carelitz
Guest
Another new one to me 
Any help would be appreciated. i have so far
36200 50 (cath placements)
34713 50 (perQ access with 12 French or larger)
34705 62 (Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft)
Is this close? Am i missing anything?
ROCEDURE PERFORMED: Percutaneous endovascular abdominal aortic aneurysm
repair with bilateral percutaneous access.
INDICATIONS FOR PROCEDURE: This is a gentleman, who was
recently diagnosed in end of November 2020 with a very large abdominal
aortic aneurysm measuring 7.6 cm in anterior diameter and 6.8
transversely.
DESCRIPTION OF PROCEDURE: After obtaining informed written patient's
consent, he was brought to the hybrid OR. Had general anesthesia with
intubation and ventilation. Please see general anesthesia report dictated
separately.
Once the patient was adequately sedated, with ultrasound guidance,
arterial access was obtained first to the right common femoral artery with
micropuncture kit and modified Seldinger technique. The 2 ProGlide
Perclose devices were deployed at 10 a.m. and 2 p.m., and an 8-French
sheath was positioned.
Then, same technique was used for the left common femoral artery access
with 2 ProGlide catheters deployed at 10 a.m. and 2 p.m., and 8-French
sheath was introduced.
Then, from the left femoral approach, we advanced the 12-French 33 cm GORE
sheath to the abdominal aorta and from the right femoral approach over the
Lunderquist wire, we advanced the 16-French sheath to the distal abdominal
aorta.
The patient was respectively heparinized with ACT more than 250.
Then, we used 26 x 14.5 x 16 cm GORE Excluder aortobiiliac stent graft,
which was positioned immediately distal to the ostium of the renal
arteries and angiogram was obtained with power injection in cranial
projection to compensate for and position of the device was
confirmed.
Once adequate position was confirmed, we deployed the main body and the
contralateral limb gate.
Then, the pigtail catheter was pulled back and 260 cm angled Glidewire was
advanced from the left femoral approach, and with the support of 6-French
JR4 catheter, we navigated the Glidewire to the contralateral limb and
then to the descending aorta and exchanged the catheter again to the
5-French measuring pigtail catheter, which confirmed our intrastent graft
position. After that, the 12-French sheath was pulled immediately distal
to the origin of the left hypogastric artery and angiogram obtained in RAO
caudal projection showing origin of the hypogastric artery and respective
measurements were performed followed by use of 18 mm x 13.5 cm left iliac
extension and it was successfully deployed. Once this was performed, we
pulled the 16-French sheath immediately distal to the position of the
right hypogastric artery, confirmed with angiogram the position of the
hypogastric artery and completed the deployment of the main body and right
iliac limb of the graft to the right common iliac artery.
Then, we used GORE MOB balloon to post-dilate first the main body of the
graft under fluoroscopic control, then we post-dilated the overlap of the
left iliac limb in the gate of the main bifurcating graft and then we
post-dilated the distal portion of the limb in the left common iliac
artery, all this was performed over the SupraCore wire from the left
femoral approach.
Then, we used the same balloon to post-dilate the distal limb of the right
iliac extension and balloon was removed.
Then, from the left femoral approach, we again positioned the 5-French
pigtail catheter through the left limb of the graft into the abdominal
aorta and performed aortogram in cranial projection, which showed no
evidence of type 1A or B endoleak, no evidence of type 3 endoleak and no
definitive evidence of type 2 endoleak with excellent expansion of the
stent graft.
We then exchanged the Lunderquist wire from the right femoral approach
over the JR4 catheter to the SupraCore wire. Both sheaths were
sequentially removed. ProGlide sutures tightened and excellent hemostasis
was achieved on both groin. The blood loss was estimated in the range of
50-60 mL. There were no immediate complications.
CONCLUSIONS:
1. Large 7.6 x 6.8 abdominal aortic aneurysm without rupture.
2. Successful percutaneous endovascular abdominal aneurysm repair with
the use of bifurcating aortic GORE Excluder graft 26 x 14.5 x 16 cm with left limb extension by 18 x 13.5 cm.
