMED: Aortogram with runoff and rotational views.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: Local with sedation.
IV FLUIDS: 600 mL.
ESTIMATED BLOOD LOSS: Minimal.
URINE OUTPUT: 100 mL.
FINDINGS: See below.
DRAINS: None.
COMPLICATIONS: None.
DISPOSITION: The patient was transferred to the cardiovascular recovery room in stable condition.
DESCRIPTION OF PROCEDURE: The patient was brought to the angio suite and placed in the supine position on the operating room table. After induction of sedation, the patient’s bilateral groins were prepped and draped in the standard surgical fashion. The right femoral pulse was not able to be palpated; therefore, the SonoSite ultrasound was used to guide needle entry into the common femoral artery. This was accomplished easily. A 5-French sheath was then placed via the Seldinger technique into the right common femoral artery and an Omni-Flush catheter was placed at the level of T12. An aortogram was performed.
AORTOGRAM RESULTS: The aortogram showed a calcified aorta below the renal arteries. There were two single renal arteries bilaterally with the right renal artery bifurcating early. The visualized portions of the SMA and celiac artery were patent, though the origins were not specifically visualized. The bilateral iliac stents were imaged, and it did not appear that there was in-stent stenosis. The bilateral iliac arteries filled. The external iliac artery on the left appeared severely stenosed with multiple collaterals reconstituting the SFA and profunda on the left. The right external iliac artery did appear to be stenosed, but due to the presence of the catheter and sheath, it was hard to diagnose this for sure.
The Omni-Flush catheter was then placed above aortic bifurcation, and bilateral runoff was performed. Results of the runoff on the left are as follows; the iliac artery stent is patent. The internal iliac artery is patent. The external iliac artery minimally fills, mostly by collaterals. It appears that the common femoral artery minimally fills, also with reconstitution fully of the superficial femoral artery, which is widely patent to the knee and the profunda, which does not appear patent at its origin but fills by collaterals. The left popliteal artery is widely patent with a trifurcation that is patent. The trifurcation on the left is widely patent.
The posterior tibial artery is the inline flow to the foot to constitute plantar arch. The proximal origin of the peroneal and anterior tibial artery appear patent; however, on the foot shots, the peroneal and anterior tibial artery do not reach the ankle. On the right, on rotational view, it does appear there is a short segment of right external iliac artery stenosis above the common femoral artery. The common femoral artery does appear patent, but again because of the sheath and catheter, it is hard to know the extent of disease here. The profunda and SFA are widely patent and normal on the right. The popliteal artery is normal on the right. The trifurcation is normal on the right. The posterior tibial artery is the inline flow to the foot, which appears normal and constitutes the plantar arch. The proximal origin of the anterior tibial and peroneal artery are visualized. However, on foot and ankle shots, it does not appear that these arteries reach the foot.
The patient tolerated the procedure well and was transported to the cardiovascular recovery room in stable condition.
