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Please help...
PROCEDURE: Informed consent obtained from the patient, and a procedural pause was held to confirm patient identity as well as intended procedure and operative site. Skin over the left groin prepped in the usual sterile fashion and total of 7 ml of 1% lidocaine utilized for local anesthesia. Small skin incision made and 21-gauge micropuncture needle advanced under direct ultrasound visualization into the left mid common femoral artery. Access obtained without difficulty on the first attempt, allowing placement of micropuncture guide wire and catheter. 0.035-inch Bentson wire then advanced under fluoroscopic control through the iliac arteries into the abdominal aorta without difficulty. 5-French vascular sheath was placed. 5-French Omni Flush catheter was then advanced into the distal abdominal aorta and bilateral pelvic oblique arteriography obtained. Catheter removed over a guide wire and left lower extremity arteriography performed through the indwelling sheath.
FINDINGS: Mild atherosclerotic disease of the distal abdominal aorta without focal stenosis. Mild fusiform aneurysmal dilatation of the common iliac arteries bilaterally. There is a linear web-like narrowing in the distal aspect of the left common iliac artery resulting in 40-50% narrowing. There is a focal, approximately 80% left proximal external iliac artery stenosis. There is chronic occlusion of the left internal iliac artery.
Right common iliac artery demonstrates no focal area of significant stenosis. Right external iliac artery is normal in caliber and widely patent without stenosis. Right internal iliac artery is patent with a moderately severe 60-70% origin stenosis. Reconstitution of left internal iliac artery branches via profunda femoris branches as well as transpelvic collateral branches. Mild irregular common femoral artery atherosclerotic plaque bilaterally.
Left lower extremity runoff: Profunda femoris artery, superficial femoral artery, and popliteal artery are patent with mild atherosclerotic disease in the superficial femoral artery, but no stenosis exceeding 20%. Tibioperoneal trunk, posterior tibial, and peroneal arteries are patent without significant stenosis with patent plantar runoff into the foot. The proximal anterior tibial artery is patent, but no dorsalis pedis runoff is detected in the foot. Incidental note is made of a small branch AV fistula arising from a small branch of the proximal peroneal artery.
INTERVENTION: Following diagnostic arteriography, a 10-mm x 60-mm self-expanding nitinol Absolute Pro stent was advanced over the guide wire into the left external iliac artery. This was deployed from the origin of the left external iliac artery into the distal third of the left external iliac artery, covering areas of moderate stenosis in the mid and mid-to-distal left external iliac artery as evidenced on the arteriogram and CT angiogram. 8-mm x 40-mm angioplasty balloon was then placed over the guide wire, and the stent was dilated to profile. Patient experienced mild pain during balloon inflation which subsided on balloon deflation. Control arteriography then performed demonstrating excellent result with no residual stenosis or complication. Manual hemostasis obtained without complication. Patient tolerated the procedure well. A total of 200 mcg of fentanyl and 4 mg of Versed administered IV in divided doses throughout the procedure for procedural sedation. Patient monitored throughout the procedure by an interventional radiology nurse whose sole responsibility was monitoring the patient from 0935 to 1031 hours. Fluoroscopy time: 4 minutes 13 seconds. Total contrast used: 115 ml. EBL: 2 ml.
IMPRESSION:
Mild aneurysmal dilatation of common iliac arteries bilaterally. There is a focal web-like stenosis in the distal left common iliac artery resulting in approximately 40-50% narrowing. This does not appear flow-limiting.
Severe focal 80% proximal left external iliac artery stenosis. Moderate to severe 50-60% stenosis of the mid and mid-to-distal left external iliac artery.
Chronic occlusion of the left internal iliac artery. Right internal iliac artery is patent with a moderately severe, approximately 70% origin stenosis.
No significant left femoropopliteal arterial obstructive disease. Two-vessel left tibial runoff via the posterior tibial and peroneal arteries. Anterior tibial artery does not opacify in the distal calf or foot.
Successful angioplasty and stent placement of left external iliac artery with 10-mm x 60-mm nitinol stent dilated to 8 mm with no residual stenosis or complication. This restored a normal palpable left pedal pulse.
Codes:
37221
36200-59
75736-59
75710-59
Thank you in advance!
