Hello, Happy New Year to all....
Can you please help me code this procedure....Thank you very much.
Reason for Evaluation: Peripheral arterial disease
Procedure: The patient was brought to the catheterization lab,prepped and draped in a sterile fashion. Lidocaine was placed to the right common femoral area, anda 6 french sheath was placed to the right common femoral artery using micropuncture technique.
Next, angiography of the right leg from the sheath site down into the infrapopliteal vessels was performed.
Next, the LIMA catheter was placed over the Glidewire into the descending aorta,brought back, and the Glidewire was able to cross into the SFA and bring the 6-French LIMA catheter to the level of the left common femoral artery. The glidewire was removed, and angiography from the LIMA catheter was used down the left leg.
At this point the Glidewire was replaced and put into the mid level of the SFA. The LIMA catheter was removed, and the 6-French sheath ED exchanged over the wire for an Ansel sheath.
Next, Heparin was given per weight-based protocol. Next, the Glidewire was placed into the distal portion of the popliteal space, and a 2.0 x 120 peripheral balloon was used over the entire popliteal and distal SFA segment to the proximal level of the stent. Angiography again was performed. At this point a Glidecatheter was placed into the popliteal space, and infrapopliteal angiography was performed. There was significant spasm of the vessel. Thus 300 mcg of nitroglycerine was given via the Glidecatheter which was positioned into the popliteal space. Repeat angiography showed dramatic improvement of flow in the infrapopliteal segment.
At this point, throught the Glidewire the Viper wire was placed into the distal portion of the anterior tibial artery, and a self-atherectomy catheter 1.5 bur was prepped in a standard fashion. Atherectomy was performed from the proximal segment of the stent in the distal SFA into the distal portion of the popliteal artery right before the bifurcation of the anterior tibial. Multiple runs were performed. At this point,repeat nitroglycerine was given and angiography was performed.
Next, the 2.0 bur was used over the level of the entire stented segment to just distal to the segment but prior to entering the popliteal space. The 2.0 bur was then removed. The Glidecatheter was then brought back down. Nitroglycerine was given, and repeat angiography was performed. At this point the luge wire was placed into the anterior tibial artery, and a 4.0 x 80 anhgioplasty was performed over the entire segment. Repeat nitroglycerin was given and a final run was performed. Wire was removed.
The ansel sheath was brought back to the right external iliac. A J-wire was placed. The ansel sheath was removed and exchanged for a 7-French short sheath, and then the StarClose was prepped per standasrd fashion and placed to the common femoral artery with good groin hemostasis. No evidence of oozing,bruising, or hematoma. The patient tolerated the procedure well and was well comfortable. The patient remained hemodynamically stable throughout the entire procedure.
IMPRESSION:
1. On the right side, the right common femoral artery and right proximalto mid segment of the superficial femoral artery are widely patent. In the mid to distal portion there is a 90 plus percent stenosis of the right superficial femoral artery. In the popliteal space the vessels become small, and the infrapopliteal flow reveals small vessels but 3-vessel flow.
2. On the left side, the left common femoral artery and superficial femoral artery in its proximal portion are widely patent. There is no pressure gradient across the iliac segment. In the distal superficial femoral artery there is a complete occlusion of the stented segment into the level of the popliteal space. There is evidence of very little flow and no evidence of infrapopliteal flow. Status post 2.0 angioplasty revealed reperfusion of the stented and through the popliteal segment with marked vessel spasm that responded well to nitroglycerin. In the infrapopliteal space the posterior tibial and peroneal are now widely patent. The anterior tibial has a proximal and mid to distal 2-level focal stenosis of approximately 70% t0 80 % stenosis: however, status post procedure the popliteal and distal superficial femoral artery reveal brisk flow into the dorsal pedal arch in both the dorsal pedal arch and posterior tibial at the level of the ankle in the posterior segment of the foot are now widely patent. Status post angioplasty of the popliteal segment reveals 30% to 50% stenosis. There is recurring evidence of significant spasm that responded markedly to nitroglycerin. We will start the patient on Imdur therapy. In the distal segment of the superficial femoral artery there was severe stenosis, now widely patent with 0% stenosis of the stented segment.
