sslater
Networker
These still have me so confused. Please look at this one too and tell me what you think? I have these codes but i'm second guessing myself. I'm just still not comfortable with these.. Thanks again!!!!
34804
75952 26
34812/50
36200/50
and then i get lost...?????
OPERATIVE PROCEDURE:
Aortic stent graft for treatment of aortic aneurysmAn 8-French sheath was placed in the right femoral artery
percutaneously for access. The left groin cutdown was made using
a transverse suprainguinal crease incision. Common femoral
artery was dissected out and looped for vascular control. A
guidewire was passed up the right femoral artery into the aortic
arch area. An 18-gauge needle was used to access the exposed
left femoral artery and a guidewire likewise positioned up the
thoracic aorta.
Next a snare was placed up the right femoral sheath. Following
this the 17-French AFX sheath was placed up the left femoral
artery replacing it for the previously placed 6-French sheath.
This was done and the contralateral limb wire was passed up the
17-French sheath, snared with a snare, and brought out the right
femoral sheath. Once we had these under control. The AFX
bifurcated device was transferred to the AFX sheath and advanced
under fluoroscopy to the distal end to well above the aortic
bifurcation releasing the limb to the graft. We then pulled the
entire system down the aortic bifurcation. At that point we then
advanced the 0.014 Endologix guidewire up the contralateral limb
wire hypotube. Once this was done the main body of the graft was
deployed by pulling the control cord handle.
At this point retracted the AFX sheet deploying the ipsilateral
limb. We then removed the inner core assembly and advanced the
dilator into the AFX sheet. We then advanced the dilator and
sheath assembly to just above the level of the lowest renal
artery.
At this point we released the contralateral limb by retracting
the SurePass wire and pulling the limb cover from the limb. We
then passed up a pigtail catheter up over the 0.014 wire and
placed at just above the renal arteries.
At this point arteriogram was done to visualize the areas of the
renals. These were marked and a C-arm fixed.
Once this was done we advanced the infra- and suprarenal aortic
cuff above the renal arteries. We then removed the safety clip
and began deployment deploying two segments. We then pulled the
whole assembly back to place the highest point of the aortic cuff
graft just at the lower edge of the left renal artery, which was
about a centimeter distal from the right renal artery. Once we
had this in place deployment was completed. We then pulled back
the pigtail catheter and advanced up the center of the graft
through the aortic cuff. Arteriogram was done at this point
showing no visible endoleaks and good placement of the graft.
Because the deployment was made complete the decision was made to
forego any balloon dilatation.
Once we had accomplished this the device was removed from the
left femoral artery and clamps applied. The artery was repaired
using interrupted 6-0 Prolene sutures. Clamps released and good
pulse felt beyond repair. The right 8-French sheath was removed
using a Mynx closure device. This worked well without any
problems.
34804
75952 26
34812/50
36200/50
and then i get lost...?????
OPERATIVE PROCEDURE:
Aortic stent graft for treatment of aortic aneurysmAn 8-French sheath was placed in the right femoral artery
percutaneously for access. The left groin cutdown was made using
a transverse suprainguinal crease incision. Common femoral
artery was dissected out and looped for vascular control. A
guidewire was passed up the right femoral artery into the aortic
arch area. An 18-gauge needle was used to access the exposed
left femoral artery and a guidewire likewise positioned up the
thoracic aorta.
Next a snare was placed up the right femoral sheath. Following
this the 17-French AFX sheath was placed up the left femoral
artery replacing it for the previously placed 6-French sheath.
This was done and the contralateral limb wire was passed up the
17-French sheath, snared with a snare, and brought out the right
femoral sheath. Once we had these under control. The AFX
bifurcated device was transferred to the AFX sheath and advanced
under fluoroscopy to the distal end to well above the aortic
bifurcation releasing the limb to the graft. We then pulled the
entire system down the aortic bifurcation. At that point we then
advanced the 0.014 Endologix guidewire up the contralateral limb
wire hypotube. Once this was done the main body of the graft was
deployed by pulling the control cord handle.
At this point retracted the AFX sheet deploying the ipsilateral
limb. We then removed the inner core assembly and advanced the
dilator into the AFX sheet. We then advanced the dilator and
sheath assembly to just above the level of the lowest renal
artery.
At this point we released the contralateral limb by retracting
the SurePass wire and pulling the limb cover from the limb. We
then passed up a pigtail catheter up over the 0.014 wire and
placed at just above the renal arteries.
At this point arteriogram was done to visualize the areas of the
renals. These were marked and a C-arm fixed.
Once this was done we advanced the infra- and suprarenal aortic
cuff above the renal arteries. We then removed the safety clip
and began deployment deploying two segments. We then pulled the
whole assembly back to place the highest point of the aortic cuff
graft just at the lower edge of the left renal artery, which was
about a centimeter distal from the right renal artery. Once we
had this in place deployment was completed. We then pulled back
the pigtail catheter and advanced up the center of the graft
through the aortic cuff. Arteriogram was done at this point
showing no visible endoleaks and good placement of the graft.
Because the deployment was made complete the decision was made to
forego any balloon dilatation.
Once we had accomplished this the device was removed from the
left femoral artery and clamps applied. The artery was repaired
using interrupted 6-0 Prolene sutures. Clamps released and good
pulse felt beyond repair. The right 8-French sheath was removed
using a Mynx closure device. This worked well without any
problems.