4/16/2019 1 U N C R E X H E A L T H C A R E Patrick A Washko BSRT,RDMS,RVT,FSVU Technical Director North Carolina Heart and Vascular Hospital UNC Rex Healthcare Peripheral Vascular Laboratory Raleigh, NC Interesting Case Session Leading Edge Atlantic City 2019 Left Groin Left Groin Right Popliteal Aorta Celiac SMA U N C R E X H E A L T H C A R E A Special Thanks To The : UNC Rex Healthcare North Carolina Heart and Vascular Hospital Peripheral Vascular Lab Team • S. Wayne Smith M.D.,RVT,RDMS,FSVM,RVPI • Patrick A Washko BSRT,RDMS,RVT,FSVU • Robert Mendes M.D • Elvira Castellanos RDMS,RVT • Otis Darden RDMS,RVT • Dorian de Frietas M.D. RVPI • Kelly Edwards BS RDMS • Jason Kim M.D, RVPI • Martyn Knowles M.D. RPVI • Lauren Lissenden BS, RVT • Anna Moore BS , RDMS, RVS • Liliana Nanez M.D. RPVI • Jim Morgan MS, RVT • Lauren Estrada RDMS, RVT • Brandy O’hara RDMS, RVS • Olusegun Osinbowale, M.D. RVPI • Hillary Sawyer RVT • Daniel Sherrill RVT • Daryl Smith MBA,RDMS, RVT • Kristen Stahura BS RVT • Brian Stull, RDMS,RVT • Aaron Thomas, P.A.C, RVT • Sharon Wertz RDMS, RDCS, RVS U N C R E X H E A L T H C A R E How Important Is Clinical History? Lets Make A Diagnosis……… U N C R E X H E A L T H C A R E • Patient called 911 from a hotel • Patient was extremely confused • Patient walked in bare feet and slept outside overnight during a recent snow storm • Patient has been in hotel for 2-3 weeks and is now not able to walk and has no feeling in his right finger tips nor bilateral feet U N C R E X H E A L T H C A R E • Patient called 911 from a hotel • Patient was extremely confused • Patient walked in bare feet and slept outside overnight during recent snow storm • Patient has been in hotel for 2-3 weeks and is now not able to walk and has no feeling in his right finger tips nor bilateral feet U N C R E X H E A L T H C A R E
Transcript
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Patrick A Washko BSRT,RDMS,RVT,FSVU
Technical Director
North Carolina Heart and Vascular Hospital
UNC Rex Healthcare
Peripheral Vascular Laboratory
Raleigh, NC
Interesting Case Session
Leading Edge
Atlantic City 2019
Left
Groin
Left GroinLeft
Groin
Right Popliteal
AortaCeliac
SMA
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A Special Thanks To The :
UNC Rex Healthcare
North Carolina Heart and Vascular Hospital
Peripheral Vascular Lab Team
• S. Wayne Smith M.D.,RVT,RDMS,FSVM,RVPI
• Patrick A Washko BSRT,RDMS,RVT,FSVU
• Robert Mendes M.D
• Elvira Castellanos RDMS,RVT
• Otis Darden RDMS,RVT
• Dorian de Frietas M.D. RVPI
• Kelly Edwards BS RDMS
• Jason Kim M.D, RVPI
• Martyn Knowles M.D. RPVI
• Lauren Lissenden BS, RVT
• Anna Moore BS , RDMS, RVS
• Liliana Nanez M.D. RPVI
• Jim Morgan MS, RVT
• Lauren Estrada RDMS, RVT
• Brandy O’hara RDMS, RVS
• Olusegun Osinbowale, M.D. RVPI
• Hillary Sawyer RVT
• Daniel Sherrill RVT
• Daryl Smith MBA,RDMS, RVT
• Kristen Stahura BS RVT
• Brian Stull, RDMS,RVT
• Aaron Thomas, P.A.C, RVT
• Sharon Wertz RDMS, RDCS, RVS
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How Important Is Clinical History?
Lets Make A Diagnosis………
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• Patient called 911 from a hotel
• Patient was extremely confused
• Patient walked in bare feet and slept outside overnight during a recent snow storm
• Patient has been in hotel for 2-3 weeks and is now not able to walk and has no feeling
in his right finger tips nor bilateral feet
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• Patient called 911 from a hotel
• Patient was extremely confused
• Patient walked in bare feet and slept outside overnight during recent snow storm
• Patient has been in hotel for 2-3 weeks and is now not able to walk and has no feeling
in his right finger tips nor bilateral feet
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Frostbite
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• 17 year old
• Syncope while playing basketball
• Rushed in ambulance
• No pulses in legs
• Extreme pain
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Run Off
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Common Femoral Arteries
Right CFA Left CFA
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Superficial Femoral Arteries
Right SFA Left SFA
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Popliteal Artery Sagittal
Right Popliteal Artery
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Popliteal Artery Transverse
Right Popliteal Artery
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What Next ?
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Bilateral Common Iliac Arteries
Right Common Iliac Artery Left Common Iliac Artery
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What Next ?
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Aortic Thrombus
Distal Abdominal Aorta
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What Next ?
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Heart
Heart
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Echo
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Angiogram
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Intra-Operative and Post Op
Intraoperative Post Op
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• 48 year old female
• Pain LLE
• No Trauma
• No recent procedure
• Patient is a distance runner
• Recent extended travel
• Venous duplex ordered
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Distal Posterior Tibial Artery
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Saccular Posterior Tibial Artery Aneurysm
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Saccular Posterior Tibial Artery Aneurysm
B-Flow Transverse
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Correlation PTA
6-18-20136-19-2013
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Correlation PTA
6-18-2013 6-19-2013
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Angiography
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Correlation PTA
6-18-2013 6-19-2013
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PTA Aneurysm
6-20-2013
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Post Vein Patch
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Post Vein Patch U N
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Question
Does Anyone Ever Get the
request for a Stat Arterial and
Venous of a unilateral limb
Here?
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Acute Superficial Femoral Artery Embolus
Acute Femoral Thrombosis
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• 56 year old female
• Sudden left side weakness
• Visual disturbance right eye
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Right CCA
Proximal and Distal
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Right ICA
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Right ICA U N
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Right ICAProximal
Right ICAMid
Right ICADistal
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Right ICA
M-SMI Circumventing Thrombus-Ruptured Plaque
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Right ICA
M-SMI Circumventing Thrombus-Ruptured Plaque
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Right ICA
M-SMI Circumventing Thrombus-Ruptured Plaque
Distal Right
CCA-
BifurcationRight ICA
Embolus – Ruptured Plaque
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• 67 year old
• Rushed to hospital in extreme chest pain with breathing issues
• No pulses in right leg
• Extreme pain
• Had a “ Procedure ” done 2 weeks ago on right leg not sure what
