bennieyoung
Guru
I could use some help coding this if there is someone that's more familiar with this type coding than I am. I have been looking at 75630 and 75710 ( not bilateral so I don't think this one is right) but any suggestions will be greatly appreciated. Thanks in advance for your help!
PREOPERATIVE DIAGNOSIS: Bilateral claudication.
PROCEDURE PERFORMED:
1. A 6-French sheath, left radial artery.
2. Abdominal aortogram.
3. Percutaneous intervention of right external iliac artery utilizing Misago 8.0 x 100 mm stent.
4. Shock wave lithotripsy of right external iliac utilizing a 7.0 x 100 mm shock-wave balloon.
5. Drug-coated balloon with Boston Scientific Ranger 7.0 x 100 mm balloon.
FINDINGS:
INDICATIONS: Briefly, this is a 75-year-old male with history of worsening claudication. The patient had a CTA, which showed bilateral external iliac artery occlusions with also high-grade left common iliac artery narrowing. The patient was consented for invasive angiography.
DESCRIPTION OF PROCEDURE: After informed consent, the patient's left wrist was prepped and draped in a sterile fashion. After Allen test confirmed patency of ulnar artery, utilizing local lidocaine, a 6-French sheath into the left radial artery. The patient was administered 2000 units of heparin, 200 mcg of nitroglycerin through the sheath. A pigtail catheter was advanced to the descending aorta over a baby J-wire. Angiography obtained showed what appeared to be patent right common iliac artery. The left common iliac artery had 80% to 90% calcified proximal stenosis distal to the takeoff of the internal iliac arteries bilaterally. The external iliac arteries bilaterally appeared to be occluded 100% on both sides. There appeared to be faint reconstitution of the CFAs bilaterally. At this time, and the pigtail catheter was removed over a stiff wire. A 6-French slender distant sheath was placed, 110 cm, was placed down to the distal aorta. After this was performed, the patient was administered 10,000 heparin IV with ACTs being checked for 15 minutes thereafter to maintain ACT greater than 250. Given the fact that we had a 6-French sheath in place, which potentially would not accommodate a larger than an 8 mm balloon expandable stent, we decided that we would tackle the right iliac system first, as there was clear runway through the common iliac artery to the external iliac artery.
A 2 mm angle glide catheter, as well as a straight stiff Glidewire was advanced, and this successfully traversed the lesion in the external iliac artery and was placed into what appeared to be the SFA. This was confirmed as the catheter was placed down into the SFA and angiography was obtained, which showed that this was a widely patent SFA. We then placed an 0.014 wire into the SFA and proceeded with predilatation with a 5.0 x 100 mm Boston Scientific balloon at 8 atmospheres. After this was performed, we then proceeded with shockwave therapy of this area with a shockwave 6.0 x 100 mm balloon. Multiple shocks were delivered across this area. We then proceeded with placing a 7.0 x 100 mm Boston Scientific drug-coated balloon Ranger across this area and inflated for 3 minutes at 10 atmospheres. After this was performed, angiographic image was obtained, which showed much improved patency of the external iliac artery. We decided to proceed with stenting this vessel with a Terumo Misago 8.0 x 100 mm stent. This was deployed successfully post dilatation, and post deployment, we then post dilated this area with a Boston Scientific 7.0 x 60 mm balloon multiple sequential inflations of 8 atmospheres occurred across the stented area. After this was performed, angiographic images were obtained, which showed excellent patency of the stented area with no dissection or perforation. The internal iliac artery on this side, which did have an 80% to 90% ostial pinch, was still widely patent. At this time, the wire was pulled back, the guide catheter was switched out with a dilator, and the radial band was placed on the left wrist. The patient tolerated the procedure well with no complications.
IMPRESSION: Successful percutaneous transluminal coronary angioplasty and stenting of right 100% occluded external iliac artery utilizing shockwave therapy DCP and Misago self-expanding stent.
PLAN: The patient will have 3 hours of bed rest, start on baby aspirin and Plavix. The patient will be brought back in 1 month for intervention of his left iliac artery via the right groin, as this will allow us to use a larger sheath for potential larger balloon expandable stent in the left common iliac artery.
