calorom2
Networker
Can someone take a look at my codes for these two notes and let me know if I'm on the right track (and if not what is incorrect and why?) Thank you so much!
#1) 37228-RT, 37224-RT, 75630-26-59, 75710-RT-26-59
PROCEDURE:
Left common femoral artery access, contralateral right leg angiography,
angioplasty of right TP trunk, angioplasty of right popliteal, angioplasty
of right above knee SFA to the adductor canal.
COMPLICATIONS:
None.
ESTIMATED BLOOD LOSS:
Less than 5 mL.
INDICATION FOR PROCEDURE:
Rest pain/threatened extremity.
DESCRIPTION OF PROCEDURE:
After informed consent, discussion of risks and benefits, a 5-French
sheath was placed using ultrasound and a micropuncture kit. The left
SFA was diffusely diseased, but we got access into relatively healthy
portion. I was concerned about the left common femoral which may need
to be addressed in the future depending on the patient's clinical condition.
Once micropuncture angiogram was done, a 5-French sheath was placed.
Contra catheter was placed. Abdominal aortogram was performed. A
catheter was placed up and over. Selective angiography was performed.
ANGIOGRAPHIC FINDINGS:
Abdominal aorta has diffuse disease. Bilateral common external diffusely
diseased. There are 2 stents in the right common and external, which
are patent with a 30% to 40% in-stent restenosis. The left common femoral
is 20% stenosis. Left proximal SFA has a diffuse 60% stenosis. There
is a stent in the above knee popliteal, which is subtotally occluded.
The TP trunk is subtotally occluded. Runoff is via the peroneal.
The anterior and posterior tibial come off, but are occluded at the
level of the midcalf. We decided to intervene on the TP trunk, popliteal,
and above knee SFA.
INTERVENTIONAL PROCEDURE:
The patient was anticoagulated to a therapeutic ACT. We did have some
difficulty getting across. Finally, an M-wire was used to get across.
Balloon angioplasty was performed with a 3.5 x 80 balloon. Following
that, a 4.0 x 150 was inflated for 3 minutes. We then used that same
4.0 balloon to treat the SFA. Final angiography showed significantly
improved flow. Overall prognosis is guarded given the diffuse nature
of disease, but the runoff was unchanged. There were no apparent complications.
The sheath will be pulled manually given the significant common femoral
disease on the left. Further recommendations to follow clinical course.
#2) 37226-RT, 75630-26-59, 75710-RT-26-59
PROCEDURES PERFORMED:
Left common femoral artery access, abdominal aortogram with CO2, selective
right lower extremity runoff, angioplasty of right SFA and popliteal
with drug-coated balloon, 5.0.
COMPLICATIONS:
None.
Sheath pulled, manual.
INDICATION FOR PROCEDURE:
Nonhealing ulcer, known peripheral arterial disease.
DESCRIPTION OF PROCEDURE:
After informed consent, discussion of risks and benefits, a 5-French
sheath was placed into the left common femoral artery. The left common
femoral bifurcation is very high and the patient has had a femoral-popliteal
bypass in the past. We did take micropuncture pictures and even that
the stick was on the higher side, we decided to take it given the high
bifurcation. Angiography showed bilateral common and external iliacs
to be free of significant disease. Right common femoral has a 20%-30%
stenosis, ostial right SFA 20%-30%. The stent is patent throughout.
Multiple stents are there in the SFA all the way from the proximal
SFA to the above-knee popliteal to above the knee. There is a focal
90% stenosis at the distal edge of the stent in the popliteal. There
is a further 50%-60% diffuse stenosis in the distal SFA and proximal
popliteal. Runoff is via single vessel runoff via the anterior tibial,
which essentially collateralizes the foot.
INTERVENTIONAL PROCEDURE:
A 5-French sheath was placed up and over. The patient was anticoagulated
to a therapeutic ACT. We crossed with a 035 wire, Terumo Advantage.
Balloon angioplasty was done with a drug balloon 5.0 x 60. Same balloon
was used for multiple inflations in the stent. Final angiography showed
excellent flow, 80% lesion was resolved to 0%. There were no
complications. Runoff was unchanged. The sheath will be pulled manually.
