I don't have much experience with vascular coding. For the OP note below, I am looking at using 00880 or 01270 for the anesthesia service provided. I am leaning towards the 00880 because of the Angioplasty and stenting of the right common iliac artery. Any input would greatly be appreciated.
PREOPERATIVE DIAGNOSES:
1. Severe ischemia, right lower extremity with thromboembolus of the right
popliteal and tibial arteries.
2. Stenosis of the right common iliac artery.
3. Right popliteal artery aneurysm with thrombosis.
POSTOPERATIVE DIAGNOSES:
1. Severe schemia, right lower extremity with thromboembolus of the right
popliteal and tibial arteries.
2. Stenosis of the right common iliac artery.
3. Right popliteal artery aneurysm with thrombosis.
OPERATION PERFORMED:
1. Thromboembolectomy of the right superficial femoral, popliteal, and tibial
arteries from leg incision approach.
2. Angioplasty and stenting of the right common iliac artery.
3. Angioplasty and stent graft placement of the right popliteal artery to
repair popliteal artery aneurysm.
4. Placement of PeriPatch right popliteal artery.
ANESTHESIA:
General.
DESCRIPTION OF PROCEDURE:
This patient was brought to the operating room, placed in supine position,
induced under general anesthesia. The right leg was prepped and draped in the
usual sterile fashion. An incision was made on the medial aspect of the right
leg just posterior to the saphenous vein so that the vein was not injured. The
posterior fascia was opened and the popliteal vein and artery were identified.
There was thrombus in the popliteal vein which appeared to be fairly chronic
subacute. The popliteal artery is encircled with the Vesseloop and dissection
proceeded distally. One crossing vein was ligated and divided which was not
thrombosed. The anterior tibial and tibioperoneal trunks were looped with
Vesseloop. The patient was given 5000 units of heparin intravenously. A
longitudinal arteriotomy was then made in the distal popliteal artery. Thrombus was identified. This was teased out of the origins of the tibial artery, and then we had backbleeding from those vessels. No further thrombus was recovered from and we had passed a 2 mm embolectomy catheter without recovering anymore thrombus, although there was some plaque in the vessels chronically. We then advanced a #3 embolectomy catheter proximally and removed it recovering some thrombus but still inflow was a little bit sluggish. We then advanced #4 embolectomy catheter several times recovering a fairly large amount of thrombus and then we had fairly good inflow. We then advanced a guidewire and then over this a long 7-French sheath was placed up into the mid SFA. Arteriography was performed identifying some plaque and stenosis in the right common iliac artery. A Glidewire was then advanced. We then advanced a 12 x 40 mm Wallstent from the origin of the common iliac artery to the distal common iliac artery covering all of the area where there was potential thromboembolus and stenosis. This was then angioplastied with a 10 x 40 mm balloon. A sheath pressure was good at this point, measuring about 130 mmHg. We then performed further arteriography of the SFA revealing no abnormalities there, but there was evidence of a right popliteal artery aneurysm with some thrombus remaining within it which was somewhat mobile. We did not feel that we could get any more of the thrombus out and we needed to treat this aneurysm with a stent graft. We then advanced a 10 x 5 Viabahn stent graft across this and then angioplastied this with a low pressure 10 mm balloon. This gave an excellent result sealing off the aneurysm and thrombus nicely. Inflow was excellent with good sheath pressure below this. The sheath was then removed and good inflow was noted. Good backbleeding was present as well. A pericardial patch was then applied to the arteriotomy site, which was about 2 cm in length. This was sutured as an onlay patch circumferential with a 5-0 Prolene suture in running fashion. Clamps were removed, restoring flow to the lower extremity with excellent Doppler signals resulting in the wound as well as in the foot. The wound was hemostatic and was closed with 2-0, 3-0, and 4-0 Vicryl sutures. Sterile dressings were applied. He tolerated this well and without complications. Estimated blood loss was about 200 mL. He returned to recovery in good condition.
PREOPERATIVE DIAGNOSES:
1. Severe ischemia, right lower extremity with thromboembolus of the right
popliteal and tibial arteries.
2. Stenosis of the right common iliac artery.
3. Right popliteal artery aneurysm with thrombosis.
POSTOPERATIVE DIAGNOSES:
1. Severe schemia, right lower extremity with thromboembolus of the right
popliteal and tibial arteries.
2. Stenosis of the right common iliac artery.
3. Right popliteal artery aneurysm with thrombosis.
OPERATION PERFORMED:
1. Thromboembolectomy of the right superficial femoral, popliteal, and tibial
arteries from leg incision approach.
2. Angioplasty and stenting of the right common iliac artery.
3. Angioplasty and stent graft placement of the right popliteal artery to
repair popliteal artery aneurysm.
4. Placement of PeriPatch right popliteal artery.
ANESTHESIA:
General.
DESCRIPTION OF PROCEDURE:
This patient was brought to the operating room, placed in supine position,
induced under general anesthesia. The right leg was prepped and draped in the
usual sterile fashion. An incision was made on the medial aspect of the right
leg just posterior to the saphenous vein so that the vein was not injured. The
posterior fascia was opened and the popliteal vein and artery were identified.
There was thrombus in the popliteal vein which appeared to be fairly chronic
subacute. The popliteal artery is encircled with the Vesseloop and dissection
proceeded distally. One crossing vein was ligated and divided which was not
thrombosed. The anterior tibial and tibioperoneal trunks were looped with
Vesseloop. The patient was given 5000 units of heparin intravenously. A
longitudinal arteriotomy was then made in the distal popliteal artery. Thrombus was identified. This was teased out of the origins of the tibial artery, and then we had backbleeding from those vessels. No further thrombus was recovered from and we had passed a 2 mm embolectomy catheter without recovering anymore thrombus, although there was some plaque in the vessels chronically. We then advanced a #3 embolectomy catheter proximally and removed it recovering some thrombus but still inflow was a little bit sluggish. We then advanced #4 embolectomy catheter several times recovering a fairly large amount of thrombus and then we had fairly good inflow. We then advanced a guidewire and then over this a long 7-French sheath was placed up into the mid SFA. Arteriography was performed identifying some plaque and stenosis in the right common iliac artery. A Glidewire was then advanced. We then advanced a 12 x 40 mm Wallstent from the origin of the common iliac artery to the distal common iliac artery covering all of the area where there was potential thromboembolus and stenosis. This was then angioplastied with a 10 x 40 mm balloon. A sheath pressure was good at this point, measuring about 130 mmHg. We then performed further arteriography of the SFA revealing no abnormalities there, but there was evidence of a right popliteal artery aneurysm with some thrombus remaining within it which was somewhat mobile. We did not feel that we could get any more of the thrombus out and we needed to treat this aneurysm with a stent graft. We then advanced a 10 x 5 Viabahn stent graft across this and then angioplastied this with a low pressure 10 mm balloon. This gave an excellent result sealing off the aneurysm and thrombus nicely. Inflow was excellent with good sheath pressure below this. The sheath was then removed and good inflow was noted. Good backbleeding was present as well. A pericardial patch was then applied to the arteriotomy site, which was about 2 cm in length. This was sutured as an onlay patch circumferential with a 5-0 Prolene suture in running fashion. Clamps were removed, restoring flow to the lower extremity with excellent Doppler signals resulting in the wound as well as in the foot. The wound was hemostatic and was closed with 2-0, 3-0, and 4-0 Vicryl sutures. Sterile dressings were applied. He tolerated this well and without complications. Estimated blood loss was about 200 mL. He returned to recovery in good condition.