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Please help code a Bilateral Subclavian angiography with balloon angioplasty of right subclavian stent using DCB balloon

K

kokomax

Contributor
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15
Location
Sun Lakes, AZ
After obtaining informed consent, the patient was brought to the Cath Lab. She was prepped and draped in order to obtain a sterile field. Under my supervision the patient was moderately sedated with IV Versed and fentanyl, during the procedure the blood pressure heart rate and pulse ox were continuously monitored by the nurse. My face-to-face moderate sedation time with the patient was 1 hour. The right groin was anesthetized with 1% lidocaine. The right common femoral artery was cannulated using modified Seldinger technique with a micropuncture kit, ultrasound guidance upgraded to a 6 French sheath. Then a JR4 catheter was taken to cannulate the left subclavian and angiography was performed. Then using the same catheter the right subclavian was engaged and angiography was performed. Over the supra core wire a 6 French shuttle sheath was advanced to the origin of the right subclavian artery. Then the in-stent restenosis was dilated with 7 mm balloon distally and in the mid segment. Of note that the mid segment is heavily calcified. Then more distally I took a 6 mm balloon and dilated the vessel up to 12 atm in order to get a better expansion. Subsequently I took a 7/16 mm DCB lutonix balloon and dilated the stent from the distal segment to the mid segment. Following which angiography was performed that showed 40% residual in the mid right subclavian again the segment is heavily calcified therefore we did not aim for full expansion in order to avoid rupture. However there was 0% residual in the distal aspect of the stent. Additionally the gradient had dropped from 60 mmHg to 20 mmHg. At this point I decided to stop, the patient had a good right radial pulse. The sheath was removed and the 6 French Angio-Seal device was deployed with good hemostasis in the right common femoral artery.

Thank you in advance!!
Much appreciated!!! :)
 
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