conleyclan
Guru
Hello Again,
I am not sur ehow to code this report. I have 35694, but not sure what else to use.
Thanks, Diane
LEFT SUBCLAVIAN ARTERY TRANSPOSITION TO THE LEFT CAROTID ARTERY
WITH TRANSPOSITION OF THE LEFT VERTEBRAL ARTERY TO THE PROXIMAL LEFT
INTERNAL MAMMARY ARTERY.
POSTOPERATIVE DIAGNOSIS: RUPTURED TYPE B AORTIC DISSECTION WITH
FOUR-BRANCH ARCH.
CLINICAL NOTE: This is a woman with a four-branch arch. She has a
disrupted type B aortic dissection. As part of the dissection trial, we
are performing a transposition today in order to prepare for stenting. The
vertebral artery was divided and anastomosed to the proximal left internal
mammary artery and then we transposed the left subclavian artery in an
end-to-side technique into the left carotid artery. Her SSEPs and EEG were
stable. Her arm SEEPs returned to baseline and she had a good radial pulse
after revascularization.
OPERATIVE NOTE: Once the patient was brought to operative suite, she was
prepped and draped in sterile fashion. Incision was made between the heads
of the sternocleidomastoid, just above the clavicle. Through this
incision, we isolated the carotid, the subclavian artery and the mammary
and prepared to isolate the vertebral. We gave 7500 units of heparin and
divided the subclavian at the base of the neck and oversewed it with a
pledgeted 4-0 Prolene suture. Once this was done, we moved the subclavian
out of the field and then isolated the vertebral. We divided the vertebral
proximally with a similar technique using a pledgeted 5-0 Prolene suture.
We then divided the mammary and felt that it anastomosed into the vertebral
artery easily and then, using a spatulated technique, we anastomoses these
two vessels together using 7-0 Prolene. Then, a partial side biting clamp
was placed on the left carotid artery and the sidewall was punched out
several times with a 4.0 punch and end-to-side anastomosis of the
subclavian to the carotid artery was performed with 7-0 Prolene. Once this
was done, the anastomosis was deaired and flow was restored and 75 mg
protamine were administered. Once hemostasis had been achieved, the wound
was closed in several layers. I was present for the entire duration of
this operation.
I am not sur ehow to code this report. I have 35694, but not sure what else to use.
Thanks, Diane
LEFT SUBCLAVIAN ARTERY TRANSPOSITION TO THE LEFT CAROTID ARTERY
WITH TRANSPOSITION OF THE LEFT VERTEBRAL ARTERY TO THE PROXIMAL LEFT
INTERNAL MAMMARY ARTERY.
POSTOPERATIVE DIAGNOSIS: RUPTURED TYPE B AORTIC DISSECTION WITH
FOUR-BRANCH ARCH.
CLINICAL NOTE: This is a woman with a four-branch arch. She has a
disrupted type B aortic dissection. As part of the dissection trial, we
are performing a transposition today in order to prepare for stenting. The
vertebral artery was divided and anastomosed to the proximal left internal
mammary artery and then we transposed the left subclavian artery in an
end-to-side technique into the left carotid artery. Her SSEPs and EEG were
stable. Her arm SEEPs returned to baseline and she had a good radial pulse
after revascularization.
OPERATIVE NOTE: Once the patient was brought to operative suite, she was
prepped and draped in sterile fashion. Incision was made between the heads
of the sternocleidomastoid, just above the clavicle. Through this
incision, we isolated the carotid, the subclavian artery and the mammary
and prepared to isolate the vertebral. We gave 7500 units of heparin and
divided the subclavian at the base of the neck and oversewed it with a
pledgeted 4-0 Prolene suture. Once this was done, we moved the subclavian
out of the field and then isolated the vertebral. We divided the vertebral
proximally with a similar technique using a pledgeted 5-0 Prolene suture.
We then divided the mammary and felt that it anastomosed into the vertebral
artery easily and then, using a spatulated technique, we anastomoses these
two vessels together using 7-0 Prolene. Then, a partial side biting clamp
was placed on the left carotid artery and the sidewall was punched out
several times with a 4.0 punch and end-to-side anastomosis of the
subclavian to the carotid artery was performed with 7-0 Prolene. Once this
was done, the anastomosis was deaired and flow was restored and 75 mg
protamine were administered. Once hemostasis had been achieved, the wound
was closed in several layers. I was present for the entire duration of
this operation.