# Another cath procedure



## sowmya (Nov 11, 2009)

Can anybody help me with coding this cath procedure. Thank you in advance
skk



Diagnoses
1.	Clavdication on minimal exertion
2.	Peripheral vascular disease
Procedures Performed
1.	Aortogram with runoff
2.	Angioplasty of distal right superficial femoral artery.
3.	Atherectomy for severe disease in the right distal superficial femoral artery.
Procedure:   The patient was brought to the cath lab after informed consent was obtained. Th patient was prepped and draped in a sterile fashiom. Following administration of local anesthesia in the left groin, 5- French sheath was inserted into the left femeral arteryusing modified seldinger technique. A 5 French pigtail was advanced to the junction between L1 and L2 vertebrae. Imaging was started. Following detection of total occulusion of distal right suberficial femoral artery, we switched to a 7 French Ansel sheath. Prior to switching to Ansel sheath, we crossed over to the right side using the pigtail and Newton guidewire. Leaving the pigtail in the right side, we withdrew the Newton guidewire and andvanced the stiff angled glide to the right common femoral artery. Across the exchange length stiff angled glide, we advanced a 7-French Ansel long sheath up to the right common femoral artery. Stiff angled glide and Quick-Cross catheters were used together to cross the chronic total occlusion. Prior to this crossing, intravenous heprin bolus was given to the patient. After crossing the chronic total occlusion using a stiffangled glide and Quick-Cross catheter, the plidewire was withdrawn. A spider basket was advanced through the Quick-Cross all the way up to the popliteal artery close to the knee joint. Prior to the Spider basket insertion, intraluminal positon of the tip of the Quick-Cross was confirmed by aspiration of blood and by obtaining selective images of popliteal artery by contrast injection. At this point of time, I attempted to advance a LSM Fox Hollow atherectomy deviceacross the diseased segment of the artery without success. In viewof this, atherectomy device was withdrawn and 3.0 x 40mm Nano-balloon was advanced across the diseased segment and multiple inflations were preformed up to 10 atomospheres. Following this the balloon was withdrawn and we were able to treat the diseased area in the distal right superficial femoral artery with 4 passes of LSM Fox Hollow atherectomy device. Images obtained postprocedure revealed good flow. 

Findings:
1.	Renal ateries are single bilaterally with no evidence of significant disease.
2.	Abdominal aorta demonstrates mild atherosclerosis with no evidence of significant atherosclerosis.
3.	Right common iliac is a normal-sized vessel with no significant disease. Right internal iliac demonstrats mild disease at its origin. Right external iliac is a normal-size vessel that is mildly tortuous and reveals no evidence of significant disease. Right common femoral is a normal-sized vessel with no significant disease. Right superfifial femoral is normal-sized vessel that demonstrates total occlusion in the distal segment. This is about a 4cm long occlusion. Distally it fills via collaterals. Right popliteal artery is a normal-sized vessel that reveals no evidence of significant disease. Right anterior tibial appears to be occluded soon after its origin. Tibioperoneal trunk is normal with no significant disease. Posterior tibial artery appears to be a normal-sized vessel. Peroneal demonstrates signficant disease in the proximal portion. Overall, 2 vessel runoff is noted to the right foot.
4.	Left common iliac is a normal-sized vessel with no signifcant atherosclerosis. Left evternal iliac is a normal-sized vessel with no significant disease. Left internal iliac demonstrates mild disease at its origin. Left common femoral is a normal-sized vessel with no significant disease. Left superfifial and deep femoral system appears to have mild atherosclerosis with no evidence of critical stenosis. Left popliteal is normal-sized vessel. Left-sided trifurcation demonstrates total occlusion of left anterior tibial. Tibioperoneal trunk appears to be with no significant disease. Left peroneal artery appears to be severely diseased throughout. There is single-vessel runoff to the left foot via the posterior tibial artery. 
FINAL IMPRESSION: Successful atherectomy treatment for chronic total occlusion of 40mm segment of distal right superficial femoral artery.


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