Any help would be appreciated. i have so far36200 50 (cath placements)
34713 50 (perQ access with 12 French or larger)
34705 62 (Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft)
Is this close? Am i missing anything?
ROCEDURE PERFORMED: Percutaneous endovascular abdominal aortic aneurysm
repair with bilateral percutaneous access.
INDICATIONS FOR PROCEDURE: This is a gentleman, who was
recently diagnosed in end of November 2020 with a very large abdominal
aortic aneurysm measuring 7.6 cm in anterior diameter and 6.8
transversely.
DESCRIPTION OF PROCEDURE: After obtaining informed written patient's
consent, he was brought to the hybrid OR. Had general anesthesia with
intubation and ventilation. Please see general anesthesia report dictated
separately.
Once the patient was adequately sedated, with ultrasound guidance,
arterial access was obtained first to the right common femoral artery with
micropuncture kit and modified Seldinger technique. The 2 ProGlide
Perclose devices were deployed at 10 a.m. and 2 p.m., and an 8-French
sheath was positioned.
Then, same technique was used for the left common femoral artery access
with 2 ProGlide catheters deployed at 10 a.m. and 2 p.m., and 8-French
sheath was introduced.
Then, from the left femoral approach, we advanced the 12-French 33 cm GORE
sheath to the abdominal aorta and from the right femoral approach over the
Lunderquist wire, we advanced the 16-French sheath to the distal abdominal
aorta.
The patient was respectively heparinized with ACT more than 250.
Then, we used 26 x 14.5 x 16 cm GORE Excluder aortobiiliac stent graft,
which was positioned immediately distal to the ostium of the renal
arteries and angiogram was obtained with power injection in cranial
projection to compensate for and position of the device was
confirmed.
Once adequate position was confirmed, we deployed the main body and the
contralateral limb gate.
Then, the pigtail catheter was pulled back and 260 cm angled Glidewire was
advanced from the left femoral approach, and with the support of 6-French
JR4 catheter, we navigated the Glidewire to the contralateral limb and
then to the descending aorta and exchanged the catheter again to the
5-French measuring pigtail catheter, which confirmed our intrastent graft
position. After that, the 12-French sheath was pulled immediately distal
to the origin of the left hypogastric artery and angiogram obtained in RAO
caudal projection showing origin of the hypogastric artery and respective
measurements were performed followed by use of 18 mm x 13.5 cm left iliac
extension and it was successfully deployed. Once this was performed, we
pulled the 16-French sheath immediately distal to the position of the
right hypogastric artery, confirmed with angiogram the position of the
hypogastric artery and completed the deployment of the main body and right
iliac limb of the graft to the right common iliac artery.
Then, we used GORE MOB balloon to post-dilate first the main body of the
graft under fluoroscopic control, then we post-dilated the overlap of the
left iliac limb in the gate of the main bifurcating graft and then we
post-dilated the distal portion of the limb in the left common iliac
artery, all this was performed over the SupraCore wire from the left
femoral approach.
Then, we used the same balloon to post-dilate the distal limb of the right
iliac extension and balloon was removed.
Then, from the left femoral approach, we again positioned the 5-French
pigtail catheter through the left limb of the graft into the abdominal
aorta and performed aortogram in cranial projection, which showed no
evidence of type 1A or B endoleak, no evidence of type 3 endoleak and no
definitive evidence of type 2 endoleak with excellent expansion of the
stent graft.
We then exchanged the Lunderquist wire from the right femoral approach
over the JR4 catheter to the SupraCore wire. Both sheaths were
sequentially removed. ProGlide sutures tightened and excellent hemostasis
was achieved on both groin. The blood loss was estimated in the range of
50-60 mL. There were no immediate complications.
CONCLUSIONS:
1. Large 7.6 x 6.8 abdominal aortic aneurysm without rupture.
2. Successful percutaneous endovascular abdominal aneurysm repair with
the use of bifurcating aortic GORE Excluder graft 26 x 14.5 x 16 cm with left limb extension by 18 x 13.5 cm.