EikaMTGQueen
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Help! An embolization was performed in the left internal iliac. Is this considered part of the graft placement or can you code this separate as 37242?
Thanks
Erica Ross CIRCC, RCC
Reason for Visit: AAA
Reason for Exam: AAA
Abdominal aortic endograft 10/20/2015
History: Abdominal aortic aneurysm.
Impression:
1. Successful Endograft placement: Medtronic Endurant
2. Endoleak: Type II.
3. Additions Procedures: Bilateral extensions into the external iliac
arteries. Embolization of the left internal iliac artery with
Amplatzer plug.
Anesthesia: General endotracheal.
Fluoro time: 32.6 minutes
Contrast: Isovue-250, 160 mL.
Procedure: Informed consent was obtained. Risk benefits and
alternative procedures were discussed.
Once anesthetized the patient was placed on the angio table. The
abdomen and groins were sterilely prepped and draped. The common
femoral arteries were surgically exposed. Each common femoral artery
was entered with a micropuncture needle.
Left internal iliac artery embolization: The left internal iliac
artery was selectively catheterized from contralateral approach. A 6
French sheath was advanced. A 16 mm Amplatzer II plug was deployed.
Catheter and wires were manipulated into the aorta. The position of
the wires was checked in the thoracic aorta. The renal arteries were
identified, the main body of the endograft was placed from the
rightcommon femoral artery approach. The left iliac limb was placed
after checking the position of the internal iliac artery. The graft
extends into the right external iliac artery and the left external
iliac artery. The iliac endpoints were planned.The graft was ballooned
in place.
The following endograft components were utilized
1. Main body: 28 x 16 x 1 66
2. Left Iliac limb: 16 x 10 x 1 99
3. Planned Iliac extension: Right external iliac artery with 16 x 10 x
1 24.
4. Un-planned iliac extension: Extension of right external iliac limb
due to tortuosity and accordion narrowing with 10 x 10 x 82]
Other procedures:
1. As noted above embolization of the left internal iliac artery was
performed.
2. Extension deep into the right external iliac artery just above the
inguuinal ligament due to tortuosity.
Findings: The aorta is atherosclerotic. There is an infrarenal
abdominal aortic aneurysm. The left renal artery is in the inferior
position.
Post endograft placement the endograft appears in good position. There
is a Type II endoleak. The internal iliac arteries are occluded
bilaterally by coils.. External iliac arteries remain intact and
patent bilaterally.
Thanks
Erica Ross CIRCC, RCC
Reason for Visit: AAA
Reason for Exam: AAA
Abdominal aortic endograft 10/20/2015
History: Abdominal aortic aneurysm.
Impression:
1. Successful Endograft placement: Medtronic Endurant
2. Endoleak: Type II.
3. Additions Procedures: Bilateral extensions into the external iliac
arteries. Embolization of the left internal iliac artery with
Amplatzer plug.
Anesthesia: General endotracheal.
Fluoro time: 32.6 minutes
Contrast: Isovue-250, 160 mL.
Procedure: Informed consent was obtained. Risk benefits and
alternative procedures were discussed.
Once anesthetized the patient was placed on the angio table. The
abdomen and groins were sterilely prepped and draped. The common
femoral arteries were surgically exposed. Each common femoral artery
was entered with a micropuncture needle.
Left internal iliac artery embolization: The left internal iliac
artery was selectively catheterized from contralateral approach. A 6
French sheath was advanced. A 16 mm Amplatzer II plug was deployed.
Catheter and wires were manipulated into the aorta. The position of
the wires was checked in the thoracic aorta. The renal arteries were
identified, the main body of the endograft was placed from the
rightcommon femoral artery approach. The left iliac limb was placed
after checking the position of the internal iliac artery. The graft
extends into the right external iliac artery and the left external
iliac artery. The iliac endpoints were planned.The graft was ballooned
in place.
The following endograft components were utilized
1. Main body: 28 x 16 x 1 66
2. Left Iliac limb: 16 x 10 x 1 99
3. Planned Iliac extension: Right external iliac artery with 16 x 10 x
1 24.
4. Un-planned iliac extension: Extension of right external iliac limb
due to tortuosity and accordion narrowing with 10 x 10 x 82]
Other procedures:
1. As noted above embolization of the left internal iliac artery was
performed.
2. Extension deep into the right external iliac artery just above the
inguuinal ligament due to tortuosity.
Findings: The aorta is atherosclerotic. There is an infrarenal
abdominal aortic aneurysm. The left renal artery is in the inferior
position.
Post endograft placement the endograft appears in good position. There
is a Type II endoleak. The internal iliac arteries are occluded
bilaterally by coils.. External iliac arteries remain intact and
patent bilaterally.