Wiki AV fistula intervention

AgnieszkaLakritz

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36905,36907???

PROCEDURE NAME:
Pharmacal mechanical thrombectomy thrombolysis of the right arm
brachiocephalic fistula/fistula declot.

PREOPERATIVE DIAGNOSIS:
Clotted fistula.

POSTOPERATIVE DIAGNOSIS:
Clotted fistula likely due to severe juxta anastomotic stenosis, and
cephalic arch stent thrombosis.
Severe focal stenosis of the right subclavian vein and thoracic
outlet.


TECHNIQUE/FINDINGS:
The risks, benefits and alternatives of the procedure were discussed
with the patient, and informed written consent was obtained. The
patient was brought to the angiography suite, and the right arm was
prepped and draped in sterile fashion. All elements of maximal sterile
barrier technique were followed including cap and mask, sterile gown,
sterile gloves, large sterile sheet, hand hygiene and 2% chlorhexidine
for cutaneous antisepsis. Sterile ultrasound technique was used,
including sterile gel and sterile probe covers.

Preprocedure physical and ultrasound examination demonstrated patent
inflow artery. Total thrombosis of the brachial cephalic fistula under
ultrasound.

Under ultrasound and fluoroscopic guidance the fistula was accessed in
the antegrade direction towards the venous outflow with a
micropuncture set. The micropuncture sheath was upsized to a 7 French
short vascular sheath. Next, with a combination of Glidewire and the
Kumpe catheter, the thrombosed cephalic vein and cephalic arch stent
was crossed.

Next, in similar fashion, the fistula was accessed in retrograde
fashion towards the inflow artery with micropuncture set. The inflow
brachial artery was accessed with a combination of Kumpe catheter and
Glidewire. Next, sheath was upsized to a 6 French.

Next, 4 French glide catheter was placed into the inflow artery,
angiography was performed. The brachial vein. There is complete
thrombosis of the fistula.

Next, a Kumpe catheter pullback venography was performed. Patent
central vein. Severe focal stenosis of the right subclavian vein in
the thoracic. Total thrombosis of the cephalic arch stent. Total
thrombosis of the outflow cephalic vein.

The decision was made to proceed with pharmacal mechanical
thrombectomy and thrombolysis.

4 mg TPA was deposited throughout entire length of thrombosed segment.

Next, the outflow cephalic vein, cephalic arch stent was angioplastied
in overlapped fashion in 6 mm follow x 8 mm balloon.

Next, the anastomosis was angioplastied to 4 mm.

Next, Fogarty balloon thrombectomy was performed via the retrograde
access, followed by angiographic access.

Next, there was restoration of flow at this point. There is severe
focal stenosis in the juxta anastomotic segment. There is severe
stenosis of the cephalic arch stent, and severe focal stenosis of the
subclavian vein at the thoracic outlet.

The arterial anastomotic stenosis was angioplastied with high pressure
6 mm balloon, followed by x 6 mm cutting balloon with good
angiographic result.

Next, the cephalic arch and thoracic outlet stenosis was treated with
10 mm drug coated balloon angioplasty.

The wire, catheter and sheaths were removed and hemostasis was
achieved with Woggle suture. A sterile dressing was applied.

The patient tolerated the procedure well and there were no immediate
complications. The patient was transported to the recovery area in
stable condition.

FINDINGS /IMPRESSION:
1. Pharmacal mechanical thrombectomy thrombolysis of the right arm
brachiocephalic fistula/fistula declot.
2. Total fistula thrombosis likely caused by severe arterial
anastomotic stenosis, stented cephalic arch stenosis, and subclavian
artery stenosis and thoracic outlet.
3. The severe arterial anastomotic stenosis was treated with 6 mm
high-pressure, and cutting balloon angioplasty with good angiographic
result.
4. stented cephalic arch stenosis, and subclavian artery stenosis
and thoracic outlet were treated with angioplasty, followed by drug
coated balloon to 10 mm. With good angiographic result.
 
36905,36907???

PROCEDURE NAME:
Pharmacal mechanical thrombectomy thrombolysis of the right arm
brachiocephalic fistula/fistula declot.

PREOPERATIVE DIAGNOSIS:
Clotted fistula.

POSTOPERATIVE DIAGNOSIS:
Clotted fistula likely due to severe juxta anastomotic stenosis, and
cephalic arch stent thrombosis.
Severe focal stenosis of the right subclavian vein and thoracic
outlet.


