# Lower Extremity Angiogram



## Tvuong (Apr 29, 2014)

I coded 37228, 37232, 93454-26-59, and 75710-26-59 for the report included below. Just wanted to know if this is correct.

Diagnostic Lower Extremity Angiogram

Pre-Procedure Diagnosis: Claudiaction, severe peripheral ans atherosclerotic disease of the anterior and posterior left tibial areteries.
Post-Procedure Diagnosis: Same

Procedure performed: Selective coronary arteriogram Abdominal aortic angiogram and left lower extremity run-offs, selective iliac angiogram x 2.PERIPHERAL ANGIOPLASTY OF THE LEFT TIBIOPERONEAL TRUNK, AND THE LEFT ANTERIOR TIBIAL ARTERY.

Anesthesia Used: IV versed and fentanyl, local 2% lidocaine

Blood Loss: less than 10 mL

Condition: stable

IV Contrast Used:  195 mL

Complications: none

Procedure and Findings in Detail: The procedure was described to the patient including benefits, risks, and alternatives to the procedure.  The patient confirmed understanding.  The patient signed the informed consent.  She was brought into the cath lab.  The left  GROINS:23205 was prepped in a sterile fashion, and a sterile drape was placed over the patient.

The left common femoral artery (CFA) was palpated and the region above the artery was anesthetized with 2% local lidocaine.  A Cook needle was used to access the left CFA.  The wire was visualized under fluoroscopy ascending into the common iliac artery.  A 6 French sheath was placed over the wire without difficulty in the normal form and fashion. AJL4 catheter was utilized to opacifiy the keft coronary in multiple projections; subsequently the right coronary was opacified in the LAO projection.


A 5Fr Omniflushl was advanced over the J wire to the proximal abdominal aorta.  The catheter was aspirated and flushed with normal saline.  The position of the catheter was adjusted to just proximal of the bilateral renal arteries.  An abdominal aortic angiogram was taken using the injector.  The results of the abdominal aortic angiogram showed the following: Critical long stenosis of the eleft anterior tibial artery and a lesser stenosis of the tibioperoneal trunk.

r  .The Omniflush catheter directed the J wire into the left common iliac artery.  The wire was advanced to the proximal femoral artery.  The catheter was then advanced to the external iliac artery, and the wire removed.  The catheter was aspirated and flushed with normal saline.  A left lower extremity run-off was performed and revealed as described above. It was decided to proceeed with peripheral intervention. 5000 units of heparin was given, The short sheath was exchanged for 6 x 65 destination sheath. A support seeker 014 x 135 cm was advanced under fluoroscopy and positioned in the left tibioperoneal trunk. The lesion was crossed withan Asahi Miraclebros wire 014 x 300 cm. A Vascutrak balloon was then advanced and positined at the site of the stenosis, and the balloon was inflated to 4 ATM until by fluorocopy ws noted to be fully inflated. 2 minute inflation was done. An iliac angiogram with a runoff revealed an excellent result. Thereafter  The anterior tibial was cannulated with the seekeer and an Asahi Prowater crossed the lesion The Vascutrak balloon 2.5 x 60 was inflated to 5 ATM until full inflation was noted. A 2 minute inflation was performed. Thereafter the balloon ws removed and final angiography demonstrated a good final angiographic result.

The catheter was pulled back into the opposite external iliac artery over the wire.  The wire was removed.  A left lower extremity run-off was performed and revealed good angiographic result..

The patient was in hemodynamically stable condition throughout entirety of the procedure.  The sheath was removed and manual pressure was held for 20 min.  A 10 lb sandbag was placed over the groin of entry for 4 hours, and the patient will be on bed rest for the duration.  Aggressive medical management for CAD and associated risk factors will continue and there are no changes to the medications.  The patient has been encourage to start a walking regimen.  Patient will follow-up with me on April 30  2014.


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## lovelyadd (Apr 30, 2014)

I would also add 75625,26 for the abdominal aaortography


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