reneedanielle22
Networker
The skin and subcutaneous tissues overlying the right internal jugular vein were infiltrated with 1 % lidocaine to achieve sufficient local anesthesia. Utilizing sonographic guidance, the internal jugular vein was accessed with a 21 gauge needle. A microwire was passed through the needle into the IVG. The needle was removed. A micropuncture sheath was placed. An 035 J wire was placed through the sheath which was removed and replaced with a 6F sheath.
Then using a 5F MP catheter the left common iliac vein was catheterized. A venogram was performed demonstrating a patent IVG and left common iliac vein stent. Then using the catheter the left renal vein was catheterized and a venogram was performed. The catheter was then negotiated into the left gonadal vein. The catheter was passed distally into the pelvic veins above the pelvic rim. Venogram was performed showing a refluxing large caliber left gonadal vein, extensive pelvic collateral vein network and eventual! filling of a large right gonadal vein. The network was filled with approximately 10 cc of contrast. Then a mixture of 4:1 1% polidocanol with air foam was prepared and a total of 10 cc of foam sclerotherapy was injected into the pelvis through the distal gonadal vein. Then the proximal and mid gonadal vein was embolized with five 9 mm non-detachable and one 12 x 9 mm detachable 20 cm Interlock coil. Repeat injections showed stasis of flow in the left gonadal vein.
Attention was then directed to the right gonadal vein. However despite multiple attempts and using multiple different catheters, the vein could not be accessed. Given limitations of contrast use and time, we elected to complete the procedure at this stage to determine if unilateral embolization would provide substantial clinical improvement and determine if we should bring her back for right sided embolization at a different time if she does not feel substantial improvement.
How would i code this?
Then using a 5F MP catheter the left common iliac vein was catheterized. A venogram was performed demonstrating a patent IVG and left common iliac vein stent. Then using the catheter the left renal vein was catheterized and a venogram was performed. The catheter was then negotiated into the left gonadal vein. The catheter was passed distally into the pelvic veins above the pelvic rim. Venogram was performed showing a refluxing large caliber left gonadal vein, extensive pelvic collateral vein network and eventual! filling of a large right gonadal vein. The network was filled with approximately 10 cc of contrast. Then a mixture of 4:1 1% polidocanol with air foam was prepared and a total of 10 cc of foam sclerotherapy was injected into the pelvis through the distal gonadal vein. Then the proximal and mid gonadal vein was embolized with five 9 mm non-detachable and one 12 x 9 mm detachable 20 cm Interlock coil. Repeat injections showed stasis of flow in the left gonadal vein.
Attention was then directed to the right gonadal vein. However despite multiple attempts and using multiple different catheters, the vein could not be accessed. Given limitations of contrast use and time, we elected to complete the procedure at this stage to determine if unilateral embolization would provide substantial clinical improvement and determine if we should bring her back for right sided embolization at a different time if she does not feel substantial improvement.
How would i code this?