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Was needing some help on the report below; as always thank you for your help!
36252 bilateral renal
37205 renal stent
75726(26)
75625 (26)
PROCEDURE:
After obtaining informed consent the patient was transported in a
nonsedated condition where she was prepped and draped in a sterile
fashion. During the procedure we monitored continuously her heart
rate, arterial blood pressure saturations, and respirations.
Intermittent boluses of Versed and Fentanyl were administered
between 11:24 and 11:58. A total of 2 mg of Versed and 100 mcg of
Fentanyl were used for conscious sedation. Lidocaine 2% was used
to infiltrate the skin and subcutaneous tissue overlying the left
radial artery after an Allen's test demonstrated adequate
collateral circulation. Utilizing a micropuncture kit a #5 French
sheath was placed in the right renal artery utilizing the
Seldinger technique. I then advanced a #5 French pigtail under
fluoroscopic guidance into the descending artery and positioned it
above the level of the renal arteries. Abdominal aortography was
performed by injecting 30 cc of contrast in the shallow LAO
oblique angulation. Following aortography we exchanged the
pigtail catheter for a multipurpose catheter and used this to
selectively engage the inferior mesenteric artery, the main right
renal artery and the left renal artery. Each of these arteries
were selective engaged and angiography was performed. We then
proceeded with the intervention as described below.
FINDINGS:
The patient's blood pressure ranged from 136 to 179/66 to 75.
ABDOMINAL AORTOGRAPHY:
The aorta to be normally tapered throughout its descending segment
and up to the aortic bifurcation. There are mild luminal
irregularities. The right kidney fills only the superior pole
well with contrast. The inferior pole appears as a vague outline
with clear differential in the filling of the inferior two-thirds
of the right kidney. The right kidney appears to have two renal
arteries, a small renal artery that supplies the superior third
and a larger renal artery that supplies the inferior two-thirds.
The larger of the two renal arteries is not well visualized
secondary to overlap from the superior mesenteric artery. The
celiac artery appears to be widely patent although its origin
cannot be visualized in this angulation. The superior mesenteric
artery appeared to have a tapering of 70% throughout its proximal
to mid segment and the inferior mesenteric artery is not well seen
at its origin although it is seen to fill on aortography. The
left kidney appears to have a solitary renal artery with
moderate-to-severe calcification in its proximal segment. The
severity of the stenosis could not be determined based on overlap
at its ostial proximal segment.
SELECTIVE INFERIOR MESENTERIC ANGIOGRAPHY:
There is a eccentric calcified plaque in the proximal-to-mid
segment of the inferior mesenteric artery that results in a 60-70%
stenosis.
RENAL ANGIOGRAPHY:
1. The main right renal artery supplies the inferior two-thirds.
It has a 90% stenosis in its proximal segment.
2. The left renal artery has moderate-to-severe calcification in
its proximal segment. It results in a 50% stenosis.
INTERVENTION:
Based on findings of high-grade stenosis to the renal artery to
the inferior two-thirds of the kidney we proceeded with
intervention. Heparin 5,000 units were administered and we
maintained an ACT greater than 250 throughout the duration of the
case. We engaged the inferior right renal artery with a #6 French
multipurpose guide catheter and passed a Spartacore 014 wire into
the renal artery. I then used a 4.0 x 12 mm Apex balloon to
dilate the proximal right renal artery. I then positioned and
deployed a 5.0 x 19 mm Boston Scientific Express bare-metal stent
with a maximal inflation up to 16 atmospheres dilating the
proximal two-thirds of the stent at that pressure. After removal
of the balloons and wires we had 10% residual stenosis in the
proximal renal artery. No evidence of perforation or dissection.
A TR band was applied for hemostasis.
36252 bilateral renal
37205 renal stent
75726(26)
75625 (26)
PROCEDURE:
After obtaining informed consent the patient was transported in a
nonsedated condition where she was prepped and draped in a sterile
fashion. During the procedure we monitored continuously her heart
rate, arterial blood pressure saturations, and respirations.
Intermittent boluses of Versed and Fentanyl were administered
between 11:24 and 11:58. A total of 2 mg of Versed and 100 mcg of
Fentanyl were used for conscious sedation. Lidocaine 2% was used
to infiltrate the skin and subcutaneous tissue overlying the left
radial artery after an Allen's test demonstrated adequate
collateral circulation. Utilizing a micropuncture kit a #5 French
sheath was placed in the right renal artery utilizing the
Seldinger technique. I then advanced a #5 French pigtail under
fluoroscopic guidance into the descending artery and positioned it
above the level of the renal arteries. Abdominal aortography was
performed by injecting 30 cc of contrast in the shallow LAO
oblique angulation. Following aortography we exchanged the
pigtail catheter for a multipurpose catheter and used this to
selectively engage the inferior mesenteric artery, the main right
renal artery and the left renal artery. Each of these arteries
were selective engaged and angiography was performed. We then
proceeded with the intervention as described below.
FINDINGS:
The patient's blood pressure ranged from 136 to 179/66 to 75.
ABDOMINAL AORTOGRAPHY:
The aorta to be normally tapered throughout its descending segment
and up to the aortic bifurcation. There are mild luminal
irregularities. The right kidney fills only the superior pole
well with contrast. The inferior pole appears as a vague outline
with clear differential in the filling of the inferior two-thirds
of the right kidney. The right kidney appears to have two renal
arteries, a small renal artery that supplies the superior third
and a larger renal artery that supplies the inferior two-thirds.
The larger of the two renal arteries is not well visualized
secondary to overlap from the superior mesenteric artery. The
celiac artery appears to be widely patent although its origin
cannot be visualized in this angulation. The superior mesenteric
artery appeared to have a tapering of 70% throughout its proximal
to mid segment and the inferior mesenteric artery is not well seen
at its origin although it is seen to fill on aortography. The
left kidney appears to have a solitary renal artery with
moderate-to-severe calcification in its proximal segment. The
severity of the stenosis could not be determined based on overlap
at its ostial proximal segment.
SELECTIVE INFERIOR MESENTERIC ANGIOGRAPHY:
There is a eccentric calcified plaque in the proximal-to-mid
segment of the inferior mesenteric artery that results in a 60-70%
stenosis.
RENAL ANGIOGRAPHY:
1. The main right renal artery supplies the inferior two-thirds.
It has a 90% stenosis in its proximal segment.
2. The left renal artery has moderate-to-severe calcification in
its proximal segment. It results in a 50% stenosis.
INTERVENTION:
Based on findings of high-grade stenosis to the renal artery to
the inferior two-thirds of the kidney we proceeded with
intervention. Heparin 5,000 units were administered and we
maintained an ACT greater than 250 throughout the duration of the
case. We engaged the inferior right renal artery with a #6 French
multipurpose guide catheter and passed a Spartacore 014 wire into
the renal artery. I then used a 4.0 x 12 mm Apex balloon to
dilate the proximal right renal artery. I then positioned and
deployed a 5.0 x 19 mm Boston Scientific Express bare-metal stent
with a maximal inflation up to 16 atmospheres dilating the
proximal two-thirds of the stent at that pressure. After removal
of the balloons and wires we had 10% residual stenosis in the
proximal renal artery. No evidence of perforation or dissection.
A TR band was applied for hemostasis.