# case



## MLS2 (Jul 1, 2009)

here's another one to play with


The patient gave verbal consent for the procedure. The left groin was prepped and draped in the usual sterile fashion. Puncture of the left common femoral artery was performed using Seldinger technique. A 5Fr sheath was placed over a Bentson wire. Through the sheath, a 5Fr Contra catheter was advanced into the distal aorta. Contrast was injected through the catheter and DSA imaging of the pelvis was performed. Up and over access to the right internal iliac artery was performed using the Contra. Contrast was injected and DSA imaging was performed as a right internal iliac arteriogram. A 5Fr Ansel sheath was placed. Through the sheath, a 5Fr Bern catheter was used to select and inject the origin of the right iliolumbar artery. DSA imaging was performed. More distal access to the iliolumbar artery was achieved using a Renegade microcatheter. Contrast was injected and DSA imaging was performed. The iliolumbar artery was embolized using gel foam slurry and coils. Contrast was injected and DSA imaging was performed as follow-up to the embolization. The catheter was redirected into the superior gluteal artery. Contrast was injected and DSA imaging was performed. The superior gluteal artery was then embolized to occlusion using gel foam slurry. Contrast was injected through the catheter and DSA imaging was performed as follow-up to the embolization. The catheter was then redirected into the external iliac artery. Contrast was injected and DSA imaging was performed. The origin of the deep iliac circumflex artery was then catheterized using a 5Fr C2 catheter and an angled Glidewire. Contrast was injected and DSA imaging was performed as a selective arteriogram. Superselective catheterization of two distal branches was achieved using the Renegade catheter and a GT wire. In each case, contrast was injected and DSA imaging was performed. In each case, the vessel was embolized using 018 coils. In each case, contrast was injected and DSA imaging was performed. The sheath was exchanged for a short 5Fr sheath. The C2 catheter was redirected into the aorta and used to select and inject the right renal artery. DSA imaging was performed. Over the glidewire, the catheter was advanced into a lower pole branch. Contrast was injected and DSA imaging was performed. The catheter was removed. Contrast was injected through the sheath side arm and DSA imaging of the left groin was performed in the LAO projection. The punture site was then closed using an Angioseal device. 
FINDINGS: 
Active extravasation was seen from distal branches of the right iliolumbar, superior gluteal and deep iliac circumflex artery. Each vessel was embolized to occlusion as described. Nonselective and selective right renal arteriogram showed a mild defect in the inferior medial nephrogram without associated vessel injury. There is mild atherosclerotic disease in the distal aorta, common iliac and external iliac arteries. The common femoral and proximal SFA and profundas are without significant disease. The left femoral puncture site is in to the mid common femoral artery. 
INTERPRETATION: 
1. Active extravasation was seen from distal branches of the right iliolumbar, superior gluteal and deep iliac circumflex artery treated by coil and gel foam embolization as described. 
2. No other angiographic evidence of vessel injury.


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## Shirleybala (Jul 2, 2009)

Codes for int iliac and iliolumbar
36247
75736(int iliac)
75774(iliolumbar)
37204(embo)
75894
75898(post embo)

Superior gluteal
36248(sup gluteal)
75774-59(sup gluteal S & I)

Ext iliac and deep circumflex
36248-59(deep circum)
75710(ext iliac S & I)
75774-59(deep circum S & I)

Renal and lower pole branch
36246-59(cath upto lower pole branch)
75722(Renal S & I)
75774-59 (lower pole branch S & I)

Abdominal aortogram is included in 75722
I have coded embolization only once because those are in same operative field.(I dont have clear idea abt embolization)


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