# PTA + Stenting



## amym (Aug 26, 2011)

PROCEDURE PERFORMED: 
1. Peripheral arteriogram with bilateral lower extremity runoff. 
2. Percutaneous transluminal angioplasty of the proximal superficial 
femoral artery. 
3. Percutaneous transluminal angioplasty and stenting of the left 
tibiofemoral trunk. 

INDICATION:  Severe claudication effect in the left leg. 

SUMMARY:  After informed consent, the patient was brought to the 
peripheral vascular lab and the right groin access was obtained without 
difficulty and OmniFlush catheter was advanced at the level of L1. 
Imaging was obtained for abdominal aorta with digital subtraction.  The 
catheter was pulled above the bifurcation and bilateral lower extremity 
runoff was performed using bolus chase method.  No complications 
occurred.  Subsequently percutaneous transluminal angioplasty of the 
left leg was performed. 

FINDINGS: 
1. The visualized portions of the aorta are normal. 
2. Bilateral common iliac, external iliac, and common femoral arteries 
show only mild atherosclerosis. 
3. There is severe disease below the common femoral artery. 
4. Right circulation reveals flash occlusion of the right superficial 
femoral artery, which reconstitutes at the level of the popliteal 
artery.  There is high grade stenosis of the posterior tibial artery of 
90% and anterior tibial is totally occluded.  There is two vessel runoff 
to the distal extremity with posterior tibial and peroneal artery and 
reconstitution of a portion of the anterior tibial artery. 
5. The left superficial femoral artery shows heavy disease diffusely in 
the proximal third and at the junction of proximal third to the middle 
third there is a 95% stenosis, which is followed by once again diffuse 
disease leading up to 60-70% stenosis in the middle third and then 
subsequently fairly normal caliber at the level of the popliteal artery. 
The left popliteal artery then leads to tibioperoneal trunk.  The 
anterior tibial artery is occluded immediately after the takeoff and at 
the take off of the anterior tibial artery there is a 90% stenosis of 
the tibioperoneal trunk leading up to two vessel runoff with posterior 
tibial and peroneal artery supplying the foot with some reconstitution 
of the anterior tibial artery as well. 
6. Severe vascular disease as described above effecting the right 
superficial femoral artery occlusion throughout its length with 
reconstitution of the popliteal artery and two vessel runoff using 
posterior tibial and peroneal arteries in the right leg. 
7. Left superficial femoral artery with 95% stenosis in the proximal 
third and 90% stenosis of the tibioperoneal trunk leading to two vessel 
runoff on the left side. 
8. Recommend PCI and CPI protocol.  Recommend percutaneous transluminal 
angioplasty.  Percutaneous transluminal angioplasty with contralateral 
approach was used and a 7-French sheath was advanced and crossed over 
the bifurcation into the left common femoral artery.  Imaging was 
obtained and subsequently an 0.014 guidewire was advanced and lesion in 
the superficial femoral artery was first crossed.  The superficial 
femoral artery was dilated with a 4 mm balloon.  Multiple inflations 
were done with marked improvement, with excellent improvement in flow. 
The middle lesions were not dilated due to concern for dissection.  Wire 
was then advanced and attention was focused to the tibioperoneal 
disease. 
9. The tibioperoneal trunk was crossed with an 0.014 wire and 
significant attempt was made to cross into the anterior tibial artery. 
This was not successful.  The wire was placed in the peroneal artery and 
then using the 4 mm balloon this was dilated and subsequently a 4 x 60 
I- 
DEV stent was then delivered to the tibioperoneal trunk with excellent 
results.  Marked improvement was noted in the distal extremity as well 
and at this point the entire assembly was removed.  No complications 
occurred. 

FINAL RESULTS: 
1. Successful percutaneous transluminal angioplasty of the left 
superficial femoral artery with 4 mm balloon with stenosis reduction 
from 95% to less than 40%. 
2. Successful percutaneous transluminal angioplasty and stenting of the 
tibioperoneal trunk using I-DEV 4 x 60 stent with stenosis reduction 
from 90% to less than 20%. 

Is it appropriate to code this as: 37224, 37230, 75716-26-59, 75625-26?


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## Jim Pawloski (Aug 26, 2011)

amym said:


> PROCEDURE PERFORMED:
> 1. Peripheral arteriogram with bilateral lower extremity runoff.
> 2. Percutaneous transluminal angioplasty of the proximal superficial
> femoral artery.
> ...



That's the way I would code the case.

Jim Pawloski, CIRCC


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