What should be the codes for the following procedure?
1. Thoracic aortagram
2. Selective and superselective right bronchial arteriogram
3. Bronchial artery embolization
4. Conscious sedation
The patient's right groin was prepped and draped in the usual
sterile manner and locally anesthetized with 1% lidocaine. The
right common femoral artery was accessed with a micropuncture set,
exchange made for a 6-French vascular sheath. A 5-French Omni
flush catheter was advanced into the thoracic aorta. Digital
subtraction aortography was performed in several projections.
Selective catheterization was performed of the right
intercosto-bronchial trunk. Digital subtraction arteriography was
performed.
Findings:
There is a large caliber right intercosto-bronchial trunk which is
visible on the thoracic aortogram. Selective catheterization was
performed with a Mickelson catheter and digital subtraction
angiography demonstrates intercostal branch going to the second
and third intercostal arteries on the right, and a large dilated
abnormal appearing right bronchial artery, supplying areas with
abnormal hypervascularity at multiple locations. No AV shunting
is identified.
Intervention:
A Progreat microcatheter was advanced into the bronchial artery,
beyond the origin of the intercostal artery. Embolization was
performed to stasis using the less than one vial of 500 --
700-micron. embospheres to complete stasis. Completion
angiography was performed both via the microcatheter and the
Mickelson catheter, demonstrating good angiographic result.
At the end of the procedure the catheter and the sheath were
removed and hemostasis achieved with manual compression. The
patient tolerated the procedure well, left the department in
stable condition.
Impression:
Abnormal right intercostobronchial trunk and right bronchial
artery, with multiple areas of hypervascularity. The right
bronchial artery was embolized to stasis with 500 -- 700-micron
embosphere particles. No immediate complications.
1. Thoracic aortagram
2. Selective and superselective right bronchial arteriogram
3. Bronchial artery embolization
4. Conscious sedation
The patient's right groin was prepped and draped in the usual
sterile manner and locally anesthetized with 1% lidocaine. The
right common femoral artery was accessed with a micropuncture set,
exchange made for a 6-French vascular sheath. A 5-French Omni
flush catheter was advanced into the thoracic aorta. Digital
subtraction aortography was performed in several projections.
Selective catheterization was performed of the right
intercosto-bronchial trunk. Digital subtraction arteriography was
performed.
Findings:
There is a large caliber right intercosto-bronchial trunk which is
visible on the thoracic aortogram. Selective catheterization was
performed with a Mickelson catheter and digital subtraction
angiography demonstrates intercostal branch going to the second
and third intercostal arteries on the right, and a large dilated
abnormal appearing right bronchial artery, supplying areas with
abnormal hypervascularity at multiple locations. No AV shunting
is identified.
Intervention:
A Progreat microcatheter was advanced into the bronchial artery,
beyond the origin of the intercostal artery. Embolization was
performed to stasis using the less than one vial of 500 --
700-micron. embospheres to complete stasis. Completion
angiography was performed both via the microcatheter and the
Mickelson catheter, demonstrating good angiographic result.
At the end of the procedure the catheter and the sheath were
removed and hemostasis achieved with manual compression. The
patient tolerated the procedure well, left the department in
stable condition.
Impression:
Abnormal right intercostobronchial trunk and right bronchial
artery, with multiple areas of hypervascularity. The right
bronchial artery was embolized to stasis with 500 -- 700-micron
embosphere particles. No immediate complications.