# Abd aortogram, pelvic arteriogram, iliac.....



## sslater (Oct 30, 2014)

Help- CV Surgery is very new to me. Can someone help me with this?? I have the 37221 for the iliac stenting.. 


*OPERATIVE PROCEDURE: Abdominal aortogram, pelvic arteriogram, 

bilateral lower extremity arteriogram and runoff from the femoral 

artery level, right common iliac artery stent angioplasty. *
Pelvic arteriogram: The pelvic vessels were patent with internal and 
external iliac arteries patent with calcified walls but no high-grade 

disease other than the high-grade calcific plaque at the inflow the 

right common iliac artery. Left lower extremity arteriogram and 

runoff, left common femoral artery, superficial femoral artery, 

profunda femorus were patent with calcifications in the walls and 

luminal irregularities. Left popliteal artery was patent. There was 

luminal irregularities in the tibial vessels; however, she had 

2-vessel runoff to the left foot. 

DESCRIPTION OF OPERATION: 

Right lower extremity arteriogram and runoff: Right common femoral 

artery, profunda femorus and superficial femoral arteries were patent. 

However, there was calcification and luminal irregularities. The 

right superficial femoral artery had multiple areas of calcification 

and 40-50 in some areas of 60% diffuse stenotic areas in the mid to 

distal right superficial femoral artery. Popliteal artery was patent. 

Tibial vessels have calcified plaque but were patent to the foot. 

DESCRIPTION OF OPERATION: The patient was taken to the operating room 

and placed in a supine position. General endotracheal anesthesia was 

administered. Lower abdomen, groins and legs were prepped and draped 

in the usual sterile manner. Using the CT angiogram for guidance, we 

accessed the left common femoral artery and a Glidewire was advanced 

into the thoracic aorta. All wire manipulation was done under 

continuous fluoroscopic guidance. A 4-French sheath was placed. An 

oblique angiogram done of the puncture site documenting common femoral 

artery puncture site. The pelvic angiogram was performed and left 

lower extremity arteriogram was performed. We accessed the right 

common femoral artery and noted approximately 40 mmHg difference 

between the radial artery pressure in the right common femoral artery. 

We advanced the Glidewire through the lesion and into the thoracic 

aorta. We heparinized the patient with a total of 10,000 units of 

intravenous Heparin and activated clotting time was approximately 300 

seconds. I placed a 6-French x 30 cm Raabe sheath on the right wire 

through the lesion with the tip in the lower abdominal aorta. The 

image intensifier and the bed were locked and flush aortography was 

performed and the lesion was visualized and measured. We placed a 7 

mm x 30 mm stent through the Raabe sheath and then withdrew the Raabe 

sheath positioning it in the common iliac artery extending into the 

aorta approximately 1 cm. We inflated this to 8-1/2 atmospheres and 

had good profiling. This stent material, because of the small 

diameter of the aorta and its protruding into the aorta, was in the 

blood flow track to the left common iliac artery. I had the up on the 

left side and decided to not place a stent in the left common iliac 

artery as this would have required an 8 mm stent because of the 

relative larger diameter and no stenosis on the left side. My concern 

with been to then in that deployment to crush the right-sided stent 

against the lateral aortic wall plaque which would then more an 

obstruction to flow than a widely open stent from the right side 

alone. We measured pressures and found approximately a 4 mmHg 

difference between the two legs and angiogram showed no evidence of 

extravasation or dissection. I used a StarClose device for hemostasis 

on the right side since a 4-French sheath was placed on the left we 

used digital pressure for hemostasis. Lower extremity perfusion was 

judged at the completion and found to have excellent flow with the 

right side, commensurate with the superficial femoral artery stenotic 

disease noted. Sterile dressings were applied and the patient was 

awakened and transported to the intensive care unit having tolerated 

the procedure well. All needles and wires, sharps and sponge count 

were correct x2.


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## Amy Pritchett (Oct 30, 2014)

You may want to also code for the 36200 for the bilateral arteriogram with runoff


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## theresa.dix@tennova.com (Nov 4, 2014)

sslater said:


> Help- CV Surgery is very new to me. Can someone help me with this?? I have the 37221 for the iliac stenting..
> 
> 
> *OPERATIVE PROCEDURE: Abdominal aortogram, pelvic arteriogram,
> ...



This is poor dictation but what I can get out of it is 75716-59 and your iliac stent code 37221. barely!


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