Procedures Performed
1. Ultrasound imaging of the right common femoral artery
2. Abdominal aortogram w/ bilateral lower extremity run off
3. Bilateral selective renal angiography
4. Bilateral fractional flow reserve and pressure gradient measurement of the renal arteries
5. Pressure gradient measurement of the left common iliac artery and right common iliac artery
the pt. was prepped and draped in sterile fashion. an ultrasound probe was used to image the right common femoral artery. the common femoral artery was readily identified with pulsatile. It was greater than 3mm in diameter. It was punctured directly with needle access and a $ French sheath was inserted. A $French UF catheter was advanced to the mid abdominal aorta. The mid abdominal aortography was performed, just to the level of the renal artery, so the renal artery was not well visualized, but did appear to suggest possible stenosis bilaterally. Subsequently, the catheter was pulled down to the distal aorta and distal abdominal aortography was performed. The catheter was then advanced over a GLidewire into the contralateral left common femoral artery. The left common femoral artery and left lower extremity angiogram were performed with digital subtraction. The catheter was changed out over an exchange length J-wire for a short 4 French end hole glide catheter and a pressure gradient evaluation was performed on pullback across the left common iliac artery to the distal aorta. After this, the catheter was pulled down from the distal aorta to the right external iliac artery to evaluate for gradient in the right common iliac artery. The catheter was then removed and right lower extremity angiogram was performed via digital subtraction and injection through the right common femoral artery sheath. After this a 4 French JR$ catheter was advanced and used to perform selective left renal angiography. pressure gradient was measured with the catheter advanced into the proximal left renal artery, which showed a roughly 20 mm systolic gradient. Right renal angiogram was then performed with the same catheter. There was a moderate stenosis, just borderline at the proximal right renal artery as well. AT this point it was decided to perform more accurate pressure measurement and FFR wire was taken. IV heparin was given for anticoagulation. Through the diagnostic 4french cathter, the FFR wire was advanced into the right renal artery and pressure measurement was obtained with the catheter disengaged from the renal artery. The wire was pulled back and the cathter is being engaged in the left renal artery and FFR was advanced and FFR measurement was performed to measure the pressure gradient across the left renal artery. After this the wire and catheter were removed. It was felt that there was no plans for immediate intervention and procedure was terminated. The pt. tolerated the procedure w/o incident.
I would use these could and please tell me what Im missing or doing wrong. Thank You
36252
75630 26 59
93799 26 59 (unlisted code, FFR renal arteries, since 93571 is for coronary)
76942 59
1. Ultrasound imaging of the right common femoral artery
2. Abdominal aortogram w/ bilateral lower extremity run off
3. Bilateral selective renal angiography
4. Bilateral fractional flow reserve and pressure gradient measurement of the renal arteries
5. Pressure gradient measurement of the left common iliac artery and right common iliac artery
the pt. was prepped and draped in sterile fashion. an ultrasound probe was used to image the right common femoral artery. the common femoral artery was readily identified with pulsatile. It was greater than 3mm in diameter. It was punctured directly with needle access and a $ French sheath was inserted. A $French UF catheter was advanced to the mid abdominal aorta. The mid abdominal aortography was performed, just to the level of the renal artery, so the renal artery was not well visualized, but did appear to suggest possible stenosis bilaterally. Subsequently, the catheter was pulled down to the distal aorta and distal abdominal aortography was performed. The catheter was then advanced over a GLidewire into the contralateral left common femoral artery. The left common femoral artery and left lower extremity angiogram were performed with digital subtraction. The catheter was changed out over an exchange length J-wire for a short 4 French end hole glide catheter and a pressure gradient evaluation was performed on pullback across the left common iliac artery to the distal aorta. After this, the catheter was pulled down from the distal aorta to the right external iliac artery to evaluate for gradient in the right common iliac artery. The catheter was then removed and right lower extremity angiogram was performed via digital subtraction and injection through the right common femoral artery sheath. After this a 4 French JR$ catheter was advanced and used to perform selective left renal angiography. pressure gradient was measured with the catheter advanced into the proximal left renal artery, which showed a roughly 20 mm systolic gradient. Right renal angiogram was then performed with the same catheter. There was a moderate stenosis, just borderline at the proximal right renal artery as well. AT this point it was decided to perform more accurate pressure measurement and FFR wire was taken. IV heparin was given for anticoagulation. Through the diagnostic 4french cathter, the FFR wire was advanced into the right renal artery and pressure measurement was obtained with the catheter disengaged from the renal artery. The wire was pulled back and the cathter is being engaged in the left renal artery and FFR was advanced and FFR measurement was performed to measure the pressure gradient across the left renal artery. After this the wire and catheter were removed. It was felt that there was no plans for immediate intervention and procedure was terminated. The pt. tolerated the procedure w/o incident.
I would use these could and please tell me what Im missing or doing wrong. Thank You
36252
75630 26 59
93799 26 59 (unlisted code, FFR renal arteries, since 93571 is for coronary)
76942 59