Case Files: Angiogram and Angioplasty

Presenting Scenario: Patient presents complaining of weakness in both legs with decreased pulse bilaterally in the lower extremities (legs).

ER Physician Orders: Refer to Surgical Service

Surgical Procedures Ordered: Angiogram (see explanation below) with Angioplasty (see explanation below) and possible stent placement. No anesthesia will be used for the angiogram and angioplasty, however, the anesthesiologist must monitor patient's vitals.

Angiogram: Procedure of visualizing blood flow through arteries to assess level of lumen narrowing. In this case, we were visualizing the iliac arteries (near the legs/abdomen). We found some pretty extensive narrowing of the lumen of the artery that leads to the right leg. BUT, we also found that due to chronic stenosis of the artery that leads to the left leg, the patient had extensive vessel growth (anastomoses) to the left leg from the one good vessel for the right leg. Therefore, when the vessel for the right leg became stenosed, the patient experienced problems in both legs.

Angioplasty: Process of getting a small balloon to the site of stenosis in the vessel. We then inflate the balloon with some pressure and let is stay there for a minute or two. We then remove the balloon and use the fluoroscopy to visualize the site of the vessel again. The goal is that the balloon will cause the vessel to stay open. It is not uncommon, however, to have restenosis at a later date.

Results: In this case, we found that the vessel was fixed successfully following angioplasty, therefore no stent placement was necessary. Patient can be discharged within the day.