# portal venography



## prabha (Oct 19, 2010)

Can anyone please confirm my codes for the below procedure,

37187
37201-59
37205
36011
75896-26
75960-26
75885-26

  Using real time ultrasound guidance, access was
       obtained into the a peripheral right portal vein branch using a 21
       gauge Chiba needle.  A 0.018 inch guide wire was advanced through
       the needle into the portal vein.  The needle was removed and
       exchange for a Neff coaxial dilator.  A seven French vascular
       sheath was then placed extending into the portal vein. Portal
       venography was performed. A 6 French MPA guiding catheter and a
       coaxially.-placed 4 French Berenstein catheter were advanced
       through the sheath and guided to the site of occlusion. A
       rock-hard occlusion of the main portal was then crossed using a
       hydrophilic guidewire and the catheter advanced into the superior
       mesenteric vein. The catheter was then exchanged for a 5 French
       sizing pigtail catheter which was positioned within the midportion
       of the superior mesenteric vein. A superior mesenteric/portal
       venogram was performed.

       After exchanging over a stiff guide wire, a 12 mm x 60 mm
       self-expanding Smart stent was deployed across the main portal
       vein occlusion extending into the right portal vein.  The stent
       was dilated using a 10 mm x 4 cm angioplasty balloon.  Repeat
       portal venography was performed.  A 6 French Possis mechanical
       thrombectomy device was then deployed within the main and right
       portal vein. Approximately 200 cc of fluid was aspirated. Repeat
       venography was performed. A multi-sidehole infusion catheter with
       a 10 cm long infusion length was then deployed extending from the
       upper superior mesenteric vein through the right portal vein. The
       right portal veins was then laced with 4 cc of alteplase. The
       patient was started on continuous infusion of alteplase through
       the infusion catheter at a total rate of 0.5 mg per hour. The
       catheter and sheath were sutured into place and a sterile dressing
       applied to the site. 

       Findings:  Portal venography demonstrates patency of the superior
       mesenteric and splenic veins.  Abrupt occlusion of the main portal
       vein beyond the junction of the superior mesenteric and splenic
       veins is noted. The occlusion extends for approximately 2.5-3 cm
       in length. Outflow is via tortuous, enlarged collateral vessels
       within the upper abdomen. A splenorenal shunt is identified.
       Partially obstructing intraluminal thrombus is identified within
       the right and left portal veins as well as in several right portal
       vein branches.  The stent was deployed extending from junction of
       the splenic and superior mesenteric veins, across the main portal
       vein and extending into the right portal vein. Following stent
       deployment and dilatation, poor flow is identified within the
       distal branches secondary to intraluminal thrombus. Mechanical
       thrombectomy using a 6 French Possis thrombectomy device was then
       performed with restoration of flow within the portal veins.
       However, intraluminal thrombosis was still identified within
       several branches. The patient was started on continuous infusion
       of alteplase into the portal vein as described above.

       Conclusion: Portal venogram demonstrating 2.5-3 cm long occlusion of the main
       portal from its origin and extending to the right and left portal
       veins. Partially-obstructing thrombus is identified within the
       right and left portal veins, as identified on previous CT scan of
       August 3. Outflow from the superior mesenteric and splenic veins
       is via enlarged collateral vessels within the upper abdomen. A
       prominent splenorenal shunt is identified.

       Successful deployment and dilatation of 12 mm x 6 cm
       self-expanding Smart stent across the portal venous occlusion
       extending into the right portal with good cosmetic result as
       described above.

       Mechanical thrombectomy of  portal vein thrombus was performed
       using a 6 French Possis thrombectomy device as described above.
       The patient was started on continuous thrombolytic infusion via
       multi-sidehole infusion catheter deployed across the main and
       right portal veins. The patient is to continue infusion overnight
       while being observed in the intensive care unit and is to return
       tomorrow for followup examination.


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## dpeoples (Oct 20, 2010)

prabha said:


> Can anyone please confirm my codes for the below procedure,
> 
> 37187
> 37201-59
> ...



I agree.


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