Hi, I'm new to Vascular and would love some input to make sure I'm doing this correctly. The report is included. Here are the codes I used:
34802
34812,50
34825
75953,26
75952,26
36200
Thanks,
Hope
PROCEDURES:
1. Bilateral femoral cutdown.
2. Aortogram.
3. Endovascular repair of abdominal aortic aneurysm with Medtronic Endurant
device. Main body, left, 28 x 16 x 166; ipsilateral limb extension to
the bifurcation of the left common iliac 16 x 24 x 24; contralateral limb
to the bifurcation of the right common iliac 16 x 24 x 156.
4. Primary closure of bilateral common femoral puncture site.
INDICATIONS: Patient is an 89-year-old white male with history of
hypertension, known abdominal aortic aneurysm, who is a resident of the
Maplewood Garden. Patient was admitted to the hospital after being found down
from drinking alcohol. Orthopedic workup was negative with no spine injury.
The patient underwent CAT scan evaluation, which showed a 9.1-cm abdominal
aortic aneurysm with significant enlargement since the previous study. After
long discussion with his POA and with the patient, he wished to proceed with
endovascular repair of abdominal aortic aneurysm. He understood the risks of
bleeding, infection, endoleak requiring secondary procedure, heart attack,
kidney failure resolved with contrast, nephropathy and agreed to proceed.
PROCEDURE IN DETAIL: Patient was placed on the operating table in supine
position. The legs, groins and abdomen were prepped and draped in usual
sterile fashion. A transverse incision was made just cephalad to the inguinal
crease, overlying the femoral pulse on the right and carried down to the
subcutaneous tissue. The common femoral artery was carefully dissected out
and controlled with 2 vessel loops. On the left, similar incision and
dissection and control of the common femoral artery was achieved. Under
fluoroscopic guidance, a 6-French sheaths were placed bilaterally using
sterile Seldinger technique. On the right, using an 0.035 wire, a pigtail
catheter was placed above the renal arteries. On the left, using an exchange
catheter, a stiff Meier wire was placed up into the descending thoracic aorta.
The patient was given 5000 units of heparin and the main body was placed at
the level of the renal arteries after removing the left 6-French sheath over
the stiff Meier wire. Aortogram was performed and the renal arteries marked
on the screen. The main body was deployed into the opening of the
contralateral gate and the proximal fixation deployed with the stent graft
plate placed immediately below the renal arteries. Attempts were made at
cannulating the gate without success and therefore, a snare was placed through
the contralateral sheath and a wire placed cephalad through the ipsilateral
sheaths and directed contralaterally, using a directional catheter and snared
and brought out the contralateral sheath. The 0.035 wire was removed over the
directional catheter and replaced with a Meier wire through the contralateral
limb. The hypogastric was then marked through a retrograde angiogram through
the right contralateral sheath and the contralateral limb placed in an
overlapping fashion, as described above. The same procedure was performed on
the left with marking of the hypogastric through a retrograde angiogram
through the left ipsilateral sheath and subsequent overlapping the ipsilateral
limb was placed as described above through the bifurcation of the common
iliac. Bilateral balloons were utilized to fix the stent graft below the
renal arteries to the bifurcation of the common iliac and kissing balloon
technique. The post deployment angiogram showed exclusion of the abdominal
aortic aneurysm with no evidence of endoleak. There was excellent
opacification of both renal arteries and both hypogastric arteries. The
distally. Both wounds were copiously irrigated. Hemostasis achieved with
cautery and fibrillar. Both transverse incisions were closed with 3-0 Vicryl
subcutaneous in layers and 4-0 Vicryl subcuticular. Dry sterile dressing was
placed. The patient was extubated in the operating room, taken to the
recovery room hemodynamically stable.
ESTIMATED BLOOD LOSS: 200 mL.
34802
34812,50
34825
75953,26
75952,26
36200
Thanks,
Hope
PROCEDURES:
1. Bilateral femoral cutdown.
2. Aortogram.
3. Endovascular repair of abdominal aortic aneurysm with Medtronic Endurant
device. Main body, left, 28 x 16 x 166; ipsilateral limb extension to
the bifurcation of the left common iliac 16 x 24 x 24; contralateral limb
to the bifurcation of the right common iliac 16 x 24 x 156.
4. Primary closure of bilateral common femoral puncture site.
INDICATIONS: Patient is an 89-year-old white male with history of
hypertension, known abdominal aortic aneurysm, who is a resident of the
Maplewood Garden. Patient was admitted to the hospital after being found down
from drinking alcohol. Orthopedic workup was negative with no spine injury.
The patient underwent CAT scan evaluation, which showed a 9.1-cm abdominal
aortic aneurysm with significant enlargement since the previous study. After
long discussion with his POA and with the patient, he wished to proceed with
endovascular repair of abdominal aortic aneurysm. He understood the risks of
bleeding, infection, endoleak requiring secondary procedure, heart attack,
kidney failure resolved with contrast, nephropathy and agreed to proceed.
PROCEDURE IN DETAIL: Patient was placed on the operating table in supine
position. The legs, groins and abdomen were prepped and draped in usual
sterile fashion. A transverse incision was made just cephalad to the inguinal
crease, overlying the femoral pulse on the right and carried down to the
subcutaneous tissue. The common femoral artery was carefully dissected out
and controlled with 2 vessel loops. On the left, similar incision and
dissection and control of the common femoral artery was achieved. Under
fluoroscopic guidance, a 6-French sheaths were placed bilaterally using
sterile Seldinger technique. On the right, using an 0.035 wire, a pigtail
catheter was placed above the renal arteries. On the left, using an exchange
catheter, a stiff Meier wire was placed up into the descending thoracic aorta.
The patient was given 5000 units of heparin and the main body was placed at
the level of the renal arteries after removing the left 6-French sheath over
the stiff Meier wire. Aortogram was performed and the renal arteries marked
on the screen. The main body was deployed into the opening of the
contralateral gate and the proximal fixation deployed with the stent graft
plate placed immediately below the renal arteries. Attempts were made at
cannulating the gate without success and therefore, a snare was placed through
the contralateral sheath and a wire placed cephalad through the ipsilateral
sheaths and directed contralaterally, using a directional catheter and snared
and brought out the contralateral sheath. The 0.035 wire was removed over the
directional catheter and replaced with a Meier wire through the contralateral
limb. The hypogastric was then marked through a retrograde angiogram through
the right contralateral sheath and the contralateral limb placed in an
overlapping fashion, as described above. The same procedure was performed on
the left with marking of the hypogastric through a retrograde angiogram
through the left ipsilateral sheath and subsequent overlapping the ipsilateral
limb was placed as described above through the bifurcation of the common
iliac. Bilateral balloons were utilized to fix the stent graft below the
renal arteries to the bifurcation of the common iliac and kissing balloon
technique. The post deployment angiogram showed exclusion of the abdominal
aortic aneurysm with no evidence of endoleak. There was excellent
opacification of both renal arteries and both hypogastric arteries. The
distally. Both wounds were copiously irrigated. Hemostasis achieved with
cautery and fibrillar. Both transverse incisions were closed with 3-0 Vicryl
subcutaneous in layers and 4-0 Vicryl subcuticular. Dry sterile dressing was
placed. The patient was extubated in the operating room, taken to the
recovery room hemodynamically stable.
ESTIMATED BLOOD LOSS: 200 mL.