iamlou
Networker
I'm confused with using 75774. Can someone please help me to figure out how many I need to apply to this case? For the codes on this, I thought: 36247, 75716, 75774x3. Opinions??
PROCEDURES PERFORMED:
1. PELVIC ANGIOGRAM MULTIPLE PROJECTIONS
2. LEFT LEG ANGIOGRAM.
3. ATTEMPTED RECANALIZATION AND ANGIOPLASTY OF THE PERONEAL ARTERY AND THE
TIBIOPERONEAL TRUNK.
ACCESS SITE:
Right common femoral artery
CATHETER POSITION:
1. Distal aorta
2. Left external iliac artery
3. Left superficial femoral artery and popliteal artery
4. Left peroneal artery and tibioperoneal trunk
TECHNIQUE:
The right common femoral artery was accessed without difficulty. With a 4
French pigtail catheter, pelvic angiogram was performed in RAO and LAO
projection, following which the catheter was advanced over the aortic
bifurcation into the left external iliac artery and multiple digital
angiograms of the left lower extremity are performed following which
angioplasty was attempted.
FINDINGS:
Minimal plaque at the origin of the left common iliac artery, there is
however no significant iliac stenosis. There is calcified eccentric plaque
in the left common femoral artery. This is causing stenosis of 50 percent
or less. Flow is quite good and in fact is slightly greater than the right
side.
Runoff left side: The profunda is patent. There is mild to moderate
diffuse disease in the left superficial femoral artery however there is no
focal high-grade stenosis in the SFA. There is diffuse plaque but no
significant stenosis in the popliteal artery. There is a long occlusion in
the proximal anterior tibial artery. The anterior tibial is reconstituted
approximately 12-15 cm above the ankle. The DP is patent into the foot.
There is 60-70 percent stenosis in the proximal tibioperoneal trunk. There
is a short approximately 3 cm segmental occlusion at the origin of peroneal
artery which is the largest runoff vessel and is otherwise patent to the
level of the ankle where collaterals reconstitute posterior tibial artery
and most of the flow to the foot is via a reconstituted anterior tibial as
well as the peroneal branches. The posterior tibial is mostly occluded.
Left peroneal artery attempted recanalization angioplasty: Given the
findings, non healing ulcer with early gangrene, it was elected to proceed
with angioplasty recannulization of the peroneal artery even with the high
risk of occlusion. Over a wire, a 5 French sheath is placed over the
aortic bifurcation. The sheath is then advanced into the left superficial
femoral artery. Next utilizing a very soft 0.18 wire with a 3 French
Quick-cross catheter, the tibioperoneal trunk is catheterized.
Wire is gently passed. The lumen of the peroneal artery is not easily
gauged. It appears the wire is extraluminal. Imaging is performed at this
time which demonstrates that the wire has in fact passed extraluminal with
contrast collection outside the vessel. The catheter is then removed. An
angiogram was obtained which demonstrates that the peroneal is still patent
similar to the earlier examination. Another attempt was then made to cross
the peroneal again. The wire is extraluminal and the distal pattern is
not engaged. At this point the procedure is terminated as the vessel cannot
be safely crossed. Final angiogram is obtained. The peroneal is fairly
patent and a short segmental occlusion of around 4 cm is again noted but
the vessel is patent to the ankle. The anterior tibial is likewise patent
and there is good flow to the foot on the final angiogram.
PROCEDURES PERFORMED:
1. PELVIC ANGIOGRAM MULTIPLE PROJECTIONS
2. LEFT LEG ANGIOGRAM.
3. ATTEMPTED RECANALIZATION AND ANGIOPLASTY OF THE PERONEAL ARTERY AND THE
TIBIOPERONEAL TRUNK.
ACCESS SITE:
Right common femoral artery
CATHETER POSITION:
1. Distal aorta
2. Left external iliac artery
3. Left superficial femoral artery and popliteal artery
4. Left peroneal artery and tibioperoneal trunk
TECHNIQUE:
The right common femoral artery was accessed without difficulty. With a 4
French pigtail catheter, pelvic angiogram was performed in RAO and LAO
projection, following which the catheter was advanced over the aortic
bifurcation into the left external iliac artery and multiple digital
angiograms of the left lower extremity are performed following which
angioplasty was attempted.
FINDINGS:
Minimal plaque at the origin of the left common iliac artery, there is
however no significant iliac stenosis. There is calcified eccentric plaque
in the left common femoral artery. This is causing stenosis of 50 percent
or less. Flow is quite good and in fact is slightly greater than the right
side.
Runoff left side: The profunda is patent. There is mild to moderate
diffuse disease in the left superficial femoral artery however there is no
focal high-grade stenosis in the SFA. There is diffuse plaque but no
significant stenosis in the popliteal artery. There is a long occlusion in
the proximal anterior tibial artery. The anterior tibial is reconstituted
approximately 12-15 cm above the ankle. The DP is patent into the foot.
There is 60-70 percent stenosis in the proximal tibioperoneal trunk. There
is a short approximately 3 cm segmental occlusion at the origin of peroneal
artery which is the largest runoff vessel and is otherwise patent to the
level of the ankle where collaterals reconstitute posterior tibial artery
and most of the flow to the foot is via a reconstituted anterior tibial as
well as the peroneal branches. The posterior tibial is mostly occluded.
Left peroneal artery attempted recanalization angioplasty: Given the
findings, non healing ulcer with early gangrene, it was elected to proceed
with angioplasty recannulization of the peroneal artery even with the high
risk of occlusion. Over a wire, a 5 French sheath is placed over the
aortic bifurcation. The sheath is then advanced into the left superficial
femoral artery. Next utilizing a very soft 0.18 wire with a 3 French
Quick-cross catheter, the tibioperoneal trunk is catheterized.
Wire is gently passed. The lumen of the peroneal artery is not easily
gauged. It appears the wire is extraluminal. Imaging is performed at this
time which demonstrates that the wire has in fact passed extraluminal with
contrast collection outside the vessel. The catheter is then removed. An
angiogram was obtained which demonstrates that the peroneal is still patent
similar to the earlier examination. Another attempt was then made to cross
the peroneal again. The wire is extraluminal and the distal pattern is
not engaged. At this point the procedure is terminated as the vessel cannot
be safely crossed. Final angiogram is obtained. The peroneal is fairly
patent and a short segmental occlusion of around 4 cm is again noted but
the vessel is patent to the ankle. The anterior tibial is likewise patent
and there is good flow to the foot on the final angiogram.