PREOPERATIVE DIAGNOSIS: Bilateral claudication.
PROCEDURE PERFORMED:
1. A 6-French sheath, left radial artery.
2. Abdominal aortogram.
3. Percutaneous intervention of right external iliac artery utilizing Misago 8.0 x 100 mm stent.
4. Shock wave lithotripsy of right external iliac utilizing a 7.0 x 100 mm shock-wave balloon.
5. Drug-coated balloon with Boston Scientific Ranger 7.0 x 100 mm balloon.
FINDINGS:
INDICATIONS: Briefly, this is a 75-year-old male with history of worsening claudication. The patient had a CTA, which showed bilateral external iliac artery occlusions with also high-grade left common iliac artery narrowing. The patient was consented for invasive angiography.
DESCRIPTION OF PROCEDURE: After informed consent, the patient's left wrist was prepped and draped in a sterile fashion. After Allen test confirmed patency of ulnar artery, utilizing local lidocaine, a 6-French sheath into the left radial artery. The patient was administered 2000 units of heparin, 200 mcg of nitroglycerin through the sheath. A pigtail catheter was advanced to the descending aorta over a baby J-wire. Angiography obtained showed what appeared to be patent right common iliac artery. The left common iliac artery had 80% to 90% calcified proximal stenosis distal to the takeoff of the internal iliac arteries bilaterally. The external iliac arteries bilaterally appeared to be occluded 100% on both sides. There appeared to be faint reconstitution of the CFAs bilaterally. At this time, and the pigtail catheter was removed over a stiff wire. A 6-French slender distant sheath was placed, 110 cm, was placed down to the distal aorta. After this was performed, the patient was administered 10,000 heparin IV with ACTs being checked for 15 minutes thereafter to maintain ACT greater than 250. Given the fact that we had a 6-French sheath in place, which potentially would not accommodate a larger than an 8 mm balloon expandable stent, we decided that we would tackle the right iliac system first, as there was clear runway through the common iliac artery to the external iliac artery.
A 2 mm angle glide catheter, as well as a straight stiff Glidewire was advanced, and this successfully traversed the lesion in the external iliac artery and was placed into what appeared to be the SFA. This was confirmed as the catheter was placed down into the SFA and angiography was obtained, which showed that this was a widely patent SFA. We then placed an 0.014 wire into the SFA and proceeded with predilatation with a 5.0 x 100 mm Boston Scientific balloon at 8 atmospheres. After this was performed, we then proceeded with shockwave therapy of this area with a shockwave 6.0 x 100 mm balloon. Multiple shocks were delivered across this area. We then proceeded with placing a 7.0 x 100 mm Boston Scientific drug-coated balloon Ranger across this area and inflated for 3 minutes at 10 atmospheres. After this was performed, angiographic image was obtained, which showed much improved patency of the external iliac artery. We decided to proceed with stenting this vessel with a Terumo Misago 8.0 x 100 mm stent. This was deployed successfully post dilatation, and post deployment, we then post dilated this area with a Boston Scientific 7.0 x 60 mm balloon multiple sequential inflations of 8 atmospheres occurred across the stented area. After this was performed, angiographic images were obtained, which showed excellent patency of the stented area with no dissection or perforation. The internal iliac artery on this side, which did have an 80% to 90% ostial pinch, was still widely patent. At this time, the wire was pulled back, the guide catheter was switched out with a dilator, and the radial band was placed on the left wrist. The patient tolerated the procedure well with no complications.
IMPRESSION: Successful percutaneous transluminal coronary angioplasty and stenting of right 100% occluded external iliac artery utilizing shockwave therapy DCP and Misago self-expanding stent.
PLAN: The patient will have 3 hours of bed rest, start on baby aspirin and Plavix. The patient will be brought back in 1 month for intervention of his left iliac artery via the right groin, as this will allow us to use a larger sheath for potential larger balloon expandable stent in the left common iliac artery.