James Mitchell
71 / MaleMRN: SYNTH-MRN-001Lower Extremity PVI
1
AI First Pass2
Human Review3
Approved0/18 fields abstracted
Source Data
OPERATIVE NOTE
INDICATIONS
INDICATIONS:
This 71-year-old male presents with peripheral arterial disease (PAD), Rutherford Classification 3, manifesting as progressive left lower extremity claudication that now limits his walking distance to approximately one block on level ground. The patient has undergone a 6-month trial of conservative management including a supervised exercise program and cilostazol therapy, with inadequate symptom improvement. Non-invasive vascular studies demonstrated a left ankle-brachial index (ABI) of 0.58. CT angiography revealed an 85% stenosis of the left superficial femoral artery (SFA) at the mid-segment, extending over an approximate length of 8 cm. Given the severity of symptoms, failure of conservative therapy, and favorable lesion anatomy, endovascular revascularization was recommended. Risks, benefits, and alternatives were discussed, and informed consent was obtained.
PROCEDURE
PROCEDURE:
The patient was brought to the interventional suite and positioned supine on the angiography table. The right groin was prepped and draped in standard sterile fashion. Under ultrasound guidance, access was obtained at the right common femoral artery using a micropuncture technique. A 6-French vascular sheath was placed. Using a contralateral crossover approach, a 5-French Omni Flush catheter was advanced into the distal aorta and diagnostic angiography of the left lower extremity was performed. The 0.035-inch Glidewire was used to cross the SFA lesion, and catheter exchange was performed over an Amplatz Super Stiff wire. Pre-dilation of the lesion was performed using a 5mm x 80mm non-compliant balloon inflated to nominal pressure for 60 seconds. Definitive treatment was then performed with a 6mm x 80mm IN.PACT Admiral drug-coated balloon (Medtronic), which was inflated to rated burst pressure and maintained for 3 minutes per the instructions for use. Completion angiography was performed.
FINDINGS
FINDINGS:
Pre-intervention angiography demonstrated an 85% stenosis of the left superficial femoral artery at the mid-segment with a lesion length of approximately 8 cm. The lesion was characterized by eccentric, moderately calcified plaque. Post-intervention angiography demonstrated excellent technical result with residual stenosis of less than 10%, TIMI grade 3 flow, and no evidence of flow-limiting dissectionresidual stenosis of less than 10%, TIMI grade 3 flow, and no evidence of flow-limiting dissection. Three-vessel runoff was preserved with patent anterior tibial, posterior tibial, and peroneal arteries.
COMPLICATIONS
COMPLICATIONS:
None. There was no evidence of distal embolization, vessel perforation, or access site complication. Hemostasis at the right common femoral artery access site was achieved with manual compression. The patient tolerated the procedure well, was hemodynamically stable throughout, and was transferred to the recovery area in satisfactory condition. The post-procedure plan includes dual antiplatelet therapy with aspirin 81 mg and clopidogrel 75 mg daily for a minimum of 30 days, with follow-up ABI and clinical assessment at 4 weeks.