REPORT OF CATH LAB PROCEDURE
FACILITY: Garfield Medical Center (Cath Lab)
DATE OF PROCEDURE: ____
SURGEON: Peter Lin, MD
PREOPERATIVE DIAGNOSIS: 1. Left subclavian artery stenosis, 2. Left arm ischemia
POSTOPERATIVE DIAGNOSIS: Same
1. Percutaneous access of left brachial artery under ultrasound guidance (CPT# 76937)
2. Catheter placement in the thoracic aorta for aortogram and extracranial carotid artery angiogram (CPT# 36221)
3. Selective catheterization of left subclavian artery with selective angiogram (CPT# 36140 & 75710-XU)
4. Percutaneous stent placement of left subclavian artery using balloon expandable stent (CPT# 37236)
ANESTHESIA: Local anesthesia
ESTIMATED BLOOD LOSS: 2 ml
BLOOD ADMINISTERED: None
IV FLUID: 200 ml
DRAIN / TUBE PLACED: None
INDICATIONS: This is a ___ year-old patient who has been diagnosed with left subclavian artery stenosis. The patient reports symptoms including left arm fatigue and pain. Due to the symptomatic left subclavian artery stenosis, the patient was scheduled to undergo left subclavian artery stent placement. I've discussed with the patient regarding the benefits and risks of the procedure. The patient is aware of the benefits of the planned procedure which is to improve his left upper extremity arterial circulation. The patient is also aware of the potential risks of the procedure, which include contrast-induced nephropathy, vessel perforation, arterial dissection, contrast-induced allergic reaction, bleeding, and wound infection. The overall risk of these complications is 1%. The patient has accepted these benefits and risks, and agreed to proceed with the planned procedure.
PROCEDURE IN DETAIL: The patient was brought to the cath lab and placed on the cath lab table in the supine position. The patient's left arm was prepped sterilely and draped in the standard fashion. Appropriate time out was performed whereby the patient and site of surgery were identified. Local anesthesia was administered in the left antecubital region. Using ultrasound guidance, the left brachial artery was accessed and a 6F introducer sheath was inserted. Next a guidewire and a diagnostic pigtail catheter were placed in the ascending thoracic aorta and an aortogram was performed using a power injector. Next we placed a catheter in the left subclavian artery, which was followed by left subclavian artery angiogram. This confirmed a high grade 90% stenosis of the left subclavian artery. Next we deployed a ____ mm x ____ mm _________ balloon expandable stent across the left subclavian artery stenosis. Completion angiogram showed successful stent placement with 0% residual stenosis. Next the catheter and sheath were removed from the left arm. Manual pressure was applied in the left arm to achieve groin hemostasis. The patient tolerated the procedure well and suffered no complications. I was present throughout the entire procedure.
IMPRESSION: Successful left subclavian artery stent placement for high grade left subclavian artery stenosis.
TREATMENT DISPOSITION - The patient will be discharged to home and follow up in my office in 2 weeks.
Peter Lin, MD | Vascular Surgery
Office: 612 W. Duarte Ave. #303, Arcadia, CA 91007