I'm not sure what is included in this thrombectomy (36870), if repeat thrombectomy is included. (Angiography/Fistulogram 36147 besides) Do I code the addl angioplasty. procedure is as follows:
SEDATION TIME: 60 minutes. Intravenous conscious sedation was monitored by the Radiology nursing staff.
CONTRAST: 60 mL of Omnipaque-240.
TECHNIQUE: Informed written consent was obtained. The patient was brought to the Angiography suite, and the right arm was prepped and draped in sterile fashion. A time out was performed. After local anesthesia with 1% lidocaine, the AVF was accessed in
an antegrade fashion with a 5 Fr micropuncture set. A 6 Fr French sheath was placed over an 0.035 inch Coons wire. A 5 French Berenstein catheter was advanced over the wire into the central veins. The AVF was then accessed in a retrograde fashion with
the micropuncture set, and a second sheath was placed. Central and pullback venography showed patent central veins and thrombosis of the fistula to the level of the upper humerus. Mechanical thrombectomy of the fistula was performed through both limbs
with the Angiojet. Balloon maceration of the fistula and angioplasty of the venous outflow stenosis was then performed with a 7 mm x 4 cm Conquest balloon. Subsequently, a 5.5 French Fogarty balloon embolectomy catheter was placed over the wire into the
brachial artery and pulled back across the arterial anastomosis to dislodge the arterial plug. Extravasation of contrast was noted in the juxta-anastomotic region. Prolonged angioplasty with a 4 mm x 4 cm Rival balloon was used to successfully treat the
extravasation. Flow was still however poor and residual thrombus was noted in the venous outflow. Repeat mechanical thrombectomy was performed with the Angiojet device. Upon completion of the thrombectomy, a palpable thrill was restored in the graft, and
a final dialysis shunt angiogram was performed. Vascular sheaths were removed, and hemostasis was obtained, using two 2-0 Prolene woggle purse-string sutures. The patient tolerated the procedure well with no immediate complication.
FINDINGS:
1. Initial dialysis shunt angiography showed a clotted right AVF. Right subclavian, and innominate veins were widely patent to the superior vena cava.
2. Mechanical thrombectomy of the fistula with the Angiojet device. Angioplasty of the venous outflow with a 7 mm high pressure balloon. Thrombectomy of the arterial plug with a Fogarty balloon. Extravasation of contrast was noted in the
juxta-anastomotic region which was successfully treated with prolonged angioplasty.
3. Final shunt angiography showed a widely patent arterial anastomosis and brisk flow through the AVF. Brachial artery runoff to the forearm was preserved.
4. A palpable thrill was restored in the fistula upon completion of the procedure.
Thank you in advance for your help.
SEDATION TIME: 60 minutes. Intravenous conscious sedation was monitored by the Radiology nursing staff.
CONTRAST: 60 mL of Omnipaque-240.
TECHNIQUE: Informed written consent was obtained. The patient was brought to the Angiography suite, and the right arm was prepped and draped in sterile fashion. A time out was performed. After local anesthesia with 1% lidocaine, the AVF was accessed in
an antegrade fashion with a 5 Fr micropuncture set. A 6 Fr French sheath was placed over an 0.035 inch Coons wire. A 5 French Berenstein catheter was advanced over the wire into the central veins. The AVF was then accessed in a retrograde fashion with
the micropuncture set, and a second sheath was placed. Central and pullback venography showed patent central veins and thrombosis of the fistula to the level of the upper humerus. Mechanical thrombectomy of the fistula was performed through both limbs
with the Angiojet. Balloon maceration of the fistula and angioplasty of the venous outflow stenosis was then performed with a 7 mm x 4 cm Conquest balloon. Subsequently, a 5.5 French Fogarty balloon embolectomy catheter was placed over the wire into the
brachial artery and pulled back across the arterial anastomosis to dislodge the arterial plug. Extravasation of contrast was noted in the juxta-anastomotic region. Prolonged angioplasty with a 4 mm x 4 cm Rival balloon was used to successfully treat the
extravasation. Flow was still however poor and residual thrombus was noted in the venous outflow. Repeat mechanical thrombectomy was performed with the Angiojet device. Upon completion of the thrombectomy, a palpable thrill was restored in the graft, and
a final dialysis shunt angiogram was performed. Vascular sheaths were removed, and hemostasis was obtained, using two 2-0 Prolene woggle purse-string sutures. The patient tolerated the procedure well with no immediate complication.
FINDINGS:
1. Initial dialysis shunt angiography showed a clotted right AVF. Right subclavian, and innominate veins were widely patent to the superior vena cava.
2. Mechanical thrombectomy of the fistula with the Angiojet device. Angioplasty of the venous outflow with a 7 mm high pressure balloon. Thrombectomy of the arterial plug with a Fogarty balloon. Extravasation of contrast was noted in the
juxta-anastomotic region which was successfully treated with prolonged angioplasty.
3. Final shunt angiography showed a widely patent arterial anastomosis and brisk flow through the AVF. Brachial artery runoff to the forearm was preserved.
4. A palpable thrill was restored in the fistula upon completion of the procedure.
Thank you in advance for your help.