Hi, I'm reviving this very old post since I have the same scenario. coded 35903 but I can't find a code for the work of the stent removal. Thanks for any help. Kim
POSTOPERATIVE DIAGNOSIS: Infected left forearm dialysis graft and stent.
PROCEDURE: Complete removal of left forearm Teflon dialysis graft and removal
of the brachial vein 5 cm x 8 mm covered stent.
SPECIMEN: Entirety of left forearm dialysis graft and 5 cm stent, culture of the graft.
DESCRIPTION OF PROCEDURE: While in the supine position following the
induction of a general anesthetic, the left upper extremity was prepped and
draped sterilely. Approximate 3 cm incisions were made directly over the
venous and the arterial anastomoses. The dissection was carried in both
locations to the level of the anastomoses. Each was completely elevated
along with the Gore-Tex suture. At the venous anastomosis there was no
return of blood and the 5 cm long stent overlapped the venous anastomosis and
extended into the outflow brachial vein. Blunt dissection around the stents
ultimately resulted in its complete removal. No indication of bleeding was
identified at this site. At the arterial anastomosis, the radial artery was
patent. The patient had a palpable ulnar pulse and with occlusion of the
radial artery peripheral to the site of the graft anastomosis, there remained
a triphasic ulnar Doppler signal and pulsatile back bleeding from the open
radial artery. The artery was gently crossclamped proximal and distal to the
anastomosis, which was completely elevated. A 5-0 Prolene figure-of-eight
sutures were used to ligate the radial artery adjacent to the anastomosis in
its inflow and outflow. A much longer incision was carried along the course
of the graft in the forearm, including at the point of drainage. The
majority of chronic scar tissue was excised and a somewhat wider excision in
the region of drainage in order to resect any nonviable tissue was completed.
A combination of sharp and blunt dissection resulted in complete
mobilization of the graft and its removal. Minimal purulence appeared to be
within the soft tissues and all nonviable tissue was removed. The 3 open
wounds were then irrigated with a dilute solution of Betadine. After
attention hemostasis, all 3 wounds were closed with running PDS suture
subcutaneous, followed by staple reapproximation of the skin margins. A dry
sterile dressing was applied and sponge and needle counts were correct.