PROCEDURES PERFORMED:
Visceral angiogram, angioplasty, and stenting:
Celiac artery trunk stenting
TOTAL FLUOROSCOPY TIME: 28 minutes
SEDATION: Monitored by the IR registered nurse or surrogate, an independent trained observer providing Moderate Sedation with fentanyl.
CONSENT: Following discussion procedure its risks benefits (including bleeding and vessel damage) and alternatives, review of readily available relevant imaging prior to the procedure informed consent was obtained witnessed and documented upon the chart. Standard presurgical timeout confirming patient procedure and when relevant side and site was performed. Any discrepancies were resolved via consultation with appropriate readily available data sources. The patient was prepared and draped in standard sterile fashion.
DESCRIPTION OF PROCEDURE: After obtaining informed consent, the patient was prepped and draped in the usual sterile manner in supine position. After applying local anesthesia and making a small incision, the right common femoral artery was accessed using Seldinger technique using a micropuncture needle under real-time ultrasound guidance. The system was then converted to a .035 system and a 6-French sheath was advanced into the right groin. Next, a pigtail catheter was placed and a lateral aortogram was performed, delineating the SMA + Celiac artery origins. Next, a 5-French C2 Cobra and a SOS reverse angle catheters were advanced into the abdominal aorta over the wire. The C2 catheter was then carefully advanced into the proximal superior mesenteric artery over a Terumo Glidewire. SMA visceral angiogram images were then obtained. A 6 F long Ancel sheath was then placed at the origin of the SMA and over a Rosen wire, the sheath was advanced into the SMA. A 6mm balloon was then placed across the stenosis, and the balloon was then unsheath. Full inflation was performed. Final angiogram shows wide patency without significant residual stenosis. Next, the high grade celiac artery origin stenosis was cross with a Kumpe catheter and a glide wire, and a Rosen wire was placed. A 6F Ancel sheath was then placed over the stenosis and a 6mm balloon was used to dilate the stenosis. Due to significant elastic recoil and poor response to angioplasty (80-90% stenosis), a 7mm x 17mm balloon mounted stent was deployed across this stenosis with excellent patency achieved. Post angiogram shows wide patency.
FINDINGS: High grade intra-stent SMA stenosis and celiac trunk origin stenosis were successfully treated with 6mm balloons and 7mm stent across the recalcitrant celiac artery stenosis. Wide patency was achieved.
IMPRESSION:
Successful recanalization with balloon dilation of the severe intra-stent SMA stenosis. Wide patency was achieved.
Successful stenting of the high grade celiac artery stenosis (not responding to balloon angioplasty alone). “Median arcuate syndrome” stenosis of the celiac artery is less likely due to persistent stenosis during both inspiration + expiration.
**Patient will be observed for 23 hours, and started on Plavix with _____ loading dose then daily regimen.