I am new at vascular coding and would really appreciate help on coding this procedure..!!!!! Thanks in advance..!!!
1. Ultrasound guided access right common femoral artery
2. Antegrade access of the right common femoral artery
3. Failed Angioplasty attempt of the RT popliteal artery
4. Ultrasound guided access of the RT posterior tibial artery
5. Posterior tibial access.
6. Retrograde Angiogram of the left posterior tibial artery
7. Second order catheter placement from the right common femoral to the popliteal artery.
8. placement of IV
9. IV sedation and monitoring
Procedure:
Ultrasound was used to visualize the Rt common femoral artery and under U/S guidance the RT common femoral artery was accessed in an antegrade fashion. This was done with a micropuncture needle and then advanced a wire using Seldenger technique and placed a small sheath and I then placed a J-wire and a lager #6 French sheath and through this I was able to get a wire down the superficial femoral artery and advanced the sheath down the proximal superficial femoral artery. The sheath was then exchanged out for a longer 75 cm. sheath after performing an angiogram showing the superficial femoral artery to be open but became very diseased and narrowed down distally towards the popliteal and the popliteal artery was chronically occluded with reconstitution of the peroneal artery there was one vessel run-off to the foot. Once I got my 78 French sheath down in the distal SFA using various hydrophilic wires of various diameters I attempted to cross the popliteal artery occlusive lesion multiple times and multiple different ways using different catheters and wires. After spending greater than an hour trying the antegrade crossing, I then went down to the RT foot that was already prepped out and using U/S guidance and Lidocain was injected over the posterior tibial artery and this was accessed with a needle and using the same Seldenger technique I was able to put a #4 French sheath into the posterior tibial artery and shot a retrograde angiogram that showed the artery to be open and the distal most third of it but midcalf and up that was chronically occluded. I made multiple attempts to get the wire up the posterior tibial into the popliteal lesion in hopes of getting through the occlusive lesion from below; however, attempts to go retrograde up the posterior tibial were unsuccessful. I then tried again from working down antegrade from the groin and again unable to cross.
Decided to close procedure after 2 hours of time.
1. Ultrasound guided access right common femoral artery
2. Antegrade access of the right common femoral artery
3. Failed Angioplasty attempt of the RT popliteal artery
4. Ultrasound guided access of the RT posterior tibial artery
5. Posterior tibial access.
6. Retrograde Angiogram of the left posterior tibial artery
7. Second order catheter placement from the right common femoral to the popliteal artery.
8. placement of IV
9. IV sedation and monitoring
Procedure:
Ultrasound was used to visualize the Rt common femoral artery and under U/S guidance the RT common femoral artery was accessed in an antegrade fashion. This was done with a micropuncture needle and then advanced a wire using Seldenger technique and placed a small sheath and I then placed a J-wire and a lager #6 French sheath and through this I was able to get a wire down the superficial femoral artery and advanced the sheath down the proximal superficial femoral artery. The sheath was then exchanged out for a longer 75 cm. sheath after performing an angiogram showing the superficial femoral artery to be open but became very diseased and narrowed down distally towards the popliteal and the popliteal artery was chronically occluded with reconstitution of the peroneal artery there was one vessel run-off to the foot. Once I got my 78 French sheath down in the distal SFA using various hydrophilic wires of various diameters I attempted to cross the popliteal artery occlusive lesion multiple times and multiple different ways using different catheters and wires. After spending greater than an hour trying the antegrade crossing, I then went down to the RT foot that was already prepped out and using U/S guidance and Lidocain was injected over the posterior tibial artery and this was accessed with a needle and using the same Seldenger technique I was able to put a #4 French sheath into the posterior tibial artery and shot a retrograde angiogram that showed the artery to be open and the distal most third of it but midcalf and up that was chronically occluded. I made multiple attempts to get the wire up the posterior tibial into the popliteal lesion in hopes of getting through the occlusive lesion from below; however, attempts to go retrograde up the posterior tibial were unsuccessful. I then tried again from working down antegrade from the groin and again unable to cross.
Decided to close procedure after 2 hours of time.