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History & Physical

History & Physical. 77 yo retired physician with B LE claudication, R>L. PMH: CAD s/p CABG +AVR 12/03, prostate CA, HTN Exam: diminished L femoral pulse, no R femoral pulse, nonpalpable distal pulses, no tissue changes Lab: ABI=0.34 right, 0.30 on L. 50% aortic stenosis.

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History & Physical

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  1. History & Physical • 77 yo retired physician with B LE claudication, R>L. • PMH: CAD s/p CABG +AVR 12/03, prostate CA, HTN • Exam: diminished L femoral pulse, no R femoral pulse, nonpalpable distal pulses, no tissue changes • Lab: ABI=0.34 right, 0.30 on L

  2. 50% aortic stenosis High grade proximal RCI stenosis Mid LCI stenosis Occluded R ext iliac Left ext iliac stenosis

  3. Able to pass wire down occluded R ext iliac

  4. 4x2 balloon of proximal R CI to get 6F sheath up and over unsuccessful due to alpha looping of wire

  5. Decided to abort treating R lesion, turned attention to aorta + L iliac system

  6. 10x40 self expanding stent

  7. Post-stent dilatation with 6, 7, and 8mm balloons

  8. 8 x 20mm self expanding stent Post-stent dilation using 6 and 7mm balloons

  9. 6x20mm balloon on external iliac

  10. Follow-Up • Seen back in clinic one month later with resolution of L claudication • Walking significantly improved in terms of L leg, able to walk from parking lot to vascular center without stopping. • Still c/o R leg claudication

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