margaret fahy
Guru
Hi,
What venogram/catheterization codes would you use for this?
36012, 36012 and 75820...or 36012, 36005, 75820?
History: 17-year-old boy with right upper extremity swelling,
heaviness and paresthesias whose previous imaging has shown a
congenital rib anomaly and obstruction of his medial right
subclavian vein
Procedure:
Preliminary view of the thoracic inlet shows congenital right rib
anomaly with fusion of the first and second ribs.
The right upper arm and the right groin were prepped and draped
in usual fashion. The right upper basilic vein was punctured
under ultrasound guidance with a 21-gauge needle, and a 0.018
inch diameter mandril was placed. After placement of a 5 French
sizing coaxial sheath, a 0.035 inch diameter hydrophilic wire was
placed, and a long 8 French sheath was passed in the subclavian
vein just lateral to the first rib. DSA venography was performed
showing similar findings to the January 23 MRV with a smooth
occlusion to the right medial subclavian vein just lateral to the
first rib with collateral drainage via large veins to the chest
wall, external jugular vein, anterior jugular vein and
reconstituting as the lower right internal jugular vein and the
right innominate vein. No direct flow through the 2.5 CM medial
right subclavian vein occlusion was seen. No appearance of
thrombus was noted. The occlusion was probed with a coaxial 4
French Navicross catheter and a hydrophilic wire. No true venous
lumen was entered.
Under ultrasound guidance, the right common femoral vein was
entered with a 21-gauge needle and placement of a 0.018 inch
diameter mandril. After placement of a 5 French upsizing of axial
sheath, a 5 French vascular sheath was placed. A variety of 5
French curved catheters using 0.035 inch diameter hydrophilic
guidewires attempted to find the right subclavian vein from the
medial aspect of the right innominate vein. None of the maneuvers
found a right subclavian vein lumen.
Toward the end of the procedure, a sheath venogram via the right
upper extremity was performed to show that the original
collateral system remained patent and unchanged.
The vascular sheaths in the right arm and right groin were
removed without complication. Pressure was held for hemostasis.
The site was dressed with Dermabond, Steri-Strips, gauze and
Tegaderm.
The patient left the IR suite in stable condition, and Dr.
was present for the entire study.
The findings were reviewed with Dr. rin the IR suite at
the end of the procedure.
IMPRESSION
Right thoracic outlet syndrome with right subclavian vein
compression by the rib anomaly. Complete right subclavian vein
occlusion over a 2.5 CM length with prominent venous
collateralization.
What venogram/catheterization codes would you use for this?
36012, 36012 and 75820...or 36012, 36005, 75820?
History: 17-year-old boy with right upper extremity swelling,
heaviness and paresthesias whose previous imaging has shown a
congenital rib anomaly and obstruction of his medial right
subclavian vein
Procedure:
Preliminary view of the thoracic inlet shows congenital right rib
anomaly with fusion of the first and second ribs.
The right upper arm and the right groin were prepped and draped
in usual fashion. The right upper basilic vein was punctured
under ultrasound guidance with a 21-gauge needle, and a 0.018
inch diameter mandril was placed. After placement of a 5 French
sizing coaxial sheath, a 0.035 inch diameter hydrophilic wire was
placed, and a long 8 French sheath was passed in the subclavian
vein just lateral to the first rib. DSA venography was performed
showing similar findings to the January 23 MRV with a smooth
occlusion to the right medial subclavian vein just lateral to the
first rib with collateral drainage via large veins to the chest
wall, external jugular vein, anterior jugular vein and
reconstituting as the lower right internal jugular vein and the
right innominate vein. No direct flow through the 2.5 CM medial
right subclavian vein occlusion was seen. No appearance of
thrombus was noted. The occlusion was probed with a coaxial 4
French Navicross catheter and a hydrophilic wire. No true venous
lumen was entered.
Under ultrasound guidance, the right common femoral vein was
entered with a 21-gauge needle and placement of a 0.018 inch
diameter mandril. After placement of a 5 French upsizing of axial
sheath, a 5 French vascular sheath was placed. A variety of 5
French curved catheters using 0.035 inch diameter hydrophilic
guidewires attempted to find the right subclavian vein from the
medial aspect of the right innominate vein. None of the maneuvers
found a right subclavian vein lumen.
Toward the end of the procedure, a sheath venogram via the right
upper extremity was performed to show that the original
collateral system remained patent and unchanged.
The vascular sheaths in the right arm and right groin were
removed without complication. Pressure was held for hemostasis.
The site was dressed with Dermabond, Steri-Strips, gauze and
Tegaderm.
The patient left the IR suite in stable condition, and Dr.
was present for the entire study.
The findings were reviewed with Dr. rin the IR suite at
the end of the procedure.
IMPRESSION
Right thoracic outlet syndrome with right subclavian vein
compression by the rib anomaly. Complete right subclavian vein
occlusion over a 2.5 CM length with prominent venous
collateralization.