mcauffman86
Networker
Just want to confirm my coding on this case. I have 36245x2, 75726-26x2, 75774-26??
Procedure Ordered:
Procedure(s):
Mesenteric Angiogram Poss PTA
Indications:
Chronic mesenteric ischemia.
Procedure Performed:
Abdominal angiogram, selective angiography celiac axis, superior mesenteric artery, inferior mesenteric artery
Pre-Procedure Diagnosis:
Mesenteric ischemia
Post-Procedure Diagnosis:
No evidence of significant stenosis involving the celiac axis or superior mesenteric artery.
Case Classification:
Add-on (Includes Emergency, NOT trauma)
Stress or Imaging Test Performed:
CT angiogram abdomen and pelvis.
Indicating ostial severe stenosis involving the celiac axis and inferior mesenteric artery.
Moderate Sedation:
Moderate sedation was administered using IV Versed and Fentanyl. Patient received continuous EKG, hemodynamic and oximetry monitoring with physician being present for the entire time. Total moderate sedation duration = 13 min.
Estimated Blood Loss:
Minimal
Complications:
No Complications were logged
Procedure Technique:
The risk, the benefits, alternatives were explained at length with the patient and informed consent was obtained. The patient was brought to the cardiac catheterization laboratory in the postabsorptive state. The right groin was prepped and draped in usual sterile fashion conscious patient was administered. Fluoroscopy and ultrasound guidance was used to access the right common femoral artery and 18 x 7 needle was used to access the right common femoral artery and a J-wire was advanced without difficulty. A 6 French seats was placed utilizing the modified Seldinger technique. A 5 French racquet catheter was advanced up to the level of the celiac axis and digital subtraction angiography nonselective was performed in the lateral projection. The catheter was then exchanged for a 5 French I am catheter which was advanced to the celiac access were selective angiography in the lateral projection was performed. The catheter was then repositioned at the origin this. Mesenteric artery were angiography was performed. Finally the catheter was used to engage the inferior mesenteric artery and angiography was performed. Catheter was carefully disengaged and removed over a J-wire. Angiography of the right common femoral artery in the RAO projection was performed demonstrating the arteriotomy to be at the proximal portion of the right superficial femoral artery which has a high bifurcation with the profunda femoris. It was decided to proceed with manual compression for hemostasis. Patient tolerated procedure well as transported to the holding area in stable condition.
Contrast:
Medication Name Total Dose
iodixanol (Visipaque) 320 mg/mL injection 97 mL
Hemodynamic Data:
Aortic pressure was: 6/12/2020 6/12/2020 5/19/2021
AO Systolic Pressure 148 165 138
AO Diastolic Pressure 63 61 45
AO Mean Pressure 97 100 79
LV pressure and LVEDP was: 6/12/2020
LV Systolic Pressure 159
LV Diastolic Pressure 10
LV End Diastolic Pressure 20
Some recent data might be hidden
Angiographic Data:
Abdominal angiogram lateral projection: Celiac access opacified and patent the superior mesenteric and inferior mesenteric were not well opacified the infrarenal abdominal aorta demonstrates no evidence of stenosis or aneurysmal dilatation.
Selective celiac axis angiography: Calcification is noted involving the ostium and proximal portion of the vessel the resultant ostial proximal stenosis of 20-30% is noted the remaining mid and distal portion of the celiac axis angiographically normal prior to bifurcation into the hepatic and splenic branches.
Selective angiography superior mesenteric artery: Extraluminal calcification noted in the ostial and proximal portion the vessel luminal irregularities but no resultant stenosis noted TIMI-3 flow noted.
Selective angiography and inferior mesenteric artery: Appears to be occluded.
Final Diagnosis:
1. Mild stenosis ostial proximal celiac axis 20-30%.
2. Superior mesenteric artery widely patent.
3. Inferior mesenteric artery occluded.
Recommendation:
No significant stenosis involving the celiac axis or superior mesenteric artery. Inferior mesenteric artery occluded undoubtedly collateralized. No indication for revascularization. Continue medical therapy
Procedure Ordered:
Procedure(s):
Mesenteric Angiogram Poss PTA
Indications:
Chronic mesenteric ischemia.
