suela923@aol.com
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Coded as:
75625
75716
75774
37221
37223
Thoughts? Suggestions? Thank you! I am not quite getting the 75774, addl after basic
Procedure:Left trans-brachial aortogram, selective catheterization of left internal iliac artery, placement of a stent in the left internal iliac artery and common iliac artery.
Indications:This is a patient who has buttock and hip claudication. This has been progressive. He has a history of an aortofemoral bypass graft. A recent CT angiogram of the abdomen and pelvis demonstrate significant iliac occlusive disease including the internal iliac arteries. He is for diagnostic arteriogram with possible intervention to improve circulation to his internal iliac arteries.
Report: The patient was taken to the angiogram suite, placed in the supine position, prepped and draped in the usual sterile fashion. The left arm was anesthetized with 2% lidocaine. A 5-French micropuncture sheath was used to access the left brachial artery. A guidewire was passed up into the aorta. Over the guidewire a 5 French sheath was placed. A combination of a Glidewire and Berenstein catheter were used to catheterize the knee sending thoracic aorta from the left subclavian artery. The guidewire was advanced down into the distal abdominal aorta. A pigtail catheter was placed over the wire into the aorta.
No prior catheter-based diagnostic angiographic study of the target vessel is available. An aortogram was performed. This demonstrated a patent aortofemoral bypass graft. There was no stenosis at the proximal anastomosis identified. There was some irregularity at the bottom of the right limb of the bypass graft near the femoral artery. The degree of stenosis does not appear to be greater than 50%. The native aorta and iliac vessels were not well visualized due to the overlying aorta femoral graft.
The pigtail catheter was changed over a wire for a Berenstein catheter. This was used to catheterize the distal aorta below the proximal anastomosis for the aorta femoral bypass graft. An angiogram was performed. This demonstrated a patent distal aorta with large lumbar arteries. The right common iliac artery had atherosclerotic disease. This appear to be heavily calcified. The degree of stenosis was probably greater than 50% but difficult to tell because this was circumferential. The internal iliac artery was patent. The external iliac artery was occluded. On the left side there was extensive disease in the common and internal iliac arteries. There appear to be a greater than 90% stenosis in the common iliac artery. There was additional occlusive disease in the internal iliac artery as well.
A combination of a Glidewire and Berenstein catheter were used to catheterize the left common iliac artery. An angiogram was performed which confirmed the extensive atherosclerotic disease in the common and internal iliac arteries. I used a frontrunner catheter to try to cross the stenoses in the common iliac arteries extending into the internal iliac artery. A combination of a frontrunner catheter and glide wire allowing passage of the wire into the internal iliac artery. There was poor ability to advance equipment across the stenosis due to the distance from the sheath to the disease. I therefore placed a 6-French shuttle sheath which extended down to the distal aorta and proximal common iliac artery. Even with this I had difficulty advancing the equipment beyond the stenosis. I then gave the patient 4000 units of intra-arterial heparin. This was allowed to circulate. I was able to get a 4 mm x 4 cm savvy balloon across the stenosis. This was used to pre-dilate the stenosis in the internal iliac artery and common iliac artery. After pre-dilating the iliac arteries with a 4 mm balloon I attempted to pass an 8 mm x 80 stent into the internal iliac artery. I was unable to advance the device down into the internal iliac artery. Multiple attempts at pre-dilatation with a 5 mm balloon still did not allow passage of the stent. An angiogram was performed. There was a shelf of calcium at the origin of the internal iliac artery. Ultimately we changed the wire to a stabilizer wire. A 8mm by 40 mm precise stent was able to be advanced down into the internal iliac artery. This was deployed. This was postdilated with a 7 mm balloon. I then placed a 8mm by 60 mm Smart stent into the common iliac artery. This was postdilated with a 7 mm balloon as well. Even with the stents in place it was difficult to advance the balloons. Ultimately the iliac arteries were post dilated with this balloon. A completion angiogram demonstrated a good result with good flow into the internal iliac artery.
The flow into the right iliac system was unchanged.
The catheter was removed. The sheath was removed. Pressure was held. There were no complications.
IMPRESSION:
1. Patent aorta femoral bypass graft. There is a stenosis in the distal limb of the aortofemoral bypass graft on the right side. This is at the level of the femoral artery. The degree of stenosis appears to be approximately 50%.
2. Extensive atherosclerotic disease in the common and internal iliac artery on the left side as described above. There is disease in the common iliac artery on the right side as well. The external iliac arteries are occluded bilateral.
