shondamiles
Contributor
Does All Rhese Digital Arteriographic view of skull mean anything to me or do I just code the Aniography-36215,75676? "Angiography left Common Carotid artery, Unilateral Selective, Magnified Schuller Digital Arteriographic view of skull"
Thanks for all your help.
Shonda Miles
ENDOVASCULAR SURGICAL PROCEDURES: Transcatheter coil embolization of 3 mm left posterior communicating artery saccular aneursym using 2 Micrus platinum embolization coils, ranging in diameter from 3 down to 1.5 mm in diameter with 100 occlusion of aneurysm cavity.
DESCRIPTION OF PROCEDURE: The patient was brought to the neural interventional operating room suite and was placed upon the procedure table ina supine position. He received IV Ancef prophylatically at the commencement of the procedure. IV neuroleptic anesthesia was used in the inital portion fo the procedure, induced and monitored by the anesthesiology staff person in attendance throughout the entirety of the procedure. The right groin was prepped and draped in a sterile fashion. Local skin anesthesia was effected by the intradermal injection of 1% lidocaine solution. Through this anesthetized skin entry zone, using standard Seldinger technique, a 5-French vascular introduction sheath was advanced into the right common femoral artery and was secured with skin entry site with 2-0 silk suture. Contrast injection through the sheath revealed adequate puncture site anatomy to allow subsequent use of a percutaneous closure device. Coaxially through the sheath, a 5-French selective catheter was then inserted into both common carotid arteries as well as the right vertegral artery and the left subclavian artery where contrast injection was made in order to obtain the aforementioned angiographic views of the skull and thorax.
These angiographic images reveal that there is a diminutive left veterbral artery arising directly from the aortic arch and the dominant vertegral artery was on the right. There was no evidence fo aneurysm, vascular stenosis or vascular malformation withint he vertebrobasilar circular. There was no evidence of aneurysm, stenosis or vascular malformation within the right anterior circulation. On the left side, there was a 3 mm saccular aneursym arising from the orgin of the left posterior communicating artery. No extravasation or daughter aneurysm was seen in association with this aneurysm. The patient was placed under general endotracheal anesthesia. He received 70 units/kg body weight IV heparin. The 5-French selective catheter was exchanged for a 5-French guiding catheter which was advanced into the high cervical left internal carotid artery. Using digitial roadmap imaging, an SL 10 microcatheter was maneuvered over a Mirage guidewire intot he left posterior communicating artery saccular aneurysm cavity. With the catheter tip located in this position, two Micrus platinum embolization coils of 3 and 1.5 mm diameters were desposited within the aneursym cavity with repeat contrast injection within the left internal carotid artery guiding catheter, following the deployment of each of these coils.
Following the placement of the 2nd coil, there appeared to be 100% occulusion of the aneurysm cavity. Following the detachment fo the 2nd coil, the microcatheter was removed from the patient and a repeat left internal caroid digitial arteriogram in the lateral plane was obtained which demonstrated no new branch occulusions within the left anterior circulation. At the occulusion of the procedure, the right groin catheter was removed and hemostasis was effected using an Angio-Seal device. However there appeared to be a developing hematoma despite the successful deployment fo the Angio-Seal device. Therefore a FemoStop device was placed at the site of arterial puncture within the right groin. The ballon of this device was gently inflated which stopped any further development of the hematoma. No hemorrhage from the right groin puncture site was noted. The right foot pulses remained intact.
At the conclusion of the procedure, the patient was awakened from general endotracheal anesthesia and was extubated.
Thanks for all your help.
Shonda Miles
ENDOVASCULAR SURGICAL PROCEDURES: Transcatheter coil embolization of 3 mm left posterior communicating artery saccular aneursym using 2 Micrus platinum embolization coils, ranging in diameter from 3 down to 1.5 mm in diameter with 100 occlusion of aneurysm cavity.
DESCRIPTION OF PROCEDURE: The patient was brought to the neural interventional operating room suite and was placed upon the procedure table ina supine position. He received IV Ancef prophylatically at the commencement of the procedure. IV neuroleptic anesthesia was used in the inital portion fo the procedure, induced and monitored by the anesthesiology staff person in attendance throughout the entirety of the procedure. The right groin was prepped and draped in a sterile fashion. Local skin anesthesia was effected by the intradermal injection of 1% lidocaine solution. Through this anesthetized skin entry zone, using standard Seldinger technique, a 5-French vascular introduction sheath was advanced into the right common femoral artery and was secured with skin entry site with 2-0 silk suture. Contrast injection through the sheath revealed adequate puncture site anatomy to allow subsequent use of a percutaneous closure device. Coaxially through the sheath, a 5-French selective catheter was then inserted into both common carotid arteries as well as the right vertegral artery and the left subclavian artery where contrast injection was made in order to obtain the aforementioned angiographic views of the skull and thorax.
These angiographic images reveal that there is a diminutive left veterbral artery arising directly from the aortic arch and the dominant vertegral artery was on the right. There was no evidence fo aneurysm, vascular stenosis or vascular malformation withint he vertebrobasilar circular. There was no evidence of aneurysm, stenosis or vascular malformation within the right anterior circulation. On the left side, there was a 3 mm saccular aneursym arising from the orgin of the left posterior communicating artery. No extravasation or daughter aneurysm was seen in association with this aneurysm. The patient was placed under general endotracheal anesthesia. He received 70 units/kg body weight IV heparin. The 5-French selective catheter was exchanged for a 5-French guiding catheter which was advanced into the high cervical left internal carotid artery. Using digitial roadmap imaging, an SL 10 microcatheter was maneuvered over a Mirage guidewire intot he left posterior communicating artery saccular aneurysm cavity. With the catheter tip located in this position, two Micrus platinum embolization coils of 3 and 1.5 mm diameters were desposited within the aneursym cavity with repeat contrast injection within the left internal carotid artery guiding catheter, following the deployment of each of these coils.
Following the placement of the 2nd coil, there appeared to be 100% occulusion of the aneurysm cavity. Following the detachment fo the 2nd coil, the microcatheter was removed from the patient and a repeat left internal caroid digitial arteriogram in the lateral plane was obtained which demonstrated no new branch occulusions within the left anterior circulation. At the occulusion of the procedure, the right groin catheter was removed and hemostasis was effected using an Angio-Seal device. However there appeared to be a developing hematoma despite the successful deployment fo the Angio-Seal device. Therefore a FemoStop device was placed at the site of arterial puncture within the right groin. The ballon of this device was gently inflated which stopped any further development of the hematoma. No hemorrhage from the right groin puncture site was noted. The right foot pulses remained intact.
At the conclusion of the procedure, the patient was awakened from general endotracheal anesthesia and was extubated.
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