Summary of Left Lower Extremity Diagnostic Arteriogram Procedure
The lecture video demonstrates a diagnostic arteriogram performed on the left lower extremity of an elderly female patient with a history of endovascular interventions and recent onset of rest pain and toe discoloration. The procedure involved using a contralateral approach to access the arteries and perform angiography to evaluate arterial occlusions and plan further management.
Key Points from the Lecture
Patient Background
- Elderly female with multiple previous left lower extremity interventions.
- Presented with 3-day history of rest pain and discoloration in the left fourth and fifth toes.
- An ultrasound arterial duplex showed occlusion in the left superficial femoral artery (SFA) and tibial anterior (TA) arteries, with reduced Doppler signals in other vessels.
Preparation and Procedure
- The procedure was done under monitored sedation and sterile conditions.
- Initial access was gained via the right groin, with preparations made to access the left groin if necessary.
Technique and Tools Employed
- Local Anesthesia: Local infiltration using lidocaine and epinephrine.
- Access Technique: Utilized a mini stick coaxial micro introducer kit and a 21-gauge needle guided by ultrasound for arterial access.
- Fluoroscopy: A Siemens Artis unit confirmed wire placement into the abdominal aorta.
- Wire and Sheath Placement:
- Introduction of a 5 French dilator and sheath over a 0.018 guide wire.
- Exchange of the initial wire for a 0.035 Benson wire for contralateral lower extremity access.
- Placement of a short 5 French sheath in the right common femoral artery post skin nick using an 11 blade.
Imaging and Visualization
- Digital Subtraction Angiography (DSA): Used to check for access vessel complications and visualize the aorta-iliac system.
- The Bentson wire and catheters facilitated detailed visualization of the entire arterial system to the level of the left lower extremity:
- Common femoral artery
- Superficial femoral artery (SFA)
- Profunda femoral artery
- Popliteal artery
- Anterior tibial, Peroneal, and Posterior tibial arteries
Findings
- Long segment occlusion of the SFA and popliteal arteries.
- Occlusion of the peroneal and anterior tibial arteries.
- The posterior tibial artery reconstituted distally via collaterals from the profunda femoral artery, without direct inline flow.
Conclusion and Next Steps
- The visualization provided necessary insights into the extent and specific locations of arterial occlusions.
- These findings will aid in planning appropriate therapeutic interventions or further endovascular procedures to manage the patient's condition.