EikaMTGQueen
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Reason for Study: AAA ENDOLEAK
Reason For Visit: AAA
Impression:
1. Type II endoleak from lumbar collaterals.
2. Embolization: distal IMA and L3-L4 of lumbar arteries bilaterally.
Onyx and thrombin were injected into the sac.
History: Type II endo leak with enlarging aneurysm.
Anesthesia:
1. 1% lidocaine.
2. Versed none mg IV.
3. Fentanyl 50 mcg IV.
Other medication:
1. Ancef 1 gram IV.
Contrast: Isovue-250: 50 ml
Approach: Translumbar
Estimated Blood Loss: Minimal, Fluoro time: 32.2 minutes.
Procedure:
Informed consent was obtained. The risk benefits and alternative
procedures were discussed. Risks included death, bleeding, need for
emergent surgery, renal failure and contrast reaction.
The left flank was sterilely prepped and draped. The skin was
anesthetized with lidocaine. The aneurysmal sac was entered. A
catheter was placed in the over a wire. Contrast was injected to
characterize the endoleak.
Embolization:
1. IMA origin was embolized with 3 x 14 mm coil. Left colic artery
was not visualized.
2. L3-L4 lumbar x2 were embolized again with coils with Onyx.
3. Sac thrombosis: Aneurysm sac was thrombosed by injecting 1000
units of thrombin completion of the embolization
Upon completion of the procedure the catheter was removed.
Findings:
Aorta:
Sac examination: filling the IMA and L3-L4 lumbars as well as large
amount of dense base within the sac itself. Branches were embolized
as noted above. The sac was thrombosed with thrombin.
How would you code this?
Thanks
Reason For Visit: AAA
Impression:
1. Type II endoleak from lumbar collaterals.
2. Embolization: distal IMA and L3-L4 of lumbar arteries bilaterally.
Onyx and thrombin were injected into the sac.
History: Type II endo leak with enlarging aneurysm.
Anesthesia:
1. 1% lidocaine.
2. Versed none mg IV.
3. Fentanyl 50 mcg IV.
Other medication:
1. Ancef 1 gram IV.
Contrast: Isovue-250: 50 ml
Approach: Translumbar
Estimated Blood Loss: Minimal, Fluoro time: 32.2 minutes.
Procedure:
Informed consent was obtained. The risk benefits and alternative
procedures were discussed. Risks included death, bleeding, need for
emergent surgery, renal failure and contrast reaction.
The left flank was sterilely prepped and draped. The skin was
anesthetized with lidocaine. The aneurysmal sac was entered. A
catheter was placed in the over a wire. Contrast was injected to
characterize the endoleak.
Embolization:
1. IMA origin was embolized with 3 x 14 mm coil. Left colic artery
was not visualized.
2. L3-L4 lumbar x2 were embolized again with coils with Onyx.
3. Sac thrombosis: Aneurysm sac was thrombosed by injecting 1000
units of thrombin completion of the embolization
Upon completion of the procedure the catheter was removed.
Findings:
Aorta:
Sac examination: filling the IMA and L3-L4 lumbars as well as large
amount of dense base within the sac itself. Branches were embolized
as noted above. The sac was thrombosed with thrombin.
How would you code this?
Thanks
