bevann0402@bellsouth.net
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I haven't posted in awhile, but I have been lurking!!! lol
Due to holidays and the weather, this is the first leg case I have gotten in awhile and I am a little rusty!
the codes I came up with are 37221, 37220 (59 mod??), 75630
indication: severe PVD, lifestyle limiting claudication
procedures performed:
1. a 6 French sheath placement in the left common femoral artery without difficulty
2. distal aortogram with bilateral lower extremity runoff
3. right common iliac artery selective angiography
4. right common iliac artery angioplasty utilizing plain old balloon angioplasty
5. right external iliac artery selective angiography
6. right external iliac artery angioplasty with stent placement
7. right common femoral artery selective angiography
8. right superficial femoral artery selective angiography
9. left common femoral artery selective angiography with runoff
description of procedure:
details of LE angiography andPCI were explained. A 6 French sheath placement in the left common femoral artery without significant difficulty.
a 6 French pigtail catheter was placed into the distal aorta and distal aortogram with runoff was performed. The distal aorta, heavily calcified with 50% occlusion prior to bifurcation. The runoff was then performed via the right leg.
The right common iliac artery patent with 50% in-stent re-stenosis.
The right external iliac artery 90% lesion at the takeoff of the right internal iliac artery with a gap lesion seen between the common and external iliac artery with previous stenting seen.
Right common femoral artery angiography showed 70% lesion proximally.
The right internal iliac artery seen poorly visualized, moderate disease seen.
There was a right superficial femoral artery 70% proximal lesion seen.
Right popliteal artery patent
right anterior tibial artery is small but patent
the right peroneal artery 100% proximal occlusion with reconstitution seen mid-calf.
right posterior tibial artery 100% proximal occlusion. difficult to see the second reconstitution point.
The decision had been made to replace the 6 French short sheath, to remove the pigtail catheter, and we place a long 6x45 Terumo sheath. Selective angiography was performed as described above. Angiomax was started. we took a 6x80 EverCross balloon and placed it across the severe lesion in the right common iliac artery with severe in-stent re-stenosis in the right external iliac artery with the gap lesion seen. Two inflations 11 for 30 seconds, 11 for 30 seconds.
We took a self expanding EverFlex stent 7mm x 20 and this was placed overlapping the right common iliac artery stent and right external iliac artery stent, and we posted this was a 6 x 80 EverCross balloon at 12 atmospherres for 30 seconds.
the severe in-stent re-stenosis as well as the severe gap lesion in the right external iliac artery less than 20% residual.
the Terumo sheath was removed and replaced with a short sheath to allow further angiography of the left lower extremity. please note that the following dictation showing the left upper pelvic part of her anatomy is actually down through the pigtail catheter, but it was done here for convenience.
the left common iliac artery 30% in-stent re-stenosis
the left external iliac artery widely patent
the left common femoral artery 90% ostial occlusion and actually the sheath was obstructed. it also has a 70% proximal occlusion noted as well.
the left profundus femoral artery widely patent
the left superficial femoral artery 70% proximal occlusion seen
the left popliteal artery widely patent
the left anterior tibial artery is small but patent
the left peroneal artery is small but appears to be patent
the left posterior tibial artery is small but appears to be patent. unable to determine the exact runoff to the left foot because the sheath was occlusive as above.
the 6 French was sewn into the left groin at that point. the patient was loaded with antiplatelet agents. the patient left the lab in stable condition with recommendations for a stage 2 procedure to be performed from a right access point to correct the left common femoral artery and proximal left superifical femoral artery severe lesions, likely will require a stage 3 which will be performed through the left side to correct the right popliteal and infrapopliteal trunk.
As usual I appreciate everyone's help!! Just when I got used to doing these procedures we go for some time without one and now I am freaking out!!
Thanks again
Beverly Abernathy, CPC, CIMC
Due to holidays and the weather, this is the first leg case I have gotten in awhile and I am a little rusty!
the codes I came up with are 37221, 37220 (59 mod??), 75630
indication: severe PVD, lifestyle limiting claudication
procedures performed:
1. a 6 French sheath placement in the left common femoral artery without difficulty
2. distal aortogram with bilateral lower extremity runoff
3. right common iliac artery selective angiography
4. right common iliac artery angioplasty utilizing plain old balloon angioplasty
5. right external iliac artery selective angiography
6. right external iliac artery angioplasty with stent placement
7. right common femoral artery selective angiography
8. right superficial femoral artery selective angiography
9. left common femoral artery selective angiography with runoff
description of procedure:
details of LE angiography andPCI were explained. A 6 French sheath placement in the left common femoral artery without significant difficulty.
a 6 French pigtail catheter was placed into the distal aorta and distal aortogram with runoff was performed. The distal aorta, heavily calcified with 50% occlusion prior to bifurcation. The runoff was then performed via the right leg.
The right common iliac artery patent with 50% in-stent re-stenosis.
The right external iliac artery 90% lesion at the takeoff of the right internal iliac artery with a gap lesion seen between the common and external iliac artery with previous stenting seen.
Right common femoral artery angiography showed 70% lesion proximally.
The right internal iliac artery seen poorly visualized, moderate disease seen.
There was a right superficial femoral artery 70% proximal lesion seen.
Right popliteal artery patent
right anterior tibial artery is small but patent
the right peroneal artery 100% proximal occlusion with reconstitution seen mid-calf.
right posterior tibial artery 100% proximal occlusion. difficult to see the second reconstitution point.
The decision had been made to replace the 6 French short sheath, to remove the pigtail catheter, and we place a long 6x45 Terumo sheath. Selective angiography was performed as described above. Angiomax was started. we took a 6x80 EverCross balloon and placed it across the severe lesion in the right common iliac artery with severe in-stent re-stenosis in the right external iliac artery with the gap lesion seen. Two inflations 11 for 30 seconds, 11 for 30 seconds.
We took a self expanding EverFlex stent 7mm x 20 and this was placed overlapping the right common iliac artery stent and right external iliac artery stent, and we posted this was a 6 x 80 EverCross balloon at 12 atmospherres for 30 seconds.
the severe in-stent re-stenosis as well as the severe gap lesion in the right external iliac artery less than 20% residual.
the Terumo sheath was removed and replaced with a short sheath to allow further angiography of the left lower extremity. please note that the following dictation showing the left upper pelvic part of her anatomy is actually down through the pigtail catheter, but it was done here for convenience.
the left common iliac artery 30% in-stent re-stenosis
the left external iliac artery widely patent
the left common femoral artery 90% ostial occlusion and actually the sheath was obstructed. it also has a 70% proximal occlusion noted as well.
the left profundus femoral artery widely patent
the left superficial femoral artery 70% proximal occlusion seen
the left popliteal artery widely patent
the left anterior tibial artery is small but patent
the left peroneal artery is small but appears to be patent
the left posterior tibial artery is small but appears to be patent. unable to determine the exact runoff to the left foot because the sheath was occlusive as above.
the 6 French was sewn into the left groin at that point. the patient was loaded with antiplatelet agents. the patient left the lab in stable condition with recommendations for a stage 2 procedure to be performed from a right access point to correct the left common femoral artery and proximal left superifical femoral artery severe lesions, likely will require a stage 3 which will be performed through the left side to correct the right popliteal and infrapopliteal trunk.
As usual I appreciate everyone's help!! Just when I got used to doing these procedures we go for some time without one and now I am freaking out!!
Thanks again
Beverly Abernathy, CPC, CIMC
