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I am new to Cardiology coding and need help with this procedure note.
Access to the lumen of the common vessels were gained using Potts needle and Bentson wire. An 8-French introducer sheath was then introduced over the Bentson wire. This allowed marker scale catheters to be introduced and angiography performed of the aorta and pelvic runoff. Intravascular ultrasound was then used also to measure the diameter of the aorta and iliac vessels to confirm measurements obtained on CT scan. The length of the aorta between the renal vessels and the bifurcation and the hypogastric arteries was also determined this way.
A 23 X 14 the main body graft was brought to the field. We exchanged the sheath on the right side with a 16-French sheath and an Amplatz stiff wire. This allowed us to place the main body graft over the wire and brought to the level of the infrarenal aorta just below the renal arteries. The graft was deployed and confirmation of the point just below the renal vessels was obtained by angiography. The graft was deployed to just below the level of the gate. We then used a Kumpe catheter to gain access to the contralateral gate using a Glidewire. This was exchanged also for an Amplatz stiff wire. Ultrasound was used to measure the distance between the gate and hypogastric artery. A contralateral limb 20 X 14 was brought to the field, positioned and deployed without difficulty. It was deployed such that the distal aspect of the graft was above the hypogastric artery on the left side.
Likewise because if the length of the aorta and iliac segment an iliac limb needed to be inserted on the right side. This time we used a 20 x 10 iliac limb which was positioned in the main body limb and then deployed such that the graft terminated just above the hypogastric artery. These limbs and aorta were then angioplastied sealing the device to the native vessels.
Angiography was accomplished which confirmed good placement of the graft, no evidence of type 1 or type 2, or any type of endoleak. Renal vessels were patent. Hypogastric arteries flowed well. All wires and catheters were then removed from the patient. The puncture site for the femoral vessels was closed with a horizontal mattress suture. The wounds were then checked for hemostatis and this was judged to be adequate. The wounds were closed in layers using a 3-0 Vicryl suture and 4-0 Monocryl suture for the skin. Dermaboond was applied to the skin level itself. Estimated blood loss approximately 50 cc.
Any help would be great!
Access to the lumen of the common vessels were gained using Potts needle and Bentson wire. An 8-French introducer sheath was then introduced over the Bentson wire. This allowed marker scale catheters to be introduced and angiography performed of the aorta and pelvic runoff. Intravascular ultrasound was then used also to measure the diameter of the aorta and iliac vessels to confirm measurements obtained on CT scan. The length of the aorta between the renal vessels and the bifurcation and the hypogastric arteries was also determined this way.
A 23 X 14 the main body graft was brought to the field. We exchanged the sheath on the right side with a 16-French sheath and an Amplatz stiff wire. This allowed us to place the main body graft over the wire and brought to the level of the infrarenal aorta just below the renal arteries. The graft was deployed and confirmation of the point just below the renal vessels was obtained by angiography. The graft was deployed to just below the level of the gate. We then used a Kumpe catheter to gain access to the contralateral gate using a Glidewire. This was exchanged also for an Amplatz stiff wire. Ultrasound was used to measure the distance between the gate and hypogastric artery. A contralateral limb 20 X 14 was brought to the field, positioned and deployed without difficulty. It was deployed such that the distal aspect of the graft was above the hypogastric artery on the left side.
Likewise because if the length of the aorta and iliac segment an iliac limb needed to be inserted on the right side. This time we used a 20 x 10 iliac limb which was positioned in the main body limb and then deployed such that the graft terminated just above the hypogastric artery. These limbs and aorta were then angioplastied sealing the device to the native vessels.
Angiography was accomplished which confirmed good placement of the graft, no evidence of type 1 or type 2, or any type of endoleak. Renal vessels were patent. Hypogastric arteries flowed well. All wires and catheters were then removed from the patient. The puncture site for the femoral vessels was closed with a horizontal mattress suture. The wounds were then checked for hemostatis and this was judged to be adequate. The wounds were closed in layers using a 3-0 Vicryl suture and 4-0 Monocryl suture for the skin. Dermaboond was applied to the skin level itself. Estimated blood loss approximately 50 cc.
Any help would be great!
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