3. Successful stenting of the common and internal iliac arteries of the left side. There was a good angiographic result.
75625
75716
75774
37221
37223
Thoughts? Suggestions? Thank you! I am not quite getting the 75774, addl after basic
Procedure:Left trans-brachial aortogram, selective catheterization of left internal iliac artery, placement of a stent in the left internal iliac artery and common iliac artery.
Indications:This is a patient who has buttock and hip claudication. This has been progressive. He has a history of an aortofemoral bypass graft. A recent CT angiogram of the abdomen and pelvis demonstrate significant iliac occlusive disease including the internal iliac arteries. He is for diagnostic arteriogram with possible intervention to improve circulation to his internal iliac arteries.
Report: The patient was taken to the angiogram suite, placed in the supine position, prepped and draped in the usual sterile fashion. The left arm was anesthetized with 2% lidocaine. A 5-French micropuncture sheath was used to access the left brachial artery. A guidewire was passed up into the aorta. Over the guidewire a 5 French sheath was placed. A combination of a Glidewire and Berenstein catheter were used to catheterize the knee sending thoracic aorta from the left subclavian artery. The guidewire was advanced down into the distal abdominal aorta. A pigtail catheter was placed over the wire into the aorta.
No prior catheter-based diagnostic angiographic study of the target vessel is available. An aortogram was performed. This demonstrated a patent aortofemoral bypass graft. There was no stenosis at the proximal anastomosis identified. There was some irregularity at the bottom of the right limb of the bypass graft near the femoral artery. The degree of stenosis does not appear to be greater than 50%. The native aorta and iliac vessels were not well visualized due to the overlying aorta femoral graft.
The pigtail catheter was changed over a wire for a Berenstein catheter. This was used to catheterize the distal aorta below the proximal anastomosis for the aorta femoral bypass graft. An angiogram was performed. This demonstrated a patent distal aorta with large lumbar arteries. The right common iliac artery had atherosclerotic disease. This appear to be heavily calcified. The degree of stenosis was probably greater than 50% but difficult to tell because this was circumferential. The internal iliac artery was patent. The external iliac artery was occluded. On the left side there was extensive disease in the common and internal iliac arteries. There appear to be a greater than 90% stenosis in the common iliac artery. There was additional occlusive disease in the internal iliac artery as well.
A combination of a Glidewire and Berenstein catheter were used to catheterize the left common iliac artery. An angiogram was performed which confirmed the extensive atherosclerotic disease in the common and internal iliac arteries. I used a frontrunner catheter to try to cross the stenoses in the common iliac arteries extending into the internal iliac artery. A combination of a frontrunner catheter and glide wire allowing passage of the wire into the internal iliac artery. There was poor ability to advance equipment across the stenosis due to the distance from the sheath to the disease. I therefore placed a 6-French shuttle sheath which extended down to the distal aorta and proximal common iliac artery. Even with this I had difficulty advancing the equipment beyond the stenosis. I then gave the patient 4000 units of intra-arterial heparin. This was allowed to circulate. I was able to get a 4 mm x 4 cm savvy balloon across the stenosis. This was used to pre-dilate the stenosis in the internal iliac artery and common iliac artery. After pre-dilating the iliac arteries with a 4 mm balloon I attempted to pass an 8 mm x 80 stent into the internal iliac artery. I was unable to advance the device down into the internal iliac artery. Multiple attempts at pre-dilatation with a 5 mm balloon still did not allow passage of the stent. An angiogram was performed. There was a shelf of calcium at the origin of the internal iliac artery. Ultimately we changed the wire to a stabilizer wire. A 8mm by 40 mm precise stent was able to be advanced down into the internal iliac artery. This was deployed. This was postdilated with a 7 mm balloon. I then placed a 8mm by 60 mm Smart stent into the common iliac artery. This was postdilated with a 7 mm balloon as well. Even with the stents in place it was difficult to advance the balloons. Ultimately the iliac arteries were post dilated with this balloon. A completion angiogram demonstrated a good result with good flow into the internal iliac artery.
The flow into the right iliac system was unchanged.
The catheter was removed. The sheath was removed. Pressure was held. There were no complications.
IMPRESSION:
1. Patent aorta femoral bypass graft. There is a stenosis in the distal limb of the aortofemoral bypass graft on the right side. This is at the level of the femoral artery. The degree of stenosis appears to be approximately 50%.
2. Extensive atherosclerotic disease in the common and internal iliac artery on the left side as described above. There is disease in the common iliac artery on the right side as well. The external iliac arteries are occluded bilateral.
3. Successful stenting of the common and internal iliac arteries of the left side. There was a good angiographic result.
