i need help coding this. new to vascular coding.
OPERATION:
Aortoiliac angiography with bilateral lower extremity runoff
Cannulation of right 2nd order blood vessels.
IN DETAIL:
Tha patient was brought to the operating room and placed supin on the operating table. After induction of IV sedation, the groins were prepped and draped bilaterally in the usual sterile fashion. Marcaine 0.25% containing epinephrine was used to anesthetize the skin and subcutaneous tissues over th left common femoral artery. With ultrasound guidance, a large-bore needle was inserted into the left common femoral artery in a retrograde fashion, and through this a 0.035 guidewire was advanced. The guidewire was then used to advance a 5-French sheath through which a Glidewire was advacned in the aorta followed by an Omni Flush catheter which was used to perform an aorto-iliac angiography. The aorta and iliac arteries were free of significant aorto-iliac occlusive disease.
At this point, the Omni Flush catheter was used to direct a Glidewire down the right common iliac and external iliac arteries, and the Glidewire tip was situtated in the superficial femoral artery. Once wiere position had been confirmed, the Omni Flush catheter was replaced with a diagnostic straight catheter, which was advanced down to the superficial femoral artery. the Glidewiere was then removed and replaced with an Amplatz wire.
A 6-French Terumo sheath on its dialtor was then advanced over the Amplatz wire after removing the 6-French short sheath from the left femoral puncture site. The Terumo catheter tip was situated in the right groin region. At this point, runoff images of the right lower extremity were performed. These demonstrated some diffuse femoral and popliteal disease of the rigth leg, but also confimed occlusion of the tibioperonal trunch, with reconstitution of the peroneal artery, several centimeters beneath the tibioperoneal trunk. The peroneal artery provided runoff to the ankle. The right anterior tibial and posterior tibial arteries were occluded. After identifying the problem lesion on the right side, attention was turned ot the left lower extremity. The Terumo sheath was withdrawn in to the left iliac artery and, at this point, contrast was injected and runoff images of the left leg were performed. Due to the inability to selectively cannulate the femoral atery on the left, the images were poorer quality than on the right, but distal tibial disease was seen on the left side, but without obvious clearly identified occlusions.
Having completed the agiographym the Terumo sheath was removed and pressure was applied to the left groin for 15 minutes until excellent hemostatis was confiemed. A sterile dressing was then applied.
OPERATION:
Aortoiliac angiography with bilateral lower extremity runoff
Cannulation of right 2nd order blood vessels.
IN DETAIL:
Tha patient was brought to the operating room and placed supin on the operating table. After induction of IV sedation, the groins were prepped and draped bilaterally in the usual sterile fashion. Marcaine 0.25% containing epinephrine was used to anesthetize the skin and subcutaneous tissues over th left common femoral artery. With ultrasound guidance, a large-bore needle was inserted into the left common femoral artery in a retrograde fashion, and through this a 0.035 guidewire was advanced. The guidewire was then used to advance a 5-French sheath through which a Glidewire was advacned in the aorta followed by an Omni Flush catheter which was used to perform an aorto-iliac angiography. The aorta and iliac arteries were free of significant aorto-iliac occlusive disease.
At this point, the Omni Flush catheter was used to direct a Glidewire down the right common iliac and external iliac arteries, and the Glidewire tip was situtated in the superficial femoral artery. Once wiere position had been confirmed, the Omni Flush catheter was replaced with a diagnostic straight catheter, which was advanced down to the superficial femoral artery. the Glidewiere was then removed and replaced with an Amplatz wire.
A 6-French Terumo sheath on its dialtor was then advanced over the Amplatz wire after removing the 6-French short sheath from the left femoral puncture site. The Terumo catheter tip was situated in the right groin region. At this point, runoff images of the right lower extremity were performed. These demonstrated some diffuse femoral and popliteal disease of the rigth leg, but also confimed occlusion of the tibioperonal trunch, with reconstitution of the peroneal artery, several centimeters beneath the tibioperoneal trunk. The peroneal artery provided runoff to the ankle. The right anterior tibial and posterior tibial arteries were occluded. After identifying the problem lesion on the right side, attention was turned ot the left lower extremity. The Terumo sheath was withdrawn in to the left iliac artery and, at this point, contrast was injected and runoff images of the left leg were performed. Due to the inability to selectively cannulate the femoral atery on the left, the images were poorer quality than on the right, but distal tibial disease was seen on the left side, but without obvious clearly identified occlusions.
Having completed the agiographym the Terumo sheath was removed and pressure was applied to the left groin for 15 minutes until excellent hemostatis was confiemed. A sterile dressing was then applied.