Procedure: AA, Bilateral iliac arteriograms, Percutaneous transluminal angioplasty of L iliac artery and L. renal artery
Dx: PVD, Claudication, Malig Htn and L renal artery stenosis
Procedure in detail:
Pt brought in cath lab doppler needle used to gain access to LCFA. Then needle was used to gain access to RCFA. Following this, cath was positioned in AA, digital subtraction aortography was performed. AA and both iliac arteries were visualized. Patient has chronic total occlusion of LCIA with lumbar collaterals to LCommon and external iliac arteries. The occlusion is flush total occlusion at ostium of LCommon iliac and reconstitutes just after takeoff of L internal iliac artery.
Initial attmpt was made using total occlusion crossing wire.wire position at distal cap and was advanced. The wire made it through distal cap but veered into medial aspect of vessel and apparently went subintimal at some point. Attempts were made to advance middleweight wire through Viance, but wouldnt advance and at this point the Viance and middleweight guidewire were withdrawn. Attemps were made to redirect but wirese and caths would prolapse into the dissection plane. Multiple attempts were made but unsuccessful. Mutliple attempts made to ballon but was never able to get thorugh proximal cap. Procedure was terminated w/o successfully opening L common iliac artery.
At this pint, turned attention to L renal artery. A cath was positioned at AA at level of renal arteries. Digital subtraciton of AA was performed. This demonstrated R renal artery was widely paten w/ mild irregularities only. The L renal artery had very difficult lesion and appeared to be completely occluded at it origin in AP projection w/collaterals from celiac artery, as well as lumbar collaterals filling distal L renal. HOwever a small channel on inferior surface of renal was connected to distal renal artery this was extremely tortous. I selected cath and was able to advance whisper wiree into distal renal artery, but was never able to advance a ballon across this tortuous eccentric lesion. Multiple attempts made but uncuccessful.
Lastly, there was concern about disease of proximal portion of R common iliac and since pt is candidate for a fem-fem crossover graft, I performed angiography of RCIA. it showed 20-30% narrowing of medial aspect of RCIA., but nothing hemodynamically significant. At this point rpocedure was terminated. Bilateral femoral arteiorgrams were performed and mynx closure device was used to seal arteriotomy.
I think it should be 37220 for L iliac artery, but not for sure for PTCA of L. renal artery is 36251 or 35471 & 75966.
Can someone please explain this to me. I really need help, not very good at interventional. Also, do you have some info to help with this
Dx: PVD, Claudication, Malig Htn and L renal artery stenosis
Procedure in detail:
Pt brought in cath lab doppler needle used to gain access to LCFA. Then needle was used to gain access to RCFA. Following this, cath was positioned in AA, digital subtraction aortography was performed. AA and both iliac arteries were visualized. Patient has chronic total occlusion of LCIA with lumbar collaterals to LCommon and external iliac arteries. The occlusion is flush total occlusion at ostium of LCommon iliac and reconstitutes just after takeoff of L internal iliac artery.
Initial attmpt was made using total occlusion crossing wire.wire position at distal cap and was advanced. The wire made it through distal cap but veered into medial aspect of vessel and apparently went subintimal at some point. Attempts were made to advance middleweight wire through Viance, but wouldnt advance and at this point the Viance and middleweight guidewire were withdrawn. Attemps were made to redirect but wirese and caths would prolapse into the dissection plane. Multiple attempts were made but unsuccessful. Mutliple attempts made to ballon but was never able to get thorugh proximal cap. Procedure was terminated w/o successfully opening L common iliac artery.
At this pint, turned attention to L renal artery. A cath was positioned at AA at level of renal arteries. Digital subtraciton of AA was performed. This demonstrated R renal artery was widely paten w/ mild irregularities only. The L renal artery had very difficult lesion and appeared to be completely occluded at it origin in AP projection w/collaterals from celiac artery, as well as lumbar collaterals filling distal L renal. HOwever a small channel on inferior surface of renal was connected to distal renal artery this was extremely tortous. I selected cath and was able to advance whisper wiree into distal renal artery, but was never able to advance a ballon across this tortuous eccentric lesion. Multiple attempts made but uncuccessful.
Lastly, there was concern about disease of proximal portion of R common iliac and since pt is candidate for a fem-fem crossover graft, I performed angiography of RCIA. it showed 20-30% narrowing of medial aspect of RCIA., but nothing hemodynamically significant. At this point rpocedure was terminated. Bilateral femoral arteiorgrams were performed and mynx closure device was used to seal arteriotomy.
I think it should be 37220 for L iliac artery, but not for sure for PTCA of L. renal artery is 36251 or 35471 & 75966.
Can someone please explain this to me. I really need help, not very good at interventional. Also, do you have some info to help with this