Further recommendations to follow hospital course.
#1) 37228-RT, 37224-RT, 75630-26-59, 75710-RT-26-59
PROCEDURE:
Left common femoral artery access, contralateral right leg angiography,
angioplasty of right TP trunk, angioplasty of right popliteal, angioplasty
of right above knee SFA to the adductor canal.
COMPLICATIONS:
None.
ESTIMATED BLOOD LOSS:
Less than 5 mL.
INDICATION FOR PROCEDURE:
Rest pain/threatened extremity.
DESCRIPTION OF PROCEDURE:
After informed consent, discussion of risks and benefits, a 5-French
sheath was placed using ultrasound and a micropuncture kit. The left
SFA was diffusely diseased, but we got access into relatively healthy
portion. I was concerned about the left common femoral which may need
to be addressed in the future depending on the patient's clinical condition.
Once micropuncture angiogram was done, a 5-French sheath was placed.
Contra catheter was placed. Abdominal aortogram was performed. A
catheter was placed up and over. Selective angiography was performed.
ANGIOGRAPHIC FINDINGS:
Abdominal aorta has diffuse disease. Bilateral common external diffusely
diseased. There are 2 stents in the right common and external, which
are patent with a 30% to 40% in-stent restenosis. The left common femoral
is 20% stenosis. Left proximal SFA has a diffuse 60% stenosis. There
is a stent in the above knee popliteal, which is subtotally occluded.
The TP trunk is subtotally occluded. Runoff is via the peroneal.
The anterior and posterior tibial come off, but are occluded at the
level of the midcalf. We decided to intervene on the TP trunk, popliteal,
and above knee SFA.
INTERVENTIONAL PROCEDURE:
The patient was anticoagulated to a therapeutic ACT. We did have some
difficulty getting across. Finally, an M-wire was used to get across.
Balloon angioplasty was performed with a 3.5 x 80 balloon. Following
that, a 4.0 x 150 was inflated for 3 minutes. We then used that same
4.0 balloon to treat the SFA. Final angiography showed significantly
improved flow. Overall prognosis is guarded given the diffuse nature
of disease, but the runoff was unchanged. There were no apparent complications.
The sheath will be pulled manually given the significant common femoral
disease on the left. Further recommendations to follow clinical course.
#2) 37226-RT, 75630-26-59, 75710-RT-26-59
PROCEDURES PERFORMED:
Left common femoral artery access, abdominal aortogram with CO2, selective
right lower extremity runoff, angioplasty of right SFA and popliteal
with drug-coated balloon, 5.0.
COMPLICATIONS:
None.
Sheath pulled, manual.
INDICATION FOR PROCEDURE:
Nonhealing ulcer, known peripheral arterial disease.
DESCRIPTION OF PROCEDURE:
After informed consent, discussion of risks and benefits, a 5-French
sheath was placed into the left common femoral artery. The left common
femoral bifurcation is very high and the patient has had a femoral-popliteal
bypass in the past. We did take micropuncture pictures and even that
the stick was on the higher side, we decided to take it given the high
bifurcation. Angiography showed bilateral common and external iliacs
to be free of significant disease. Right common femoral has a 20%-30%
stenosis, ostial right SFA 20%-30%. The stent is patent throughout.
Multiple stents are there in the SFA all the way from the proximal
SFA to the above-knee popliteal to above the knee. There is a focal
90% stenosis at the distal edge of the stent in the popliteal. There
is a further 50%-60% diffuse stenosis in the distal SFA and proximal
popliteal. Runoff is via single vessel runoff via the anterior tibial,
which essentially collateralizes the foot.
INTERVENTIONAL PROCEDURE:
A 5-French sheath was placed up and over. The patient was anticoagulated
to a therapeutic ACT. We crossed with a 035 wire, Terumo Advantage.
Balloon angioplasty was done with a drug balloon 5.0 x 60. Same balloon
was used for multiple inflations in the stent. Final angiography showed
excellent flow, 80% lesion was resolved to 0%. There were no
complications. Runoff was unchanged. The sheath will be pulled manually.
Further recommendations to follow hospital course.