PROCEDURES PERFORMED:
1. Abdominal aortography with iliofemoral runoff.
2. Percutaneous transluminal angioplasty and stent deployment of the right external iliac artery.
3. Percutaneous transluminal angioplasty, cutting balloon, and plaque excision of the right internal iliac artery.
4. Angiography of the right lower extremity from ipsilateral approach.
5. Angiography of the left lower extremity from ipsilateral approach.
DETAILS OF PROCEDURE: After informed consent was obtained, the patient was brought to the cardiac catheterization laboratory for abdominal aortography with iliofemoral runoff and above procedures and prepped and draped in sterile fashion.
Vascular introducer was placed in the right common femoral artery using single wall technique. A pigtail catheter was placed at the aortoiliac bifurcation, and an abdominal aortography with iliofemoral runoff was performed.
Subsequently, a 7 French sheath was placed in the left common femoral artery. A 7 French Destination sheath was then placed in the right common iliac artery. The patient underwent percutaneous transluminal angioplasty, plaque excision, and cutting balloon treatment of the right internal iliac artery.
A SilverHawk ES and subsequently MS plaque excision catheter used to treat the ostium on the right internal iliac artery.
Subsequently, a 5 mm x 20 mm in length cutting balloon was used to dilate the right internal iliac artery.
Subsequently, a 7 mm x 39 mm in length Genesis stent was deployed in the right common terminal section and the right proximal external iliac artery stenosis with an excellent angiographic result.
Finally, the patient underwent percutaneous transluminal angioplasty of the right internal iliac artery from a contralateral approach with a 5 mm x 20 mm in length Maverick angioplasty balloon catheter.
Next, angiography was performed in the right and left lower extremities from ipsilateral approach.
All the angiography hardware was removed. The arteriotomy sites were closed with the boomerang device bilaterally. It must be noted that heparin was given per protocol.
HEMODYNAMICS: Opening femoral artery pressure 140/70. Closing femoral artery pressure 140/70.
ABDOMINAL AORTOGRAPHY WITH ILIOFEMORAL RUNOFF:
1. The distal aorta is normal.
2. The left common iliac artery is normal.
3. The right common iliac artery is normal.
4. The right and left internal iliac arteries have critical or have a 90% stenosis bilaterally.
5. The right external iliac artery has a proximal 80-90% stenosis.
6. The left external iliac artery has a 10-20% stenosis.
7. The left common femoral artery is normal.
8. The right common femoral artery has 70-80% stenosis.
ANGIOGRAPHY OF RIGHT LOWER EXTREMITY:
1. The right common femoral artery has 70-80% stenosis.
2. The right profunda is normal.
3. The right superficial femoral artery is occluded in mid vessel and reconstituted at Hunter’s canal.
4. The right popliteal is normal.
5. Three-vessel infragenicular runoff.
ANGIOGRAPHY OF LEFT LOWER EXTREMITY:
1. The left common femoral artery is normal.
2. The left profunda is normal.
3. The left superficial femoral artery is normal.
4. The left popliteal artery is normal.
5. Three-vessel infragenicular runoff.
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND PLAQUE EXCISION OF THE RIGHT INTERNAL ILIAC ARTERY:
The 99% stenosis is reduced to 20% residual stenosis.
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND STENT DEPLOYMENT IN THE RIGHT EXTERNAL ILIAC ARTERY:
The 70% stenosis is reduced to 0% residual stenosis.
CONCLUSIONS:
1. Bilateral internal iliac artery disease.
2. Right distal common iliac artery and proximal right external iliac artery disease.
3. Right superficial femoral artery disease.
4. Successful percutaneous transluminal angioplasty and stent deployment of the right external iliac artery and distal right common iliac artery.
5. Successful percutaneous transluminal angioplasty, plaque excision, and cutting balloon therapy of the right internal iliac artery.
