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Any Help would be great on this case. I am not that great at coding these peripheral cases.
Acute lumbar ischemia with gangrene.
Severe peripheral vascular disease chronic total occlusion of the left superficial femoral artery.
PROCEDURE
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. Patient was further sedated with fentanyl and versed. Patient was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 6 French sheath was placed in the left radial artery. Multipurpose 6 French catheter was advanced over a wire and directed into the left common iliac artery angiography imaging using DSA to visualize the left common iliac artery and distal circulation was performed. A glide advantage wire was attempted to cross from the ostium of the SFA but due to the absence of a takeoff of the vessel and decision was made to flip the patient and under sterile procedure obtained popliteal artery access using 4–5 French sheath multiple wires were attempted finally a truma gold wire was advanced with the backup support of support catheter multiple balloon inflations using coronary balloon 2.0 followed by 4.0 balloon was then subsequently using peripheral balloon was 4.0 we acknowledge that the wire was in the dissection plane and the balloon inflations were to modify the plaque once that was done. We use a glide advantage wire using the radial artery access through the the 6 French guiding catheter and we used multiple balloon was 4.0 and 5.0 long balloons with multiple inflations through the true lumen of the vessel that was recanalized a residual dissection at the ostium of the SFA was finally treated with balloon angioplasty but without resolution so we switched the catheters and to a long sheath 6 French to be able to deliver stent 6.0×16 mm self-expanding stent was deployed and overlapped the ostium of the profunda into the common femoral artery and the tach and dissection plane and then postdilated with a 5.0 balloon. The 4 French sheath was removed and using balloon inflation and dry hemostasis was obtained.
Findings:
After the procedure was completed, sedation was stopped and the sheaths and catheters were all removed. Hemostasis was achieved with wristband for the radial artery access, dry him he states is using intra-arterial balloon inflation for the popliteal access.
Findings:
“Conscious sedation was administered by qualified nursing personnel under continuous hemodynamic monitoring, Duration 170 Min,
A total 150mcg of fentanyl and 3 mg midazolam were administered.” Contrast300, air karma 2150, final ACT 208
Estimated Blood Loss: less than 20 mL
Condition: stable
Treatment: Continue aggressive risk factor modification.
Total antiplatelet therapy.
Monitor recovery from left lower extremity post amputation.
Consideration for staged PTA of the chronic total occlusion of the right superficial femoral artery.
Continue current medical therapy and follow up in the office in one week.
Acute lumbar ischemia with gangrene.
Severe peripheral vascular disease chronic total occlusion of the left superficial femoral artery.
PROCEDURE
- Radial arterial access with angiography of the left common iliac artery using a multipurpose guiding catheter.
- Left popliteal artery access using fluoroscopy.
- Successful PTA of a chronic total occlusion of a complex SFA disease.
- Successful stenting of the left common femoral and ostial left superficial femoral artery with 6.0×16 mm self-expanding stent and post dilation with a 5.0 balloon.
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. Patient was further sedated with fentanyl and versed. Patient was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 6 French sheath was placed in the left radial artery. Multipurpose 6 French catheter was advanced over a wire and directed into the left common iliac artery angiography imaging using DSA to visualize the left common iliac artery and distal circulation was performed. A glide advantage wire was attempted to cross from the ostium of the SFA but due to the absence of a takeoff of the vessel and decision was made to flip the patient and under sterile procedure obtained popliteal artery access using 4–5 French sheath multiple wires were attempted finally a truma gold wire was advanced with the backup support of support catheter multiple balloon inflations using coronary balloon 2.0 followed by 4.0 balloon was then subsequently using peripheral balloon was 4.0 we acknowledge that the wire was in the dissection plane and the balloon inflations were to modify the plaque once that was done. We use a glide advantage wire using the radial artery access through the the 6 French guiding catheter and we used multiple balloon was 4.0 and 5.0 long balloons with multiple inflations through the true lumen of the vessel that was recanalized a residual dissection at the ostium of the SFA was finally treated with balloon angioplasty but without resolution so we switched the catheters and to a long sheath 6 French to be able to deliver stent 6.0×16 mm self-expanding stent was deployed and overlapped the ostium of the profunda into the common femoral artery and the tach and dissection plane and then postdilated with a 5.0 balloon. The 4 French sheath was removed and using balloon inflation and dry hemostasis was obtained.
Findings:
- Calcified with moderate atherosclerosis into the left external iliac artery and the left common iliac artery.
- Heavily calcified left common femoral artery..
- Complete occlusion of the ostium of the left SFA with a flush occlusion and patent left profunda artery.
- Reconstitution of the popliteal artery via collaterals from the profunda artery and three-vessel flow was noted.
- Successful percutaneous intervention of the chronic total left SFA and a stent placement into the left common femoral artery and the ostium of the SFA to abolish 100% lesion down to 0% minimum residual flow in the distal SFA with excellent TIMI 3 flow.
- Note: Recommend against common femoral artery access without ultrasound and fluoroscopy evaluation due to the presence of a stent.
After the procedure was completed, sedation was stopped and the sheaths and catheters were all removed. Hemostasis was achieved with wristband for the radial artery access, dry him he states is using intra-arterial balloon inflation for the popliteal access.
Findings:
“Conscious sedation was administered by qualified nursing personnel under continuous hemodynamic monitoring, Duration 170 Min,
A total 150mcg of fentanyl and 3 mg midazolam were administered.” Contrast300, air karma 2150, final ACT 208
Estimated Blood Loss: less than 20 mL
Condition: stable
Treatment: Continue aggressive risk factor modification.
Total antiplatelet therapy.
Monitor recovery from left lower extremity post amputation.
Consideration for staged PTA of the chronic total occlusion of the right superficial femoral artery.
Continue current medical therapy and follow up in the office in one week.