gricelarce
Guest
Need help if this was coded correctly: 36247-79 & 75710. I think 76937 should be entered as well.
Nature of procedure, risks, benefits, and alternatives were discussed with the patient in details and informed
consent was signed.
Anesthesia:
Local.
Indication:
78-year-old male with critical limb ischemia of left lower extremity with dry gangrene of left second toe.
Previously performed angiogram is not sufficient to determine bypass targets for possible revascularization
procedure. I recommended to proceed with diagnostic left lower extremity angiogram via left radial artery
access. Modified Allen's test and Doppler examination of palmar arch was performed showing adequate
supply of the hand via ulnar and radial arteries.
Technique:
The patient was brought to the endovascular suite, placed in a supine position and draped in routine sterile
fashion. All aspects of the 'time-out' verification were satisfactorily completed prior to the beginning of the
procedure.
Patient was taken to the procedure room and placed on procedural table supine with the left arm extended
onto an table. Under ultrasound guidance left radial artery was accessed with micropuncture needle after
administering local anesthesia with lidocaine.. 0.021 wire was advanced without difficulties. Small incision
was made with #11 scalpel. The needle was removed and a 5 French slender sheath was advanced. 5000
units of heparin were administered through the side port of the sheath. 2 mg of verapamil and 200 μg of
nitroglycerin was administered through the side port of the sheath. Angled J stiff shaft 0.035 Glidewire was
advanced into brachial, and then subclavian arteries. Using Terumo Pigrtaim Modified 4 Fr Glidecath I
navigated the Glidewire into the descending aorta. The catheter and wire were then advanced all the way to
the aortic bifurcation. The catheter was exchanged for Glidecath PV Multicurve catheter. Angiogram was
performed showing patent left common iliac, internal iliac, and external iliac arteries. Left common femoral
artery was patent, profunda femoris patent, near occlusion of proximal superficial femoral artery. The wire
was then exchanged for angled stiff shaft 400 cm 0.035 Glidewire. The catheter was advanced into the
common femoral artery. Multiple attempts to cross proximal SFA occlusion were made. I was able to pass the
wire into the SFA and advance it to the Hunter's canal however the catheter was not tracking through the
proximal SFA lesion. Runoff angiograms were then performed. There was delayed faint feeling of proximal
and mid SFA to the level of Hunter's canal. Several collateral vessels were reconstituting via profunda
branches. Popliteal artery occluded, anterior tibialis artery occluded, severe disease of the tibioperoneal
trunk, occlusion of posterior tibialis and peroneal arteries in proximal and mid portions. Reconstitution of
contrast in the most distal portion of the peroneal artery. Reconstitution of posterior tibialis artery at the
ankle.
The wire and catheter were then removed. Radial band was applied to them access site of the left radial
artery and sheath was removed while insufflating the radial band. There was good hemostasis. Radial band
stayed on for 2 hours. It was slowly deflated reassuring good hemostasis. Light compression dressing was
applied to the wrist. The patient was performed to touch with good cap refill. There was palpable pulse in
distal radial artery and dopplerable signals in distal radial artery and palmar arch.
Patient tolerated procedure well. There were no periprocedural complications.
Hope that some can help.
Nature of procedure, risks, benefits, and alternatives were discussed with the patient in details and informed
consent was signed.
Anesthesia:
Local.
Indication:
78-year-old male with critical limb ischemia of left lower extremity with dry gangrene of left second toe.
Previously performed angiogram is not sufficient to determine bypass targets for possible revascularization
procedure. I recommended to proceed with diagnostic left lower extremity angiogram via left radial artery
access. Modified Allen's test and Doppler examination of palmar arch was performed showing adequate
supply of the hand via ulnar and radial arteries.
Technique:
The patient was brought to the endovascular suite, placed in a supine position and draped in routine sterile
fashion. All aspects of the 'time-out' verification were satisfactorily completed prior to the beginning of the
procedure.
Patient was taken to the procedure room and placed on procedural table supine with the left arm extended
onto an table. Under ultrasound guidance left radial artery was accessed with micropuncture needle after
administering local anesthesia with lidocaine.. 0.021 wire was advanced without difficulties. Small incision
was made with #11 scalpel. The needle was removed and a 5 French slender sheath was advanced. 5000
units of heparin were administered through the side port of the sheath. 2 mg of verapamil and 200 μg of
nitroglycerin was administered through the side port of the sheath. Angled J stiff shaft 0.035 Glidewire was
advanced into brachial, and then subclavian arteries. Using Terumo Pigrtaim Modified 4 Fr Glidecath I
navigated the Glidewire into the descending aorta. The catheter and wire were then advanced all the way to
the aortic bifurcation. The catheter was exchanged for Glidecath PV Multicurve catheter. Angiogram was
performed showing patent left common iliac, internal iliac, and external iliac arteries. Left common femoral
artery was patent, profunda femoris patent, near occlusion of proximal superficial femoral artery. The wire
was then exchanged for angled stiff shaft 400 cm 0.035 Glidewire. The catheter was advanced into the
common femoral artery. Multiple attempts to cross proximal SFA occlusion were made. I was able to pass the
wire into the SFA and advance it to the Hunter's canal however the catheter was not tracking through the
proximal SFA lesion. Runoff angiograms were then performed. There was delayed faint feeling of proximal
and mid SFA to the level of Hunter's canal. Several collateral vessels were reconstituting via profunda
branches. Popliteal artery occluded, anterior tibialis artery occluded, severe disease of the tibioperoneal
trunk, occlusion of posterior tibialis and peroneal arteries in proximal and mid portions. Reconstitution of
contrast in the most distal portion of the peroneal artery. Reconstitution of posterior tibialis artery at the
ankle.
The wire and catheter were then removed. Radial band was applied to them access site of the left radial
artery and sheath was removed while insufflating the radial band. There was good hemostasis. Radial band
stayed on for 2 hours. It was slowly deflated reassuring good hemostasis. Light compression dressing was
applied to the wrist. The patient was performed to touch with good cap refill. There was palpable pulse in
distal radial artery and dopplerable signals in distal radial artery and palmar arch.
Patient tolerated procedure well. There were no periprocedural complications.
Hope that some can help.