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Vascular Surgery Operative MT Sample Report - Aortogram with Bilateral Lower Leg Extremity Runoff

PREOPERATIVE DIAGNOSIS:  Bilateral lower extremity rest pain, left worse than right.

POSTOPERATIVE DIAGNOSIS:  Bilateral lower extremity rest pain, left worse than right.

PROCEDURE PERFORMED:  Aortogram with bilateral lower leg extremity runoff.

SURGEON:  John Doe, MD

ANESTHESIA:  Local with sedation.

IV FLUIDS:  650 mL.

ESTIMATED BLOOD LOSS:  Minimal.

URINE OUTPUT:  175 mL.

COMPLICATIONS:  None.

DESCRIPTION OF PROCEDURE:  Using the SonoSite and under ultrasound guidance, we placed a 4-French sheath via Seldinger technique to the right common femoral artery. A catheter was inserted into the aorta and an aortogram was performed.

AORTOGRAM:
The visualized portions of the celiac and SMA arteries are patent, the orifices were not individually interrogated. There appears to be bilateral single renal arteries that are widely patent. The aortic bifurcation appears normal.

The Omni Flush catheter was then placed in the aortic bifurcation and a runoff was performed. The results of the angiogram are as follows.

RIGHT-SIDED ANGIOGRAM:
The right common iliac artery is widely patent as is the right external iliac artery. The right internal iliac artery is opacified faintly but is patent and of very small caliber. The right common femoral artery is normal. The profunda appears normal. The origin of the superficial femoral artery appears mildly diseased with some posterior plaque. Approximately 10 cm distal to the origin of the SFA, there is a high-grade stenosis, approximately 80%. There are multiple minimal areas of narrowing, no greater than 20%, diffusely along the superficial femoral artery. Once the SFA enters the adductor canal, the popliteal artery is widely patent to the below-knee popliteal artery. The anterior tibial artery origin appears normal. The tibioperoneal trunk origin appears normal. However, shortly after takeoff, the anterior tibial artery and the tibioperoneal trunk occlude. In the mid leg, the peroneal and posterior tibial artery reconstitute. The peroneal artery is patent and bifurcates just above the ankle as expected. The posterior tibial artery is the main runoff to the foot and forms the plantar arch.

LEFT LOWER EXTREMITY ANGIOGRAM:
The common femoral artery is widely patent. The origin of the profunda and superficial femoral artery appear widely patent. The profunda is a well-developed vessel. The superficial femoral artery, however, is a short segment though diffusely diseased along its length. Approximately 10 cm past the origin of the SFA, there is an approximately 60% stenosis of the SFA that is no longer than 1 cm long. There is another high-grade stenosis short segment just proximally to the adductor canal. There are multiple collaterals arising just proximal to the stenosis. This is approximately 80% stenosed. The above and below knee popliteal arteries are widely patent. The anterior tibial artery is not visualized. The tibioperoneal trunk is occluded. There does appear to be reconstitution of the peroneal artery at the mid leg. The posterior to the artery does reconstitute approximately two-thirds the way down the leg. This enters below the ankle joint, but there is not a clearly defined plantar arch.

Next, the Omni Flush catheter was selectively placed in the proximal SFA and contrast injections of the left leg were performed. Again, geniculate collaterals reconstitute the peroneal artery at the mid tibial level. Distally, in the distal one-third of the tibia, the posterior tibial artery reconstitutes. The peroneal artery is patent where it bifurcates just above the ankle. On the selective shots, it does appear that the posterior tibial artery does form the plantar arch nicely.

Next, an angiogram of the right lower extremity, semiselective, was performed with contrast injections through the right 4-French sheath. This revealed basically a normal caliber popliteal artery to the takeoff of the anterior tibial artery and beginning of the tibioperoneal trunk. However, both of these occlude shortly thereafter. Further shots of the foot are not able to be obtained due to difficulties and timing of the contrast bolus through the ipsilateral sheath. Therefore, this was the end of the procedure. The patient tolerated the procedure well.