AgnieszkaLakritz
Networker
PREOPERATIVE DIAGNOSIS:
PAD-severe right lower extremity intermittent claudication
POSTOPERATIVE DIAGNOSIS:
Severe diffuse right common iliac and right external iliac artery stenosis
Patent bilateral infrainguinal vessels with three-vessel runoff
PROCEDURE:
Pelvic angiography
Bilateral selective lower extremity angiography
Stenting of right common iliac artery with self-expanding stent
Stenting of right external iliac artery with self-expanding stent
Balloon angioplasty of distal right external iliac artery with drug-coated balloon
SURGEON:
FINDINGS:
Pelvic angiography:
Distal abdominal aorta is patent with mild disease.
Right common iliac artery with severe ulcerated 80 to 90% stenosis at proximal and midportion.
Right external iliac artery with severe ulcerated 80 to 90% stenosis at mid and distal portions.
Right internal iliac artery is patent.
Left common iliac artery is patent with mild diffuse disease and healed spontaneous dissection.
Left external iliac arteries patent with mild diffuse disease.
Left internal iliac arteries patent
Right lower extremity angiography:
Common femoral artery is patent.
Superficial femoral artery is patent with mild diffuse disease.
Deep femoral artery is patent.
Popliteal artery is patent with mild to moderate stenosis above the knee.
Tibioperoneal vessels are widely patent with three-vessel runoff
Left lower extremity angiography:
Common femoral artery is patent with mild to moderate disease
Superficial femoral arteries patent with mild diffuse disease.
Deep femoral arteries patent.
Popliteal arteries patent with mild diffuse disease.
Tibioperoneal vessels are widely patent with three-vessel runoff.
Intervention: Successful balloon angioplasty and stenting of right common iliac artery from the ostium with an ever flex 8.0/60 mm self-expanding stent (postdilated with a 7.0 mm Mustang balloon). End of right external iliac artery with an ever flex 7.0/60 mm self-expanding stent (postdilated with a 6.0 mm Mustang balloon). Distal portion of right external iliac artery into the proximal portion of the right common femoral artery was dilated with a Lutonix 6.0/60 mm drug-coated balloon. Very good final angiographic result with preserved three-vessel runoff to the foot.
Conclusions:
1. Indication-severe lifestyle limiting right lower extremity intermittent claudication.
2. Severe diffuse right iliac inflow disease. Left iliac vessels are patent. Patent bilateral infrainguinal vessels.
3. Successful stenting of right common iliac and right external iliac artery with self-expanding stents and balloon angioplasty of distal right external iliac artery with a drug-coated balloon.
Recommendations:
1. Dual antiplatelet therapy with aspirin and clopidogrel.
2. Optimal risk factor modification including smoking cessation.
Clinical history:
65-year-old white male, former heavy smoker (currently smokes pipe), history of worsening right lower extremity proximal intermittent claudication. ABI/PVR shows severe right inflow disease. Patient was referred for bilateral lower extremity angiography.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient was brought to the cardiac catheterization lab, prepped and draped in usual sterile manner for femoral access procedure. The patient was sedated with Versed and fentanyl. 2% lidocaine applied to both groin areas.
First arterial access was gained in the left groin under fluroscopic guidance, using micropuncture technique, and 5F sheath was inserted in the LCFA. Selective segmental left lower extremity angiography was performed via the sheath. A 4F UF catheter was then dvanced to the distal abdominal aorta and pelvic angiography performed, demonstrating the severe disease in the right common and external iliac arteries. Using roadmapping from the pelvic angiography, access was gained in the right groin using micropuncture technique, and 23 cm BriteTip 6F sheath was inserted in the RCFA.
Bolus heparin was given and repeated to achive an ACT around 250. 600 mg Plavix loading was given.
We then advanced a Stiff 0.035 Glidewire across the right iliac artery.
At this point hemodynamic evaluation of the RCIA stenosis was performed using simultaneous pressure measurments, showing signficant gradient across the lesion. The lesions in the right common and external iliac arteries were predilated with a Mustang 5.0/80 mm balloon followed by stenting of the right common iliac artery from the ostium with an EverFlex 8.0/60 mm self-expanding stent and stenting of the right external iliac artery with an EverFlex 7.0/60 mm self-expanding stent. The stents were postdilated with the 7.0 and 6.0 mm balloons, accordingly. In addition, we performed balloon angioplasty of the distal right external iliac artery into the proximal right common femoral artery with a Lutonix 6.0/60 mm drug-coated balloon.
Completion angiography showed very good final angiographic result and preserved three-vessel runoff to the right foot.
The left common femoral artery 5F sheath with suture in place. The right common femoral artery sheath was removed and successful hemostasis was achieved using a Perclose closure device.
In my opinion definitely 37221 I am also thinking 36200?? I know angiography is included in 37221 but it was the next separate approach on the opposite side. how about codes with 70000 series. I struggle with these because I code only for facilities.
