# Placement abdominal aortic stent & placement of bilateral common iliac stents



## nlbarnes (Apr 10, 2017)

Actually, I'm still looking for the placement of the abdominal aortic stent code.  My previous post has:
34812-50
37221-50

We've got a few opinions on this case.  There's an MUE on 37221 & surgeon originally had 37221 on 3 line items which I corrected to 37221 & 37221-50?.  I don't believe 37223 to be correct as it's not ipsilateral ???, 34802 to be correct because it's not an aneurysm.  

37221, 37221-50, 77001, 76937 OR
37221-50, 37223, 77001, 76937 OR
37221-50, 37223, 34802,

POSTOPERATIVE DIAGNOSIS: 
Bilateral lower extremity claudication bordering on rest pain. 

PROCEDURES: 
1.  Abdominal aortogram and pelvic angiogram. 
2.  Placement of abdominal aortic stent and placement of bilateral 
    common iliac stents in kissing stent fashion. 

The aortic stents were: 
1. 
    a.  10 x 57 balloon expandable Visi-Pro stent. 
    b.  Aortic stent 10 x 37 Visi-Pro. 
2.  Right common iliac stent, 7 x 57 Visi-Pro. 
3.  Left common iliac stent, 7 x 37 Visi-Pro. 

DESCRIPTION OF PROCEDURE: 
We accessed the bilateral common femoral arteries under ultrasound 
guidance with a micropuncture needle.  Micropuncture wire was advanced 
into the external iliac artery and exchanged for a 0.035 guidewire.  A 
6-French sheath was then placed.  Similar process was used 
bilaterally.  Ultrasound images were taken. 

At that point, we used a SOS Omniflush catheter and angled Glidewire to  
navigate the common iliac and abdominal aorta.  We placed our flush catheter  
into the distal aorta and performed abdominal aortogram. 

Abdominal aortogram revealed absent left renal artery, patent right 
renal artery, patent superior mesenteric artery, multilevel severe 
stenosis of the abdominal aorta, bilateral common iliac artery 
stenosis, diminutive yet patent external iliac arteries, absent 
bilateral hypogastric arteries, patent common femoral artery, patent 
proximal SFA and profunda femoris arteries. 

At that point, we then heparinized the patient to an ACT of greater 
than 250.  We then started by placing our proximal aortic stent, which 
was a 10 mm diameter x 57 mm length balloon expandable stent, this 
landed just below the right renal artery with excellent result.  We 
then extended this with a 10 mm x 37 mm balloon expandable stent, 
which extended just above the aortic bifurcation.  We then placed 
simultaneous 7 x 57 right common iliac artery stent and 7 x 37 left 
common iliac stent, this was placed up into the distal portion of the 
distal most aortic stent and deployed simultaneously in standard 
kissing stent fashion.  The flow through the abdominal aorta into the 
common iliac artery was excellent.  After deployment of the stents, 
there was no significant stenosis of the bilateral external iliac 
arteries into the common femoral arteries.  The common femoral 
bifurcation was patent bilaterally.  Distal runoff was not performed 
due to the patient's renal insufficiency in an attempt to use as 
little contrast as possible. 

We closed the right common femoral artery using a Perclose closure 
device.  We closed the left common femoral artery using an 8-French 
Angio-Seal without significant complication.  There were palpable 
pulses in the bilateral common femoral arteries upon completion, 
easily dopplerable signals in the pedal arteries bilaterally. 


701662665 02.15.17


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