slc112071
Networker
Could someone please give me a second opinion on the coding of this report? I believe that it is 35302 and 34201.
PROCEDURE:
1. Exposure of the right common femoral artery and right superficial femoral
artery and right profunda artery
2. Embolectomy of the infrarenal distal aorta.
3. Embolectomy of the right common iliac artery.
4. Embolectomy of the left common iliac artery.
5. Embolectomy of the right external iliac artery.
6. Embolectomy of the right common femoral artery.
7. Embolectomy of the right superficial femoral artery.
8. Embolectomy of the right popliteal artery.
9. Endarterectomy and patch arterioplasty of the right common femoral artery.
10. Endarterectomy and patch arterioplasty of the right superficial femoral
artery.
11. Angiogram of the right leg from the common femoral artery all the way to
the distal ankle vessels with interpretation of the imaging.
I first assisted Dr. P with his stent of the right common iliac artery
and with his balloon angioplasty of the left iliac artery. I also first
assisted him with his catheterization of the right superficial femoral artery
all the way to the popliteal to leave a catheter for t-PA infusion.
SURGEON: M
ASSISTANT: P
OPERATIVE REPORT IN DETAIL: The patient is a female who presented
acutely with clot likely originating from her heart for atrial fibrillation
that was occluding her distal aorta. She had cool limbs and after discussion with her and her son, we took her emergently to the operating room.
In the operating room, she underwent intubation and general anesthesia and
appropriate invasive monitoring lines. She was prepped and draped.
Appropriate preoperative timeout was performed. Appropriate preoperative
antibiotics were administered. I then made an incision in her right groin, exposing her right common femoral artery, her right superficial femoral artery and right profunda artery. I got proximal control just above the inguinal ligament at the level of the
right external iliac artery. I placed a pursestring in the right common femoral artery and vessel loops proximally and distally on all the branches. I achieved access with a
12-French sheath under direct visualization. Before achieving access with a 12-French sheath, I opened the artery and I placed an embolectomy catheter. I used a 4-0 Fogarty, 5-0 Fogarty and 6-0 Fogarty. I went initially up to the level of the infrarenal aorta and I
pulled clot out using embolectomy catheters. There was visible thick clot
that I pulled out of her distal aorta, and clot out of her iliac arteries as
well as her right external iliac artery. Once I did that, I also then pulled
the Fogarty catheters distally to pull out of clot from her right superficial
femoral artery and right profunda as well as right popliteal artery. I did
that with a 4-0 Fogerty catheter and pulled out some clot. I then placed a 12-French sheath and Dr. P achieved access on the left groin percutaneously and we had access in both groins. We then shot an angiogram and as Dr. P will discuss in his note, there
was active clot seen at the distal aorta just above the bifurcation of the
iliacs. Dr. P placed a balloon up the left iliac to protect the left side and
tried a plush clot out of the left side into the right side. We did an
angioplasty of the right side. I then placed an expandable balloon under
fluoroscopy guidance up the right common femoral, right external iliac and
into the right common iliac and into the distal aorta. I expanded the balloon
and pulled it back under visualization under fluoroscopy to perform an
embolectomy of the right distal aorta, right common iliac and the clot pushed
out of the left iliac into the right side as well as down into the right
external iliac and right common femoral. I did that several times, pulling
out chunks of clot. We did several angiograms, verifying that the majority of
the clot was removed. I flushed the artery to try to displace any remaining
clot out of the left iliac artery to perform an embolectomy on that side and
push clot out on the right side. The distal left common iliac was protected by
the expanded balloon.
Once I was happy that the majority of clot was removed, there was some clot
causing impingement in the right common iliac. Dr. P placed a stent in
that area and he will dictate a separate note for that.
Once I completed all these embolectomies, I had good inflow and good flush, I
then had proximal and distal control. I debrided any damaged endothelium at
the level of the right common femoral on the right superficial femoral artery
and I then patched the right common and right superficial femoral artery with
a bovine pericardial patch using 6-0 Prolene suture.
Once I did that, I then made accessed her Dopplers in the right and left legs
and there were good Dopplers of the left leg; however, the Dopplers in the
right leg were poor.
I then decided to do an angiogram of the right lower leg to make sure that the
distal vessels were clear. I placed a 5-French sheath through the skin and
through my patch. I used a power injector and we did a power picture from the
right common femoral all the way to the foot vessels to try to look at the
posterior tibial, anterior tibial and the peroneal. I saw cut off at the
level of the distal popliteal just before the trifurcation, with very small
visualization of the distal vessels filling up slowly with evidence of clot in
them.
I was called by Dr. P and we talked about it and we decided that we would
leave an infusion catheter to inject t-PA all the way distally. He will
dictate a separate note for that. I then irrigated her groin and I closed it
with several layers of suture and staples. I left the sheath thorough a
pericardial patch with the infusion catheter, with the plan to take it out a
later time and repair her right common femoral artery finally at a later time.