TECHNIQUE/FINDINGS:
The risks, benefits and alternatives of the procedure were discussed
with the patient, and informed written consent was obtained. The
patient was brought to the angiography suite, and the right arm was
prepped and draped in sterile fashion. All elements of maximal sterile
barrier technique were followed including cap and mask, sterile gown,
sterile gloves, large sterile sheet, hand hygiene and 2% chlorhexidine
for cutaneous antisepsis. Sterile ultrasound technique was used,
including sterile gel and sterile probe covers.

Preprocedure physical and ultrasound examination demonstrated patent
inflow artery. Total thrombosis of the brachial cephalic fistula under
ultrasound.

Under ultrasound and fluoroscopic guidance the fistula was accessed in
the antegrade direction towards the venous outflow with a
micropuncture set. The micropuncture sheath was upsized to a 7 French
short vascular sheath. Next, with a combination of Glidewire and the
Kumpe catheter, the thrombosed cephalic vein and cephalic arch stent
was crossed.

Next, in similar fashion, the fistula was accessed in retrograde
fashion towards the inflow artery with micropuncture set. The inflow
brachial artery was accessed with a combination of Kumpe catheter and
Glidewire. Next, sheath was upsized to a 6 French.

Next, 4 French glide catheter was placed into the inflow artery,
angiography was performed. The brachial vein. There is complete
thrombosis of the fistula.

Next, a Kumpe catheter pullback venography was performed. Patent
central vein. Severe focal stenosis of the right subclavian vein in
the thoracic. Total thrombosis of the cephalic arch stent. Total
thrombosis of the outflow cephalic vein.

The decision was made to proceed with pharmacal mechanical
thrombectomy and thrombolysis.

4 mg TPA was deposited throughout entire length of thrombosed segment.

Next, the outflow cephalic vein, cephalic arch stent was angioplastied
in overlapped fashion in 6 mm follow x 8 mm balloon.

Next, the anastomosis was angioplastied to 4 mm.

Next, Fogarty balloon thrombectomy was performed via the retrograde
access, followed by angiographic access.

Next, there was restoration of flow at this point. There is severe
focal stenosis in the juxta anastomotic segment. There is severe
stenosis of the cephalic arch stent, and severe focal stenosis of the
subclavian vein
at the thoracic outlet.

The arterial anastomotic stenosis was angioplastied with high pressure
6 mm balloon, followed by x 6 mm cutting balloon with good
angiographic result.

Next, the cephalic arch and thoracic outlet stenosis was treated with
10 mm drug coated balloon angioplasty.

The wire, catheter and sheaths were removed and hemostasis was
achieved with Woggle suture. A sterile dressing was applied.

The patient tolerated the procedure well and there were no immediate
complications. The patient was transported to the recovery area in
stable condition.

FINDINGS /IMPRESSION:
1. Pharmacal mechanical thrombectomy thrombolysis of the right arm
brachiocephalic fistula/fistula declot.
2. Total fistula thrombosis likely caused by severe arterial
anastomotic stenosis, stented cephalic arch stenosis, and subclavian
artery stenosis and thoracic outlet.
3. The severe arterial anastomotic stenosis was treated with 6 mm
high-pressure, and cutting balloon angioplasty with good angiographic
result.
4. stented cephalic arch stenosis, and subclavian artery stenosis
and thoracic outlet were treated with angioplasty, followed by drug
coated balloon to 10 mm. With good angiographic result.

If doctor did angioplasty in subclavian vein, codes are 36905 , 36907, and 76937.

But in finding #4, it was mentioned subclavian artery. Should clarify with doctor, because if angioplastied in subclavin artery, should be artery angioplasty with 36905 and 76937.
 
If doctor did angioplasty in subclavian vein, codes are 36905 , 36907, and 76937.

But in finding #4, it was mentioned subclavian artery. Should clarify with doctor, because if angioplastied in subclavin artery, should be artery angioplasty with 36905 and 76937.
so should be just 36905, 36215 ?
 
so should be just 36905, 36215 ?
should query the doctor
Angiopalstied in subclavian vein VS subclavian artery. Surgeon mentioned subclavian vein at the thoracic outlet angioplasty performance in description of operative report, but the finding is indicated subclavian artery.
 
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