Wiki Can anyone help with a CPT code for this procedure?

Messages
11
Location
New Palestine, Indiana
Best answers
0
DATE: 07/08/2020
PREOPERATIVE DIAGNOSIS:
Foreign body, right external iliac artery.
POSTOPERATIVE DIAGNOSIS:
Foreign body, right external iliac artery.
PROCEDURE PERFORMED:
Right retroperitoneal exploration with removal of foreign body and
repair of external iliac artery.
SURGEON:
ANESTHESIA:
General endotracheal.
INDICATIONS FOR PROCEDURE:
This 12-year-old girl has congenital heart disease with chronic
pulmonary hypertension. She was in the cath lab today, undergoing
planned placement of a stent to keep her PDA open. One stent was
placed and it was in good position. During attempt to place a second
stent, the stent dislodged from the sheath and was free-floating
within the arterial system. The interventional cardiologist was able
to bring it back down to the external iliac artery, but could not
advance it any further, and urgent assistance was requested. After
reviewing the images with the interventional cardiologist, a
discussion was had with the mother to update her on the findings and
exploration for direct removal of the stent was recommended.
DESCRIPTION OF PROCEDURE:
The patient was already under general anesthesia in the cath lab and
supine on the table. A proper time-out was repeated and a dose of
Kefzol was given. She had received a dose of heparin prior to the
beginning of the catheterization procedure. Due to the position of
the stent on image and her body habitus, a transplant type incision
was chosen. A curved incision was made in the right lower quadrant
from the anterior iliac spine, arcing down over to where the
catheters entered the skin just below the inguinal ligament.
Dissection was taken down through the subcutaneous tissues to fascia.
In the space between the inguinal ligament and the fatty tissue of the thigh, the
vessels could be identified. With further dissection, both femoral
artery and vein were identified and the catheters could be palpated
within the vessels. Extended cranial dissection revealed that the entry points of the
catheters was
approximately 1 cm above the inguinal ligament. The stent was
actually visible through the wall of the artery, approximately 3 to 5
mm above the puncture site into the arterial wall. Circumferential
proximal and distal control of the artery was then obtained with vessel loops in
Potts fashion. A side branch off the artery was also controlled in
Potts fashion. Once all exposure was secured and the tension on the
vessels was adequate. The puncture site in the artery was extended just slightly on the
anterior midline facing wall of the vessel in order to expose the pointed ends of the
stent. The tip of the stent could be grasped with a hemostat and removed. It was quite
snug but came out smoothly intact and was backed up away from the vessel wall and cut off.
Interventional Cardiology was asked to be
ready. At this point, we needed to have the sheath and wire removed, so that
we could close the artery. Interventional Cardiology then advanced
their venous sheath under fluoroscopy, so that they could safely get the wire, which
was in loop fashion from the venous to the arterial system. Once
they had pulled their wire and sheath back out of the artery, the
lumen was inspected. There was a small intimal flap, which was
secured to the adventitia with a single suture of 6-0 Prolene. The
vessel lumen was irrigated with heparin and then a running
longitudinal closure was done with 5-0 Prolene. Prior to tying the
knot, the vessel loops were released to allow a flush back and there
was very minimal flow from the artery. This raised concern of clot
on the cranial side. A 3-French Fogarty catheter was then introduced
and directed cranially and drawn back with the balloon inflated.
There was good return of blood at this point, although no clot was
seen. The suture was tied down. There was a good pulse above now
and it seemed that there had been some element of spasm, which had been
improved. Pulse was palpable on the field, both above and below the
arterial repair and there was a good Doppler signal in the right
foot. The wound was inspected for hemostasis and irrigated clean.
The deeper layers of subcutaneous tissue and Scarpa's fascia were
closed with a 2-0 Vicryl. The skin was then closed with a running 4-
0 Monocryl. Mastisol, Steri-Strips, and dry dressing were applied.
The patient was returned to the care of the Interventional Cardiology
team for removal of the venous sheath. I will also note that when we
noted a poor flow prior to tying the suture, we did give an
additional 50 units per kg heparin bolus. Dr. Billmire was present
and scrubbed throughout the procedure. The patient was then returned
to the care of the Interventional Cardiology team.
 
Top