Please help...
PROCEDURE: Informed consent obtained from the patient, and a procedural pause was held to confirm patient identity as well as intended procedure and operative site. Skin over the left groin prepped in the usual sterile fashion and total of 7 ml of 1% lidocaine utilized for local anesthesia. Small skin incision made and 21-gauge micropuncture needle advanced under direct ultrasound visualization into the left mid common femoral artery. Access obtained without difficulty on the first attempt, allowing placement of micropuncture guide wire and catheter. 0.035-inch Bentson wire then advanced under fluoroscopic control through the iliac arteries into the abdominal aorta without difficulty. 5-French vascular sheath was placed. 5-French Omni Flush catheter was then advanced into the distal abdominal aorta and bilateral pelvic oblique arteriography obtained. Catheter removed over a guide wire and left lower extremity arteriography performed through the indwelling sheath.
FINDINGS: Mild atherosclerotic disease of the distal abdominal aorta without focal stenosis. Mild fusiform aneurysmal dilatation of the common iliac arteries bilaterally. There is a linear web-like narrowing in the distal aspect of the left common iliac artery resulting in 40-50% narrowing. There is a focal, approximately 80% left proximal external iliac artery stenosis. There is chronic occlusion of the left internal iliac artery.
Right common iliac artery demonstrates no focal area of significant stenosis. Right external iliac artery is normal in caliber and widely patent without stenosis. Right internal iliac artery is patent with a moderately severe 60-70% origin stenosis. Reconstitution of left internal iliac artery branches via profunda femoris branches as well as transpelvic collateral branches. Mild irregular common femoral artery atherosclerotic plaque bilaterally.
Left lower extremity runoff: Profunda femoris artery, superficial femoral artery, and popliteal artery are patent with mild atherosclerotic disease in the superficial femoral artery, but no stenosis exceeding 20%. Tibioperoneal trunk, posterior tibial, and peroneal arteries are patent without significant stenosis with patent plantar runoff into the foot. The proximal anterior tibial artery is patent, but no dorsalis pedis runoff is detected in the foot. Incidental note is made of a small branch AV fistula arising from a small branch of the proximal peroneal artery.
INTERVENTION: Following diagnostic arteriography, a 10-mm x 60-mm self-expanding nitinol Absolute Pro stent was advanced over the guide wire into the left external iliac artery. This was deployed from the origin of the left external iliac artery into the distal third of the left external iliac artery, covering areas of moderate stenosis in the mid and mid-to-distal left external iliac artery as evidenced on the arteriogram and CT angiogram. 8-mm x 40-mm angioplasty balloon was then placed over the guide wire, and the stent was dilated to profile. Patient experienced mild pain during balloon inflation which subsided on balloon deflation. Control arteriography then performed demonstrating excellent result with no residual stenosis or complication. Manual hemostasis obtained without complication. Patient tolerated the procedure well. A total of 200 mcg of fentanyl and 4 mg of Versed administered IV in divided doses throughout the procedure for procedural sedation. Patient monitored throughout the procedure by an interventional radiology nurse whose sole responsibility was monitoring the patient from 0935 to 1031 hours. Fluoroscopy time: 4 minutes 13 seconds. Total contrast used: 115 ml. EBL: 2 ml.
IMPRESSION:
Mild aneurysmal dilatation of common iliac arteries bilaterally. There is a focal web-like stenosis in the distal left common iliac artery resulting in approximately 40-50% narrowing. This does not appear flow-limiting.
Severe focal 80% proximal left external iliac artery stenosis. Moderate to severe 50-60% stenosis of the mid and mid-to-distal left external iliac artery.
Chronic occlusion of the left internal iliac artery. Right internal iliac artery is patent with a moderately severe, approximately 70% origin stenosis.
No significant left femoropopliteal arterial obstructive disease. Two-vessel left tibial runoff via the posterior tibial and peroneal arteries. Anterior tibial artery does not opacify in the distal calf or foot.
Successful angioplasty and stent placement of left external iliac artery with 10-mm x 60-mm nitinol stent dilated to 8 mm with no residual stenosis or complication. This restored a normal palpable left pedal pulse.
Codes:
37221
36200-59
75736-59
75710-59
Thank you in advance!