This one is a little different than usual.
PAD-severe right lower extremity intermittent claudication
POSTOPERATIVE DIAGNOSIS:
Severe diffuse right common iliac and right external iliac artery stenosis
Patent bilateral infrainguinal vessels with three-vessel runoff
PROCEDURE:
Pelvic angiography
Bilateral selective lower extremity angiography
Stenting of right common iliac artery with self-expanding stent
Stenting of right external iliac artery with self-expanding stent
Balloon angioplasty of distal right external iliac artery with drug-coated balloon
SURGEON:
FINDINGS:
Pelvic angiography:
Distal abdominal aorta is patent with mild disease.
Right common iliac artery with severe ulcerated 80 to 90% stenosis at proximal and midportion.
Right external iliac artery with severe ulcerated 80 to 90% stenosis at mid and distal portions.
Right internal iliac artery is patent.
Left common iliac artery is patent with mild diffuse disease and healed spontaneous dissection.
Left external iliac arteries patent with mild diffuse disease.
Left internal iliac arteries patent
Right lower extremity angiography:
Common femoral artery is patent.
Superficial femoral artery is patent with mild diffuse disease.
Deep femoral artery is patent.
Popliteal artery is patent with mild to moderate stenosis above the knee.
Tibioperoneal vessels are widely patent with three-vessel runoff
Left lower extremity angiography:
Common femoral artery is patent with mild to moderate disease
Superficial femoral arteries patent with mild diffuse disease.
Deep femoral arteries patent.
Popliteal arteries patent with mild diffuse disease.
Tibioperoneal vessels are widely patent with three-vessel runoff.
Intervention: Successful balloon angioplasty and stenting of right common iliac artery from the ostium with an ever flex 8.0/60 mm self-expanding stent (postdilated with a 7.0 mm Mustang balloon). End of right external iliac artery with an ever flex 7.0/60 mm self-expanding stent (postdilated with a 6.0 mm Mustang balloon). Distal portion of right external iliac artery into the proximal portion of the right common femoral artery was dilated with a Lutonix 6.0/60 mm drug-coated balloon. Very good final angiographic result with preserved three-vessel runoff to the foot.
Conclusions:
1. Indication-severe lifestyle limiting right lower extremity intermittent claudication.
2. Severe diffuse right iliac inflow disease. Left iliac vessels are patent. Patent bilateral infrainguinal vessels.
3. Successful stenting of right common iliac and right external iliac artery with self-expanding stents and balloon angioplasty of distal right external iliac artery with a drug-coated balloon.
Recommendations:
1. Dual antiplatelet therapy with aspirin and clopidogrel.
2. Optimal risk factor modification including smoking cessation.
Clinical history:
65-year-old white male, former heavy smoker (currently smokes pipe), history of worsening right lower extremity proximal intermittent claudication. ABI/PVR shows severe right inflow disease. Patient was referred for bilateral lower extremity angiography.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient was brought to the cardiac catheterization lab, prepped and draped in usual sterile manner for femoral access procedure. The patient was sedated with Versed and fentanyl. 2% lidocaine applied to both groin areas.
First arterial access was gained in the left groin under fluroscopic guidance, using micropuncture technique, and 5F sheath was inserted in the LCFA. Selective segmental left lower extremity angiography was performed via the sheath. A 4F UF catheter was then dvanced to the distal abdominal aorta and pelvic angiography performed, demonstrating the severe disease in the right common and external iliac arteries. Using roadmapping from the pelvic angiography, access was gained in the right groin using micropuncture technique, and 23 cm BriteTip 6F sheath was inserted in the RCFA.
Bolus heparin was given and repeated to achive an ACT around 250. 600 mg Plavix loading was given.
We then advanced a Stiff 0.035 Glidewire across the right iliac artery.
At this point hemodynamic evaluation of the RCIA stenosis was performed using simultaneous pressure measurments, showing signficant gradient across the lesion. The lesions in the right common and external iliac arteries were predilated with a Mustang 5.0/80 mm balloon followed by stenting of the right common iliac artery from the ostium with an EverFlex 8.0/60 mm self-expanding stent and stenting of the right external iliac artery with an EverFlex 7.0/60 mm self-expanding stent. The stents were postdilated with the 7.0 and 6.0 mm balloons, accordingly. In addition, we performed balloon angioplasty of the distal right external iliac artery into the proximal right common femoral artery with a Lutonix 6.0/60 mm drug-coated balloon.
Completion angiography showed very good final angiographic result and preserved three-vessel runoff to the right foot.
The left common femoral artery 5F sheath with suture in place. The right common femoral artery sheath was removed and successful hemostasis was achieved using a Perclose closure device.
In my opinion definitely 37221 I am also thinking 36200?? I know angiography is included in 37221 but it was the next separate approach on the opposite side. how about codes with 70000 series. I struggle with these because I code only for facilities.
This one is a little different than usual.