bhargavi
Guru
Severe hypertension despite multi-agent therapy, assess for renal artery
stenosis.
CLINICAL HISTORY
Judith L. Dugan is a morbidly obese 62 years old woman with a history of
hypertension, hyperlipidemia, diabetes mellitus and thyroid disease. She was
recently admitted to the Kent General Hospital with complaints of shortness of
breath due to acute systolic congestive heart failure. She had a new left
bundle branch block and was referred for coronary angiography to assess her
coronary anatomy. We subsequently also performed selective bilateral renal
angiography in order to screen for renal artery stenosis as a contributory to
her difficult to control blood pressure.
TECHNIQUE
After obtaining informed consent, the patient was prepped and draped in the
usual fashion. Approximately 10 milliliters of two percent Lidocaine
anesthesia was administered to the left groin prior to placement of the atrial
sheath. Under fluoroscopic guidance and using the modified Seldinger
technique, a six French arterial sheath was placed in the left femoral artery.
We then obtained a six French FR4 diagnostic catheter and performed selective
bilateral renal angiography.
FINDINGS
1. The left renal artery is large and widely patent with no visible stenosis.
2. The right renal artery is a large vessel which is also patent. There is
osteal proximal stenosis of approximately 30 percent in the right renal artery.
In the middle portion of the right renal artery there is an area of
irregularity with ulceration that appears to be no worse than again
approximately 30 percent in severity. There does, however, appear to be an
area of what looks like aneurysm beyond the segment in the renal artery.
Overall, the renal perfusion appears preserved.
At the end of the procedure, the diagnostic catheter was withdrawn and manual
compression was utilized for hemostasis.
IMPRESSION
1. Normal left renal artery architecture.
2. Mild proximal and mid right renal artery disease with what appears to be an
aneurysmal segment beyond the mid stenosis.
PLAN
1. Medical therapy for hypertension.
2. Consider CTA of renal arteries for better visualization.
thanks in advance
i am thinking of 36252. this procedure was done along with left heart cath/cor/lv-93458. is 36252 billable with 93458? there was a seperate dictation of 93458
stenosis.
CLINICAL HISTORY
Judith L. Dugan is a morbidly obese 62 years old woman with a history of
hypertension, hyperlipidemia, diabetes mellitus and thyroid disease. She was
recently admitted to the Kent General Hospital with complaints of shortness of
breath due to acute systolic congestive heart failure. She had a new left
bundle branch block and was referred for coronary angiography to assess her
coronary anatomy. We subsequently also performed selective bilateral renal
angiography in order to screen for renal artery stenosis as a contributory to
her difficult to control blood pressure.
TECHNIQUE
After obtaining informed consent, the patient was prepped and draped in the
usual fashion. Approximately 10 milliliters of two percent Lidocaine
anesthesia was administered to the left groin prior to placement of the atrial
sheath. Under fluoroscopic guidance and using the modified Seldinger
technique, a six French arterial sheath was placed in the left femoral artery.
We then obtained a six French FR4 diagnostic catheter and performed selective
bilateral renal angiography.
FINDINGS
1. The left renal artery is large and widely patent with no visible stenosis.
2. The right renal artery is a large vessel which is also patent. There is
osteal proximal stenosis of approximately 30 percent in the right renal artery.
In the middle portion of the right renal artery there is an area of
irregularity with ulceration that appears to be no worse than again
approximately 30 percent in severity. There does, however, appear to be an
area of what looks like aneurysm beyond the segment in the renal artery.
Overall, the renal perfusion appears preserved.
At the end of the procedure, the diagnostic catheter was withdrawn and manual
compression was utilized for hemostasis.
IMPRESSION
1. Normal left renal artery architecture.
2. Mild proximal and mid right renal artery disease with what appears to be an
aneurysmal segment beyond the mid stenosis.
PLAN
1. Medical therapy for hypertension.
2. Consider CTA of renal arteries for better visualization.
thanks in advance
i am thinking of 36252. this procedure was done along with left heart cath/cor/lv-93458. is 36252 billable with 93458? there was a seperate dictation of 93458
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