iamlou
Networker
Please help! What are your thoughts on the coding of this op report? Pt had a aneurysm endograft leak.
CATHETER POSITION:
Abdominal aorta, abdominal aortic aneurysm endograft main body, abdominal
aortic aneurysm endograft iliac limbs, superior mesenteric artery, aneurysm
sac via perigraft approach.
TECHNIQUE:
draped in a standard fashion. Under ultrasound guidance, after achievinglocal anesthesia with 1% lidocaine, the right common femoral artery wasaccessed. A 6 French sheath was inserted. Over the guidewire, a 4 French
Omni Flush catheter was placed into the proximal abdominal aorta. With the
catheter in this position, cone beam CTA was performed. 3-D MIP and volume
rendered reconstructed images are obtained at a separate workstation. I
pilot dynamic software was utilized for additional imaging guidance. With
the catheter in the suprarenal abdominal aorta, DSA injection performed.
Catheter repositioned in the main body. DSA imaging obtained. Catheter
positioned in the right iliac limb, injection performed. Catheter
exchanged over a guidewire for a 5 French Reuter catheter which is placed
across the flow divider into the left iliac limb. Injections were
performed. Catheter was positioned in the SMA and injection performed.
The Reuter catheter was repositioned in the ipsilateral.
There is a defect along the medial aspect of the distal right iliac limb in
the proximal right common iliac artery. This is interrogated with the
Reuter catheter. Injection performed demonstrates a type I B endoleak.
Previously obtained DSA injections also demonstrate probable type II
endoleak within the aneurysm sac. Embolization was planned, via a
perigraft approach. As such, the Reuter catheter was exchanged over a
0.035 inch Glidewire, and subsequently a 5 French C2 glidecatheter was
advanced along the medial aspect of the distal right iliac limb, into the
abdominal aortic aneurysm sac. The C2 glidecatheter was advanced along the caudal aspect of the abdominal aortic aneurysm sac, and subjacent the left
iliac limb seal zone. Injections performed demonstrate probable type I B
left iliac limb endoleak. This endoleak is demonstrated via
non-physiologic injection, and therefore the significance of this is
uncertain. The left iliac limb extends to just proximal to the origin of
the left hypogastric artery. The left and right common iliac arteries are
overall short in length, which contributes to the issue bilaterally.
Additional multiple low-pressure manual injections were performed. A large
caliber lumbar artery type II endoleak was identified. Multiple attempts
were made at selectively engaging the type II endoleak. These were
unsuccessful. The type II endoleak also appears to derive its principal
feeding vessel from the left hypogastric artery via the left iliolumbar
artery. Due to the patient's marked body habitus, and need for
magnification angiography for this complicated case, the patient's
radiation dose was above the threshold at this institution. It was elected to stop the
procedure at this point, and return for a second stage procedure after a
period of time to minimize the risk of acute radiation burn. As such, the
catheter and sheath were removed. The access site was closed using
StarClose. A sterile dressing was applied.
I got 36245 x2, 75625, 75716, 76377, and 75774.
Any thoughts would be greatly appreciated!
CATHETER POSITION:
Abdominal aorta, abdominal aortic aneurysm endograft main body, abdominal
aortic aneurysm endograft iliac limbs, superior mesenteric artery, aneurysm
sac via perigraft approach.
TECHNIQUE:
draped in a standard fashion. Under ultrasound guidance, after achievinglocal anesthesia with 1% lidocaine, the right common femoral artery wasaccessed. A 6 French sheath was inserted. Over the guidewire, a 4 French
Omni Flush catheter was placed into the proximal abdominal aorta. With the
catheter in this position, cone beam CTA was performed. 3-D MIP and volume
rendered reconstructed images are obtained at a separate workstation. I
pilot dynamic software was utilized for additional imaging guidance. With
the catheter in the suprarenal abdominal aorta, DSA injection performed.
Catheter repositioned in the main body. DSA imaging obtained. Catheter
positioned in the right iliac limb, injection performed. Catheter
exchanged over a guidewire for a 5 French Reuter catheter which is placed
across the flow divider into the left iliac limb. Injections were
performed. Catheter was positioned in the SMA and injection performed.
The Reuter catheter was repositioned in the ipsilateral.
There is a defect along the medial aspect of the distal right iliac limb in
the proximal right common iliac artery. This is interrogated with the
Reuter catheter. Injection performed demonstrates a type I B endoleak.
Previously obtained DSA injections also demonstrate probable type II
endoleak within the aneurysm sac. Embolization was planned, via a
perigraft approach. As such, the Reuter catheter was exchanged over a
0.035 inch Glidewire, and subsequently a 5 French C2 glidecatheter was
advanced along the medial aspect of the distal right iliac limb, into the
abdominal aortic aneurysm sac. The C2 glidecatheter was advanced along the caudal aspect of the abdominal aortic aneurysm sac, and subjacent the left
iliac limb seal zone. Injections performed demonstrate probable type I B
left iliac limb endoleak. This endoleak is demonstrated via
non-physiologic injection, and therefore the significance of this is
uncertain. The left iliac limb extends to just proximal to the origin of
the left hypogastric artery. The left and right common iliac arteries are
overall short in length, which contributes to the issue bilaterally.
Additional multiple low-pressure manual injections were performed. A large
caliber lumbar artery type II endoleak was identified. Multiple attempts
were made at selectively engaging the type II endoleak. These were
unsuccessful. The type II endoleak also appears to derive its principal
feeding vessel from the left hypogastric artery via the left iliolumbar
artery. Due to the patient's marked body habitus, and need for
magnification angiography for this complicated case, the patient's
radiation dose was above the threshold at this institution. It was elected to stop the
procedure at this point, and return for a second stage procedure after a
period of time to minimize the risk of acute radiation burn. As such, the
catheter and sheath were removed. The access site was closed using
StarClose. A sterile dressing was applied.
I got 36245 x2, 75625, 75716, 76377, and 75774.
Any thoughts would be greatly appreciated!