# Bronchial arteriogram



## prabha (Jan 27, 2010)

What should be the codes for the following procedure?


      1. Thoracic aortagram
      2.  Selective and superselective right bronchial arteriogram
      3.  Bronchial artery embolization
      4.  Conscious sedation


      The patient's right groin was prepped and draped in the usual
      sterile manner and locally anesthetized with 1% lidocaine.  The
      right common femoral artery was accessed with a micropuncture set,
      exchange made for a 6-French vascular sheath.  A 5-French Omni
      flush catheter was advanced into the thoracic aorta.  Digital
      subtraction aortography was performed in several projections.
      Selective catheterization was performed of the right
      intercosto-bronchial trunk.  Digital subtraction arteriography was
      performed.

      Findings:      
      There is a large caliber right intercosto-bronchial trunk which is
      visible on the thoracic aortogram.  Selective catheterization was
      performed with a Mickelson catheter and digital subtraction
      angiography demonstrates intercostal branch going to the second
      and third intercostal arteries on the right, and a large dilated
       abnormal appearing right bronchial artery, supplying areas with
      abnormal hypervascularity at multiple locations.  No AV shunting
      is identified.

      Intervention:      
      A Progreat microcatheter was advanced into the bronchial artery,
      beyond the origin of the intercostal artery.  Embolization was
      performed to stasis using the less than one vial of 500 --
      700-micron. embospheres  to complete stasis.  Completion
      angiography was performed both via the microcatheter and the
      Mickelson catheter, demonstrating good angiographic result.

      At the end of the procedure the catheter and the sheath were
      removed and hemostasis achieved with manual compression.  The
      patient tolerated the procedure well, left the department in
      stable condition.

      Impression:      
      Abnormal right intercostobronchial trunk and right bronchial
      artery, with multiple areas of hypervascularity.  The right
      bronchial artery was embolized to stasis with 500 -- 700-micron
      embosphere particles.  No immediate complications.


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