nikmpayne
Contributor
Oh my....please help me, the more reading I do, the more I think I may be confusing myself, or over thinking, possibly both...
Bilateral common femoral arteries were dissected out using oblique incisions. The vessels were encircled with vessel loops. The common femoral arteries were accessed using a multipurpose needle and guidewire. 10-Fernch dilator and sheath was placed over the wires. Lunderquist wire was placed up the left common femoral artery and a glidewire was placed up the right common femoral artery. The IVUS was inserted over te lunderquist wire and the renal vein was visualized___imaging the aorta. The IVUS was then brought through to the bifurcation of the iliac vessels and the bifurcation of the internal as well as the external iliac vessels. A pigtail marking cath was placed up the right common femorral artery over the Glidewire. An angiogram was obtaqined. The 10-French sheath was exchanged for a 20-french dilator and sheath. The decision was made to go main body left and the bifurcated graft was then placed up the left common femoral artery to the level of the renal arteris which had been marked and identified. An angiogram was repeated and placement of the Gore-Tex excluder C3. The proximal portion of the graft to the gate was then deployed. The ipsilateral limb remianed contained. Another angiogram was obtained. The glidewire was inserted into the pigtail catheter. The wire remained and the pigtail cather was exchanged for a 5-french angled glide catheter. This was used to easily access the gate using a glidewire. A 12-french dilator and sheath was placed over a lunderquist wire to exchange the 10-french sheath that was previously in the right common femoral artery. At this oint the constraining loop to the proximal neck of the graft was released and the ipsilateral limb was then released. The contraleteral limb measurements are on the chart. It was palced and deployed without incident. A retro grade angiogram showed exellent positioning. It should be noted before the deployment of the contralteral and ipsilateral limb, the location of the bifurcation of the internal and external iliac arteries were identified and marked. _ballons were then placed bilaterally. They were i nflated at the proximal neck at the gate at the bifurcation and then at the distal limbs. No eveidence on endoleak, kinking or stenosis.
Thinking:
34812 mod 50
36200 LT
36200 RT
34802 LT
34802 RT
37250
34825
75952
75953
I hope I can get some assitance as this is not something I come across frequently.
Thanks for your help.
Nikki Payne, CPC
Bilateral common femoral arteries were dissected out using oblique incisions. The vessels were encircled with vessel loops. The common femoral arteries were accessed using a multipurpose needle and guidewire. 10-Fernch dilator and sheath was placed over the wires. Lunderquist wire was placed up the left common femoral artery and a glidewire was placed up the right common femoral artery. The IVUS was inserted over te lunderquist wire and the renal vein was visualized___imaging the aorta. The IVUS was then brought through to the bifurcation of the iliac vessels and the bifurcation of the internal as well as the external iliac vessels. A pigtail marking cath was placed up the right common femorral artery over the Glidewire. An angiogram was obtaqined. The 10-French sheath was exchanged for a 20-french dilator and sheath. The decision was made to go main body left and the bifurcated graft was then placed up the left common femoral artery to the level of the renal arteris which had been marked and identified. An angiogram was repeated and placement of the Gore-Tex excluder C3. The proximal portion of the graft to the gate was then deployed. The ipsilateral limb remianed contained. Another angiogram was obtained. The glidewire was inserted into the pigtail catheter. The wire remained and the pigtail cather was exchanged for a 5-french angled glide catheter. This was used to easily access the gate using a glidewire. A 12-french dilator and sheath was placed over a lunderquist wire to exchange the 10-french sheath that was previously in the right common femoral artery. At this oint the constraining loop to the proximal neck of the graft was released and the ipsilateral limb was then released. The contraleteral limb measurements are on the chart. It was palced and deployed without incident. A retro grade angiogram showed exellent positioning. It should be noted before the deployment of the contralteral and ipsilateral limb, the location of the bifurcation of the internal and external iliac arteries were identified and marked. _ballons were then placed bilaterally. They were i nflated at the proximal neck at the gate at the bifurcation and then at the distal limbs. No eveidence on endoleak, kinking or stenosis.
Thinking:
34812 mod 50
36200 LT
36200 RT
34802 LT
34802 RT
37250
34825
75952
75953
I hope I can get some assitance as this is not something I come across frequently.
Thanks for your help.
Nikki Payne, CPC