Note from Chuck Clark, MD at 1991-10-14 10:30

CLINICAL DATA: PVD, IDDM. Non-healing ulcer. Partial amputation of right foot.

AORTOGRAM WITH RUNOFF:

Initially, the right common femoral artery was punctured. There was blood return but I was not able to pass a wire successfully into the iliac artery. The needle was pulled and pressure was held on the right. The left groin was then prepped and the left common femoral artery was successfully punctured and a pigtail catheter was placed in the midabdominal aorta. An aortogram reveals moderate atherosclerotic plaquing in the distal abdominal aorta. The lesions do not appear hemodynamically significant in the aorta. There is a stenosis in the left main renal artery, 1 cm distal from the origin. It is approximately 40 to 50 percent in severity. There is also irregular narrowing in the proper and right hepatic artery approximately 50 percent in severity which extends over a 2 cm segment. This could be due to extrinsic compression from a liver mass or could be atherosclerotic disease. The SMA appears widely patent.

The catheter was pulled down to the aortic bifurcation and a bifemoral runoff was performed using cut film. On the right, this is an approximately 80 percent stenosis in the very proximal portion of the right common iliac artery. The remainder of the iliac is tortuous and shows scattered atherosclerotic plaque. The most significant is in the external iliac, approximately 50 percent in severity. The profunda is patent. The SFA is patent, although it does show multiple atherosclerotic plaques, the most significant approximately 60 percent in the proximal SFA. The popliteal is widely patent. The anterior tibial is patent, with a moderate stenosis at the origin. The posterior tibial and peroneal occlude in the proximal calf. The anterior tibial runs down to the level of the ankle. A lateral digital foot reveals the anterior tibial to occlude at the ankle joint, with minimal if any, reconstitution of the dorsalis pedis. The posterior tibial reconstitutes just above the ankle and supplies the majority of the foot through the plantar pedal artery.

On the left, there are multiple plaques in the iliac system. The most severe is approximately 50 to 60 percent in the common iliac. The profunda and SFA are patent, with mild atherosclerotic irregularities noted. The popliteal is patent. The anterior tibial is widely patent and crosses the ankle. The posterior tibial and peroneal occlude in the calf, and there is reconstitution of the posterior tibial which crosses the ankle.

IMPRESSION:

1.      Atherosclerotic disease as above.

2.      Segmental stenosis in the hepatic artery as above. This probably represents atherosclerotic plaquing. If there are any laboratory abnormalities or physical finding referable to the area that would suggest a liver tumor, I would suggest imaging with CT scanning.

Chuck Clark, M.D.

Signed by Chuck Clark, MD at 1991-10-14 10:30