Jaslene08
Guest
Please help me code this! I am new to vascular surgery coding.
ESCRIPTION OF THE PROCEDURE: The patient was brought to the operating room
and placed on to the operating room table. Bilateral lower extremity groin
sites were prepped and draped in the usual sterile fashion. Using an
ultrasound guidance, left femoral artery was accessed with a needle, a
micropuncture kit was used with a Seldinger technique to advance the wire into
the common iliac artery. A 5-French sheath was then placed over the wire.
Angiogram confirmed access of the common femoral artery. A Bentson wire was
then passed into the aorta. A pigtail catheter was then passed over the wire
into the aorta. Power injector was used with 20 mL of contrast for 10
seconds, with a PSI of 650 to perform an aortogram. Aortogram showed patent
distal aorta, patent common iliac arteries bilaterally, and patent internal
and external iliac arteries bilaterally. The pigtail catheter was then
changed over for a soft Omni using a guidewire. Using a glide, then the
contralateral iliac artery was successfully accessed and the Omni catheter was
then passed onto the common femoral artery on the right side. Serial
angiograms were then performed for the evaluation of the right leg arterial
vasculature. SFA seemed patent and opened with no specific disease up until
the distal portion at the beginning of the popliteal artery where there was a
7 to 10 cm lesion with a large collateral. Reconstitution of the popliteal
artery at the knee was appreciated, bifurcation into the tibioperoneal trunk
and the anterior tibial artery was obvious; however, the anterior tibial
artery did not opacify down into the foot. Posterior tibial artery is the
main blood flow artery down into the foot. Peroneal artery also seems to be
open. Attention was then concentrated to the lesion to try to cross it. A
TrailBlazer catheter was used with a stiff glide, Quick-Cross, and an Amplatz
wire, however, each attempt at trying to transverse the lesion was not
successful. The wires would prefer the large tributary that is transversing
around the CTO (chronic total occlusion). After multiple attempts at trying
to transverse the lesion, this was not successful and hence the catheter and
the wires were pulled back into the aorta with protection and eventually
removed from the left 5-French sheath. Sterile injections were then performed
of the right lower extremity, which showed patent SFA and profunda,
mild-to-moderate disease in the distal SFA, but no occlusions, flow in the
popliteal artery was brisk, anterior tibial peroneal and posterior tibial had
flow down to the foot except the posterior tibial seemed to be slightly
diseased. The 5-French sheath was then removed and pressure was held at the
entrance site for 20 minutes followed by a sterile compression dressing. The
left leg received a knee immobilizer for the next 4 hours where the patient
would be in the supine position in the recovery room. No hematoma was noted.
The pulse exam was unchanged postoperatively. The patient went to recovery
room in a stable condition.
ESCRIPTION OF THE PROCEDURE: The patient was brought to the operating room
and placed on to the operating room table. Bilateral lower extremity groin
sites were prepped and draped in the usual sterile fashion. Using an
ultrasound guidance, left femoral artery was accessed with a needle, a
micropuncture kit was used with a Seldinger technique to advance the wire into
the common iliac artery. A 5-French sheath was then placed over the wire.
Angiogram confirmed access of the common femoral artery. A Bentson wire was
then passed into the aorta. A pigtail catheter was then passed over the wire
into the aorta. Power injector was used with 20 mL of contrast for 10
seconds, with a PSI of 650 to perform an aortogram. Aortogram showed patent
distal aorta, patent common iliac arteries bilaterally, and patent internal
and external iliac arteries bilaterally. The pigtail catheter was then
changed over for a soft Omni using a guidewire. Using a glide, then the
contralateral iliac artery was successfully accessed and the Omni catheter was
then passed onto the common femoral artery on the right side. Serial
angiograms were then performed for the evaluation of the right leg arterial
vasculature. SFA seemed patent and opened with no specific disease up until
the distal portion at the beginning of the popliteal artery where there was a
7 to 10 cm lesion with a large collateral. Reconstitution of the popliteal
artery at the knee was appreciated, bifurcation into the tibioperoneal trunk
and the anterior tibial artery was obvious; however, the anterior tibial
artery did not opacify down into the foot. Posterior tibial artery is the
main blood flow artery down into the foot. Peroneal artery also seems to be
open. Attention was then concentrated to the lesion to try to cross it. A
TrailBlazer catheter was used with a stiff glide, Quick-Cross, and an Amplatz
wire, however, each attempt at trying to transverse the lesion was not
successful. The wires would prefer the large tributary that is transversing
around the CTO (chronic total occlusion). After multiple attempts at trying
to transverse the lesion, this was not successful and hence the catheter and
the wires were pulled back into the aorta with protection and eventually
removed from the left 5-French sheath. Sterile injections were then performed
of the right lower extremity, which showed patent SFA and profunda,
mild-to-moderate disease in the distal SFA, but no occlusions, flow in the
popliteal artery was brisk, anterior tibial peroneal and posterior tibial had
flow down to the foot except the posterior tibial seemed to be slightly
diseased. The 5-French sheath was then removed and pressure was held at the
entrance site for 20 minutes followed by a sterile compression dressing. The
left leg received a knee immobilizer for the next 4 hours where the patient
would be in the supine position in the recovery room. No hematoma was noted.
The pulse exam was unchanged postoperatively. The patient went to recovery
room in a stable condition.