attempted declotting of loop graft

JenReyn99

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So here's the report. Any help is appreciated.

"The right forearm Gore-Tex loop graft was accessed in both antegrade and retrograde fashion with 21-guage micropuncture needles. The access needles were exchanged over guidewires for short 6 French sheath. Through each sheath, a 5 French Kumpe catheter was manipulated across the arterial and venous anastomosis into the native vessel. Of note, there is difficulty traversing the proximal portion of the Gore-Tex graft due to extensive scar tissue.

Attempts were made at catheterizing the basilic vein more centrally, but this proved difficult at the upper arm due to pre-existing stents which appeared to be occluded.

A total of 10 mg was placed into the occluded graft and into the upper arm basilic vein, to the point of occlusion in the upper arm. A 6 mmx4cm angioplasty balloon was used to dilate the entire graft as well as the majority of the upper arm basilic vein. A 4mm x 2cm and plasty balloon was used to dilate the proximal aspect of the graft and to perform a pullback thrombectomy maneuver to help restore antegrade flow. This proved unsuccessful however. At this point, given the long segment venous occlusion and the poor arterial inflow, the procedure was terminated, given the low transvers is 4 VENOUS access. "

I really need help. This is a new one for me. I don't do much interventional, and these ones are a little confusing for me. I'm working on getting some training to get a better understanding. But in the meantime the help is appreciated!
 

Jim Pawloski

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So here's the report. Any help is appreciated.

"The right forearm Gore-Tex loop graft was accessed in both antegrade and retrograde fashion with 21-guage micropuncture needles. The access needles were exchanged over guidewires for short 6 French sheath. Through each sheath, a 5 French Kumpe catheter was manipulated across the arterial and venous anastomosis into the native vessel. Of note, there is difficulty traversing the proximal portion of the Gore-Tex graft due to extensive scar tissue.

Attempts were made at catheterizing the basilic vein more centrally, but this proved difficult at the upper arm due to pre-existing stents which appeared to be occluded.

A total of 10 mg was placed into the occluded graft and into the upper arm basilic vein, to the point of occlusion in the upper arm. A 6 mmx4cm angioplasty balloon was used to dilate the entire graft as well as the majority of the upper arm basilic vein. A 4mm x 2cm and plasty balloon was used to dilate the proximal aspect of the graft and to perform a pullback thrombectomy maneuver to help restore antegrade flow. This proved unsuccessful however. At this point, given the long segment venous occlusion and the poor arterial inflow, the procedure was terminated, given the low transvers is 4 VENOUS access. "

I really need help. This is a new one for me. I don't do much interventional, and these ones are a little confusing for me. I'm working on getting some training to get a better understanding. But in the meantime the help is appreciated!
You have 36147 and 36148 for the access which includes imaging. Then 36870 for the thrombectomy. I would not bill for angioplasty as I think the PTA balloon is being used to break-up the clot, and not to open a stenosis.
HTH,
Jim Pawloski, CIRCC
 
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