amym
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Can I bill anything else other than 37221?
DESCRIPTION OF PROCEDURE:
The patient was brought to the angiography suite in stable condition.
After the time-out was obtained, the patient was given sedation and
initial access was obtained in the left common femoral artery using
5-French sheath. A 0.035 Storq wire was passed the sheath and over
this wire, a 5-French Omni Flush catheter was passed; however, there
was obstruction in the proximal left iliac artery, we were unable to
cross the lesion. The lesion was ultimately crossed with 0.035 stiff
angled glidewire. After the crossing of the lesion, Omni Flush
catheter was railed on the wire and placed in the distal aorta and
intraluminal placement was confirmed.
DIAGNOSTIC PORTION OF THE PROCEDURE:
On this portion, the patient had distal aortogram, iliac aortogram and
bilateral _____ aortogram as well as lower extremity aortogram was
obtained with the catheter positioned in the distal aorta, which
revealed a subtotal 90% to 95% lesion of the proximal left iliac
artery. There was further 50% lesion in the right iliac artery.
Bilaterally both superficial femoral arteries revealed 100% stenosis.
There was one-vessel runoff in the left leg and two-vessel runoff in
the right leg.
At this point, access was obtained in the right groin into the common
femoral artery and 0.035 Storq wire was passed and placed in the
distal aorta. A 5-French JR4 catheter was placed on the wire and the
right iliac lesions were crossed and the gradient was measured across
the 50% right iliac lesion, there was no gradient across the lesion.
At this point, we decided to intervene on the left subtotal common
iliac artery lesion.
ENDOVASCULAR INTERVENTION:
Once it was decided to carry out intervention, A 5-French Omni Flush
catheter was passed through the 5-French right sheath and placed in
the distal aorta to help with balloon and stent placement. The left
5-French sheath was placed with 25-French to remove Pinnacle catheter
over the wire. Initially, the lesion was ballooned with a 6 mm x 4 cm
over the wire balloon, which revealed improvement in lesion but
suboptimal result. At this point, we decided to stent the lesion with
10 x 60 self-expanding stent. The stent was placed over the Storq
wire starting from the left side and was railed over the 0.035 Storq
wire. The stent position was confirmed with contralateral injections
from the right side. After confirmation of stent placement, the stent
was deployed with good results. At this point, the stent was
postdilated with a 10 x 40 post dilatation balloon up to good profile.
FINAL RESULTS:
The patient had excellent angiographic results. Distal angiography
was done to rule out any distal embolization, which was not present.
Also, the final shots did not reveal any dissections or any
perforations.
DESCRIPTION OF PROCEDURE:
The patient was brought to the angiography suite in stable condition.
After the time-out was obtained, the patient was given sedation and
initial access was obtained in the left common femoral artery using
5-French sheath. A 0.035 Storq wire was passed the sheath and over
this wire, a 5-French Omni Flush catheter was passed; however, there
was obstruction in the proximal left iliac artery, we were unable to
cross the lesion. The lesion was ultimately crossed with 0.035 stiff
angled glidewire. After the crossing of the lesion, Omni Flush
catheter was railed on the wire and placed in the distal aorta and
intraluminal placement was confirmed.
DIAGNOSTIC PORTION OF THE PROCEDURE:
On this portion, the patient had distal aortogram, iliac aortogram and
bilateral _____ aortogram as well as lower extremity aortogram was
obtained with the catheter positioned in the distal aorta, which
revealed a subtotal 90% to 95% lesion of the proximal left iliac
artery. There was further 50% lesion in the right iliac artery.
Bilaterally both superficial femoral arteries revealed 100% stenosis.
There was one-vessel runoff in the left leg and two-vessel runoff in
the right leg.
At this point, access was obtained in the right groin into the common
femoral artery and 0.035 Storq wire was passed and placed in the
distal aorta. A 5-French JR4 catheter was placed on the wire and the
right iliac lesions were crossed and the gradient was measured across
the 50% right iliac lesion, there was no gradient across the lesion.
At this point, we decided to intervene on the left subtotal common
iliac artery lesion.
ENDOVASCULAR INTERVENTION:
Once it was decided to carry out intervention, A 5-French Omni Flush
catheter was passed through the 5-French right sheath and placed in
the distal aorta to help with balloon and stent placement. The left
5-French sheath was placed with 25-French to remove Pinnacle catheter
over the wire. Initially, the lesion was ballooned with a 6 mm x 4 cm
over the wire balloon, which revealed improvement in lesion but
suboptimal result. At this point, we decided to stent the lesion with
10 x 60 self-expanding stent. The stent was placed over the Storq
wire starting from the left side and was railed over the 0.035 Storq
wire. The stent position was confirmed with contralateral injections
from the right side. After confirmation of stent placement, the stent
was deployed with good results. At this point, the stent was
postdilated with a 10 x 40 post dilatation balloon up to good profile.
FINAL RESULTS:
The patient had excellent angiographic results. Distal angiography
was done to rule out any distal embolization, which was not present.
Also, the final shots did not reveal any dissections or any
perforations.