Procedure Performed:
Abdominal angiogram, selective angiography celiac axis, superior mesenteric artery, inferior mesenteric artery
Pre-Procedure Diagnosis:
Mesenteric ischemia
Post-Procedure Diagnosis:
No evidence of significant stenosis involving the celiac axis or superior mesenteric artery.
Case Classification:
Add-on (Includes Emergency, NOT trauma)
Stress or Imaging Test Performed:
CT angiogram abdomen and pelvis.
Indicating ostial severe stenosis involving the celiac axis and inferior mesenteric artery.
Moderate Sedation:
Moderate sedation was administered using IV Versed and Fentanyl. Patient received continuous EKG, hemodynamic and oximetry monitoring with physician being present for the entire time. Total moderate sedation duration = 13 min.
Estimated Blood Loss:
Minimal
Complications:
No Complications were logged
Procedure Technique:
The risk, the benefits, alternatives were explained at length with the patient and informed consent was obtained. The patient was brought to the cardiac catheterization laboratory in the postabsorptive state. The right groin was prepped and draped in usual sterile fashion conscious patient was administered. Fluoroscopy and ultrasound guidance was used to access the right common femoral artery and 18 x 7 needle was used to access the right common femoral artery and a J-wire was advanced without difficulty. A 6 French seats was placed utilizing the modified Seldinger technique. A 5 French racquet catheter was advanced up to the level of the celiac axis and digital subtraction angiography nonselective was performed in the lateral projection. The catheter was then exchanged for a 5 French I am catheter which was advanced to the celiac access were selective angiography in the lateral projection was performed. The catheter was then repositioned at the origin this. Mesenteric artery were angiography was performed. Finally the catheter was used to engage the inferior mesenteric artery and angiography was performed. Catheter was carefully disengaged and removed over a J-wire. Angiography of the right common femoral artery in the RAO projection was performed demonstrating the arteriotomy to be at the proximal portion of the right superficial femoral artery which has a high bifurcation with the profunda femoris. It was decided to proceed with manual compression for hemostasis. Patient tolerated procedure well as transported to the holding area in stable condition.
Contrast:
Medication Name Total Dose
iodixanol (Visipaque) 320 mg/mL injection 97 mL
Hemodynamic Data:
Aortic pressure was: 6/12/2020 6/12/2020 5/19/2021
AO Systolic Pressure 148 165 138
AO Diastolic Pressure 63 61 45
AO Mean Pressure 97 100 79
LV pressure and LVEDP was: 6/12/2020
LV Systolic Pressure 159
LV Diastolic Pressure 10
LV End Diastolic Pressure 20
Some recent data might be hidden
Angiographic Data:
Abdominal angiogram lateral projection: Celiac access opacified and patent the superior mesenteric and inferior mesenteric were not well opacified the infrarenal abdominal aorta demonstrates no evidence of stenosis or aneurysmal dilatation.
Selective celiac axis angiography: Calcification is noted involving the ostium and proximal portion of the vessel the resultant ostial proximal stenosis of 20-30% is noted the remaining mid and distal portion of the celiac axis angiographically normal prior to bifurcation into the hepatic and splenic branches.
Selective angiography superior mesenteric artery: Extraluminal calcification noted in the ostial and proximal portion the vessel luminal irregularities but no resultant stenosis noted TIMI-3 flow noted.
Selective angiography and inferior mesenteric artery: Appears to be occluded.
Final Diagnosis:
1. Mild stenosis ostial proximal celiac axis 20-30%.
2. Superior mesenteric artery widely patent.
3. Inferior mesenteric artery occluded.
Recommendation:
No significant stenosis involving the celiac axis or superior mesenteric artery. Inferior mesenteric artery occluded undoubtedly collateralized. No indication for revascularization. Continue medical therapy