Sponge count and instrument count were correct at the end of the case and she
was taken to the Intensive Care Unit.
PROCEDURE:
1. Exposure of the right common femoral artery and right superficial femoral
artery and right profunda artery
2. Embolectomy of the infrarenal distal aorta.
3. Embolectomy of the right common iliac artery.
4. Embolectomy of the left common iliac artery.
5. Embolectomy of the right external iliac artery.
6. Embolectomy of the right common femoral artery.
7. Embolectomy of the right superficial femoral artery.
8. Embolectomy of the right popliteal artery.
9. Endarterectomy and patch arterioplasty of the right common femoral artery.
10. Endarterectomy and patch arterioplasty of the right superficial femoral
artery.
11. Angiogram of the right leg from the common femoral artery all the way to
the distal ankle vessels with interpretation of the imaging.
I first assisted Dr. P with his stent of the right common iliac artery
and with his balloon angioplasty of the left iliac artery. I also first
assisted him with his catheterization of the right superficial femoral artery
all the way to the popliteal to leave a catheter for t-PA infusion.
SURGEON: M
ASSISTANT: P
OPERATIVE REPORT IN DETAIL: The patient is a female who presented
acutely with clot likely originating from her heart for atrial fibrillation
that was occluding her distal aorta. She had cool limbs and after discussion with her and her son, we took her emergently to the operating room.
In the operating room, she underwent intubation and general anesthesia and
appropriate invasive monitoring lines. She was prepped and draped.
Appropriate preoperative timeout was performed. Appropriate preoperative
antibiotics were administered. I then made an incision in her right groin, exposing her right common femoral artery, her right superficial femoral artery and right profunda artery. I got proximal control just above the inguinal ligament at the level of the
right external iliac artery. I placed a pursestring in the right common femoral artery and vessel loops proximally and distally on all the branches. I achieved access with a
12-French sheath under direct visualization. Before achieving access with a 12-French sheath, I opened the artery and I placed an embolectomy catheter. I used a 4-0 Fogarty, 5-0 Fogarty and 6-0 Fogarty. I went initially up to the level of the infrarenal aorta and I
pulled clot out using embolectomy catheters. There was visible thick clot
that I pulled out of her distal aorta, and clot out of her iliac arteries as
well as her right external iliac artery. Once I did that, I also then pulled
the Fogarty catheters distally to pull out of clot from her right superficial
femoral artery and right profunda as well as right popliteal artery. I did
that with a 4-0 Fogerty catheter and pulled out some clot. I then placed a 12-French sheath and Dr. P achieved access on the left groin percutaneously and we had access in both groins. We then shot an angiogram and as Dr. P will discuss in his note, there
was active clot seen at the distal aorta just above the bifurcation of the
iliacs. Dr. P placed a balloon up the left iliac to protect the left side and
tried a plush clot out of the left side into the right side. We did an
angioplasty of the right side. I then placed an expandable balloon under
fluoroscopy guidance up the right common femoral, right external iliac and
into the right common iliac and into the distal aorta. I expanded the balloon
and pulled it back under visualization under fluoroscopy to perform an
embolectomy of the right distal aorta, right common iliac and the clot pushed
out of the left iliac into the right side as well as down into the right
external iliac and right common femoral. I did that several times, pulling
out chunks of clot. We did several angiograms, verifying that the majority of
the clot was removed. I flushed the artery to try to displace any remaining
clot out of the left iliac artery to perform an embolectomy on that side and
push clot out on the right side. The distal left common iliac was protected by
the expanded balloon.
Once I was happy that the majority of clot was removed, there was some clot
causing impingement in the right common iliac. Dr. P placed a stent in
that area and he will dictate a separate note for that.
Once I completed all these embolectomies, I had good inflow and good flush, I
then had proximal and distal control. I debrided any damaged endothelium at
the level of the right common femoral on the right superficial femoral artery
and I then patched the right common and right superficial femoral artery with
a bovine pericardial patch using 6-0 Prolene suture.
Once I did that, I then made accessed her Dopplers in the right and left legs
and there were good Dopplers of the left leg; however, the Dopplers in the
right leg were poor.
I then decided to do an angiogram of the right lower leg to make sure that the
distal vessels were clear. I placed a 5-French sheath through the skin and
through my patch. I used a power injector and we did a power picture from the
right common femoral all the way to the foot vessels to try to look at the
posterior tibial, anterior tibial and the peroneal. I saw cut off at the
level of the distal popliteal just before the trifurcation, with very small
visualization of the distal vessels filling up slowly with evidence of clot in
them.
I was called by Dr. P and we talked about it and we decided that we would
leave an infusion catheter to inject t-PA all the way distally. He will
dictate a separate note for that. I then irrigated her groin and I closed it
with several layers of suture and staples. I left the sheath thorough a
pericardial patch with the infusion catheter, with the plan to take it out a
later time and repair her right common femoral artery finally at a later time.
Sponge count and instrument count were correct at the end of the case and she
was taken to the Intensive Care Unit.