conleyclan
Guru
Vascular bypass surgery coding help..... thanks so much!!
PREOPERATIVE DIAGNOSIS: CEREBRAL vascular insufficiency due to occlusive
carotid and subclavian DISEASE.
PROCEDURE: Aorto right carotid aorto to right subclavian artery and aorta
to left carotid artery bypass using a 12 x 8 x 8 trifurcated GELWEAVE
GRAFT.
POSTOPERATIVE DIAGNOSIS: CEREBRAL vascular insufficiency due to occlusive
carotid and subclavian DISEASE.
OPERATIVE NOTE: Once the patient brought to the operating suite, --- was
prepped and draped in sterile fashion. Bilateral cutdowns were performed
on the distal carotid artery and the right axillary artery was also
isolated through an infraclavicular incision. Once we had done so, then we
performed a sternotomy. --- had a large amount of collaterals and severe
hypertension and we incurred a significant amount of bone and periosteal
bleeding that needed to be controlled. Once this had been controlled, we
then tunneled from the chest up to the carotid arteries bilaterally and
then began to tunnel into the right infraclavicular region with a peanut,
however, we incurred with bleeding at this point in doing so and the
patient became hypotensive and bradycardic. You know, we did not lose
significant amount of blood. --- remained hypotensive and her EEG
dampened. I thus placed --- on cardiopulmonary bypass by immediate
heparinization and a 2-stage venous cannula and then used a percutaneous
cannula in the mid arch, a soft area of the aorta. Once we had done so, we
were able to resuscitate the patient and then we placed a partial clamp on
the ascending aorta and sewed a 12 x 8 x 8 graft to this, tunneled a 12 mm
limb to the subclavian and then brought the 8 mm limbs to the carotid. We
initially performed a subclavian anastomosis using a partial clamp on the
axillary artery and 5-0 Prolene and then we performed end-to-end
anastomoses to both carotids. During this time, I had cooled the patient
to afford neurologic protection down to approximately 31 degrees. Then the
patient was rewarmed and then weaned from cardiopulmonary bypass; however,
--- required a significant amount of inotropic support and her EEG did not
return to baseline, although her _____ did return to baseline. We gave
protamine and once hemostasis had been achieved, the chest and the neck
incision were closed in several layers.
PREOPERATIVE DIAGNOSIS: CEREBRAL vascular insufficiency due to occlusive
carotid and subclavian DISEASE.
PROCEDURE: Aorto right carotid aorto to right subclavian artery and aorta
to left carotid artery bypass using a 12 x 8 x 8 trifurcated GELWEAVE
GRAFT.
POSTOPERATIVE DIAGNOSIS: CEREBRAL vascular insufficiency due to occlusive
carotid and subclavian DISEASE.
OPERATIVE NOTE: Once the patient brought to the operating suite, --- was
prepped and draped in sterile fashion. Bilateral cutdowns were performed
on the distal carotid artery and the right axillary artery was also
isolated through an infraclavicular incision. Once we had done so, then we
performed a sternotomy. --- had a large amount of collaterals and severe
hypertension and we incurred a significant amount of bone and periosteal
bleeding that needed to be controlled. Once this had been controlled, we
then tunneled from the chest up to the carotid arteries bilaterally and
then began to tunnel into the right infraclavicular region with a peanut,
however, we incurred with bleeding at this point in doing so and the
patient became hypotensive and bradycardic. You know, we did not lose
significant amount of blood. --- remained hypotensive and her EEG
dampened. I thus placed --- on cardiopulmonary bypass by immediate
heparinization and a 2-stage venous cannula and then used a percutaneous
cannula in the mid arch, a soft area of the aorta. Once we had done so, we
were able to resuscitate the patient and then we placed a partial clamp on
the ascending aorta and sewed a 12 x 8 x 8 graft to this, tunneled a 12 mm
limb to the subclavian and then brought the 8 mm limbs to the carotid. We
initially performed a subclavian anastomosis using a partial clamp on the
axillary artery and 5-0 Prolene and then we performed end-to-end
anastomoses to both carotids. During this time, I had cooled the patient
to afford neurologic protection down to approximately 31 degrees. Then the
patient was rewarmed and then weaned from cardiopulmonary bypass; however,
--- required a significant amount of inotropic support and her EEG did not
return to baseline, although her _____ did return to baseline. We gave
protamine and once hemostasis had been achieved, the chest and the neck
incision were closed in several layers.