Can you please help me code this procedure....Thank you very much.
Reason for Evaluation: Peripheral arterial disease
Procedure: The patient was brought to the catheterization lab,prepped and draped in a sterile fashion. Lidocaine was placed to the right common femoral area, anda 6 french sheath was placed to the right common femoral artery using micropuncture technique.
Next, angiography of the right leg from the sheath site down into the infrapopliteal vessels was performed.
Next, the LIMA catheter was placed over the Glidewire into the descending aorta,brought back, and the Glidewire was able to cross into the SFA and bring the 6-French LIMA catheter to the level of the left common femoral artery. The glidewire was removed, and angiography from the LIMA catheter was used down the left leg.
At this point the Glidewire was replaced and put into the mid level of the SFA. The LIMA catheter was removed, and the 6-French sheath ED exchanged over the wire for an Ansel sheath.
Next, Heparin was given per weight-based protocol. Next, the Glidewire was placed into the distal portion of the popliteal space, and a 2.0 x 120 peripheral balloon was used over the entire popliteal and distal SFA segment to the proximal level of the stent. Angiography again was performed. At this point a Glidecatheter was placed into the popliteal space, and infrapopliteal angiography was performed. There was significant spasm of the vessel. Thus 300 mcg of nitroglycerine was given via the Glidecatheter which was positioned into the popliteal space. Repeat angiography showed dramatic improvement of flow in the infrapopliteal segment.
At this point, throught the Glidewire the Viper wire was placed into the distal portion of the anterior tibial artery, and a self-atherectomy catheter 1.5 bur was prepped in a standard fashion. Atherectomy was performed from the proximal segment of the stent in the distal SFA into the distal portion of the popliteal artery right before the bifurcation of the anterior tibial. Multiple runs were performed. At this point,repeat nitroglycerine was given and angiography was performed.
Next, the 2.0 bur was used over the level of the entire stented segment to just distal to the segment but prior to entering the popliteal space. The 2.0 bur was then removed. The Glidecatheter was then brought back down. Nitroglycerine was given, and repeat angiography was performed. At this point the luge wire was placed into the anterior tibial artery, and a 4.0 x 80 anhgioplasty was performed over the entire segment. Repeat nitroglycerin was given and a final run was performed. Wire was removed.
The ansel sheath was brought back to the right external iliac. A J-wire was placed. The ansel sheath was removed and exchanged for a 7-French short sheath, and then the StarClose was prepped per standasrd fashion and placed to the common femoral artery with good groin hemostasis. No evidence of oozing,bruising, or hematoma. The patient tolerated the procedure well and was well comfortable. The patient remained hemodynamically stable throughout the entire procedure.
IMPRESSION:
1. On the right side, the right common femoral artery and right proximalto mid segment of the superficial femoral artery are widely patent. In the mid to distal portion there is a 90 plus percent stenosis of the right superficial femoral artery. In the popliteal space the vessels become small, and the infrapopliteal flow reveals small vessels but 3-vessel flow.
2. On the left side, the left common femoral artery and superficial femoral artery in its proximal portion are widely patent. There is no pressure gradient across the iliac segment. In the distal superficial femoral artery there is a complete occlusion of the stented segment into the level of the popliteal space. There is evidence of very little flow and no evidence of infrapopliteal flow. Status post 2.0 angioplasty revealed reperfusion of the stented and through the popliteal segment with marked vessel spasm that responded well to nitroglycerin. In the infrapopliteal space the posterior tibial and peroneal are now widely patent. The anterior tibial has a proximal and mid to distal 2-level focal stenosis of approximately 70% t0 80 % stenosis: however, status post procedure the popliteal and distal superficial femoral artery reveal brisk flow into the dorsal pedal arch in both the dorsal pedal arch and posterior tibial at the level of the ankle in the posterior segment of the foot are now widely patent. Status post angioplasty of the popliteal segment reveals 30% to 50% stenosis. There is recurring evidence of significant spasm that responded markedly to nitroglycerin. We will start the patient on Imdur therapy. In the distal segment of the superficial femoral artery there was severe stenosis, now widely patent with 0% stenosis of the stented segment.