TWilliam2019
Guru
Ultrasound-guided left common femoral artery access
Abdominal aortogram
Right lower extremity arteriogram
Catheterization of the abdominal aorta
Catheter placement in the right distal popliteal artery from the left femoral artery access
Intraoperative fluorescence vascular angiography using SPY technology and indocyanine green
Right transmetatarsal amputation
After consent was obtained the patient was taken to the operative suite and laid in the supine position. She was placed under general anesthesia and endotracheally intubated. The bilateral groins and right lower extremity were prepped and draped in usual sterile fashion. Antibiotics were addressed. A proper timeout was agreed upon by all parties present. The ultrasound was used to gain access to the left common femoral artery using micropuncture technique. Ultrasound-guided puncture was performed of the left common femoral artery using a micropuncture technique. Duplex was used to survey the site for vessel selection and puncture was performed under real-time ultrasound imaging. Imaging was documented of the guidance and placed in the patient's record. The micropuncture wire was advanced into the left external iliac artery and 5 French sheath was placed and flushed with heparinized saline. Universal flush catheter was guided into the abdominal aorta and abdominal aortogram was performed which showed patency of the infrarenal abdominal aorta, bilateral common iliac, external iliac, and internal iliac arteries. The right external iliac artery was noted to be tortuous but patent. Previous clips noted from prior transplant procedure. We catheter was guided over the Glidewire into the right femoral artery and arteriogram performed which showed patency of the common femoral artery, profundofemoral artery, and superficial and popliteal arteries. The right posterior tibial artery was chronically occluded with collaterals in its place noted all the way down into the foot. The right peroneal artery was patent without significant stenosis although artery is small. The right anterior tibial artery is patent into the dorsalis pedis providing collaterals into the foot however the pedal arch and digital arteries do not enhance with contrast. To further assess viability of the vasculature and tissue within the foot, 3 mg of indocyanine green green were administered intravenously and a intraoperative fluoroscopy seen vascular arteriogram was performed of the right foot. Healthy tissue and skin were noted to enhance throughout the foot with the exception of all 5 digits. It was just determined at this point the patient was appropriate for transmetatarsal amputation. Wire and catheter were removed. The access site was closed with a 5 French XO seal and direct pressure held till hemostasis achieved and sterile dressing applied. Attention was turned to the right foot.
A circumferential incision was created at the level of the metatarsal shaft. Posterior flap was created sharply and incision was carried down to the bone. The 5 digits were amputated at the metatarsophalangeal joint. The digital oscillating saw was then used to transect the metatarsal shaft of digits 1 through 5 and metatarsal heads were sent as specimen. Proximal bone culture was then taken with rongeurs and sent. Hemostasis was achieved with spot electrocautery. Meaning tissue appeared healthy with punctate bleeding noted. The posterior flap was approximated to the dorsal incision line and closed with multiple vertical mattress nylon sutures. The foot was then covered with sterile dressing. The patient tolerated the procedure well was awakened from anesthesia and transition to recovery area in stable condition.
need help is this included if not what cpt code? all i can find talks about the retina
Abdominal aortogram
Right lower extremity arteriogram
Catheterization of the abdominal aorta
Catheter placement in the right distal popliteal artery from the left femoral artery access
Intraoperative fluorescence vascular angiography using SPY technology and indocyanine green
Right transmetatarsal amputation
After consent was obtained the patient was taken to the operative suite and laid in the supine position. She was placed under general anesthesia and endotracheally intubated. The bilateral groins and right lower extremity were prepped and draped in usual sterile fashion. Antibiotics were addressed. A proper timeout was agreed upon by all parties present. The ultrasound was used to gain access to the left common femoral artery using micropuncture technique. Ultrasound-guided puncture was performed of the left common femoral artery using a micropuncture technique. Duplex was used to survey the site for vessel selection and puncture was performed under real-time ultrasound imaging. Imaging was documented of the guidance and placed in the patient's record. The micropuncture wire was advanced into the left external iliac artery and 5 French sheath was placed and flushed with heparinized saline. Universal flush catheter was guided into the abdominal aorta and abdominal aortogram was performed which showed patency of the infrarenal abdominal aorta, bilateral common iliac, external iliac, and internal iliac arteries. The right external iliac artery was noted to be tortuous but patent. Previous clips noted from prior transplant procedure. We catheter was guided over the Glidewire into the right femoral artery and arteriogram performed which showed patency of the common femoral artery, profundofemoral artery, and superficial and popliteal arteries. The right posterior tibial artery was chronically occluded with collaterals in its place noted all the way down into the foot. The right peroneal artery was patent without significant stenosis although artery is small. The right anterior tibial artery is patent into the dorsalis pedis providing collaterals into the foot however the pedal arch and digital arteries do not enhance with contrast. To further assess viability of the vasculature and tissue within the foot, 3 mg of indocyanine green green were administered intravenously and a intraoperative fluoroscopy seen vascular arteriogram was performed of the right foot. Healthy tissue and skin were noted to enhance throughout the foot with the exception of all 5 digits. It was just determined at this point the patient was appropriate for transmetatarsal amputation. Wire and catheter were removed. The access site was closed with a 5 French XO seal and direct pressure held till hemostasis achieved and sterile dressing applied. Attention was turned to the right foot.
A circumferential incision was created at the level of the metatarsal shaft. Posterior flap was created sharply and incision was carried down to the bone. The 5 digits were amputated at the metatarsophalangeal joint. The digital oscillating saw was then used to transect the metatarsal shaft of digits 1 through 5 and metatarsal heads were sent as specimen. Proximal bone culture was then taken with rongeurs and sent. Hemostasis was achieved with spot electrocautery. Meaning tissue appeared healthy with punctate bleeding noted. The posterior flap was approximated to the dorsal incision line and closed with multiple vertical mattress nylon sutures. The foot was then covered with sterile dressing. The patient tolerated the procedure well was awakened from anesthesia and transition to recovery area in stable condition.
need help is this included if not what cpt code? all i can find talks about the retina