Case #1 Done 8/25/2016
Procedures Performed:
Inferior Vena Cava Venogram (75825-26)
Angioplasty of bilateral Iliac Vein (35476-50)
Angioplasty of inferior vena cava (35476-?)
sono guided access x 2 (76937-26)
Technique/Procedure:
Patient was sterile prepped as usual. Bilateral common femoral veins were cannulated using sonographic guidance. Venogram was obtained and bilateral iliac vein stenosis at ivc confluence and inferior vena cava stenosis. Patient was given 6000 units of heparin. Using glide catheter and glide wire stenosis were crossed into right atrium. Angioplasty of bilateral iliac veins were done with 12x40 balloon. Second angioplasty of ivc was done with 14x60 balloon up to 8 atm. Patient showed restoration of flow with decreased of flow through collateral circulation. Bilateral groin sheath were removed and manual compression applied.
Case #2 Done 2/14/17
Procedures Performed:
Fistulogram (36901)
Percutaneous Thrombectomy (37184)
Catheter Thrombolysis (37212)
sono guided access (76937-26)
angioplasty of arterial and venous outflow with stenting (36909)
Technique/Procedure:
Patient was sterile prepped as usual, Arteriovenous graft was cannulated using sono guided access. 6fr sheath was placed into venous outflow, second sheath was placed into arterial in flow. Using 0.35 glide wire fistula stenosis was crossed and wire advanced into axillary vein. Second wire was advanced into brachial artery. Using angiojet catheter power pulse 4mg of alteplase were injected into venous site and arterial site in 2 separate infusions. After 4 minutes catheter was advanced into brachial vein and thrombectomy was done, catheter was advanced through second sheath into arterial inflow and thrombectomy was done with angiojet. Fistulogram was done and showed stenosis at venous outflow. Venous outflow 80% stenosis was angioplasty 7x60 balloon up to 12 atm with recoilling of stenosis. A viabahn stent was deployed and angioplasty was done after deployment. Completion fistulogram showed good flow and fistula demonstrated good thrill. Entry site was closed with 4.o prolene.
Case #3 Done 2/23/17
Procedures Performed:
Aortogram with bilateral lower extremity runoff (36200,75630-26)
sono guided access (76937-26)
angioplasty of left popliteal artery (37224)
drug eluding balloon
third order angiogram (36247)
Technique/Procedure:
Patient was sterile prepped as usual, right common femoral artery was canulated using sonographic guidance. 6fr sheath was advanced over 0.35 wire. Contra flush catheter was advanced into abdominal aorta. Aortogram with bilateral runoff was done. Findings normal proximal aorta or renal arteries 50% stenosis of right iliac artery, normal common femoral arteries, 90% stenosis of left superficial femoral artery two vessel runoff. Selective catheter placement was done over bifurcation into left femoral artery. 45cm 6fr sheath was advanced over bifurcation. Patient was given 6000 units of heparin and using 4fr glide catheter and glide wire superficial femoral artery was cannulated and stenosis were crossed. Wire was exchanged for 0.14 grand slam wire. Angioplasty was done with 4x80 balloon. Post angioplasty drug eluding balloon 6x60 was used up to 8 atm. Complation angiogram showed excellent flow and no signifaicant stenosis. Patient right groin was closed with angioseal.
Case #4 Done 4/06/17
Procedures Performed:
Aortogram with bilateral lower extremity runoff (75630-26)
Atherectomy of left femoral artery, popliteal artery and anterior tibial artery (37225)
Angioplasty of left superficial femoral artery and politeal artery 4x150 drug eluding balloon (37226)
Angioplasty of anterior tibial artery (37228)
sono guided access (76937-26)
Technique/Procedure:
Patient was sterile prepped as usual. Right common femoral artery was cannulated using sonographic guidance and direct needle visualization. 6fr sheath was placed over 0.35 wire. Contra flush catheter was advanced into abdominal aorta and angiogram was obtained with findings of normal abdominal aorta and renal arteries. Normal bilateral iliac arteries. Normal left femoral artery with two vessels runoff occlusion of left superficial femoral artery, occluded posterior tibial and peroneal artery and stenosis of anterior tibial patent to foot. Selective catheter was advanced over bifurcation into left left superficial femoral artery and 45cm 6fr sheath was advanced and parked into left superficial femoral artery. Patient was given 5000 units of heparin and using 4fr glide catheter and 0.14 victory wire occlusion was crossed. Atherectomy was done with silverhawk EXL on femoral popliteal artery and anterior tibial artery. Post atherectomy angioplasty on anterior tibial artery was angioplasty with 2.5x300 balloon. Femoral and popliteal artery angioplasty was done with 4x120 drug eluding balloon for 8th and 3 min. Completion angiogram showed excellent flow and no residual stenosis right femoral artery closed with angioseal.
Procedures Performed:
Inferior Vena Cava Venogram (75825-26)
Angioplasty of bilateral Iliac Vein (35476-50)
Angioplasty of inferior vena cava (35476-?)
sono guided access x 2 (76937-26)
Technique/Procedure:
Patient was sterile prepped as usual. Bilateral common femoral veins were cannulated using sonographic guidance. Venogram was obtained and bilateral iliac vein stenosis at ivc confluence and inferior vena cava stenosis. Patient was given 6000 units of heparin. Using glide catheter and glide wire stenosis were crossed into right atrium. Angioplasty of bilateral iliac veins were done with 12x40 balloon. Second angioplasty of ivc was done with 14x60 balloon up to 8 atm. Patient showed restoration of flow with decreased of flow through collateral circulation. Bilateral groin sheath were removed and manual compression applied.
Case #2 Done 2/14/17
Procedures Performed:
Fistulogram (36901)
Percutaneous Thrombectomy (37184)
Catheter Thrombolysis (37212)
sono guided access (76937-26)
angioplasty of arterial and venous outflow with stenting (36909)
Technique/Procedure:
Patient was sterile prepped as usual, Arteriovenous graft was cannulated using sono guided access. 6fr sheath was placed into venous outflow, second sheath was placed into arterial in flow. Using 0.35 glide wire fistula stenosis was crossed and wire advanced into axillary vein. Second wire was advanced into brachial artery. Using angiojet catheter power pulse 4mg of alteplase were injected into venous site and arterial site in 2 separate infusions. After 4 minutes catheter was advanced into brachial vein and thrombectomy was done, catheter was advanced through second sheath into arterial inflow and thrombectomy was done with angiojet. Fistulogram was done and showed stenosis at venous outflow. Venous outflow 80% stenosis was angioplasty 7x60 balloon up to 12 atm with recoilling of stenosis. A viabahn stent was deployed and angioplasty was done after deployment. Completion fistulogram showed good flow and fistula demonstrated good thrill. Entry site was closed with 4.o prolene.
Case #3 Done 2/23/17
Procedures Performed:
Aortogram with bilateral lower extremity runoff (36200,75630-26)
sono guided access (76937-26)
angioplasty of left popliteal artery (37224)
drug eluding balloon
third order angiogram (36247)
Technique/Procedure:
Patient was sterile prepped as usual, right common femoral artery was canulated using sonographic guidance. 6fr sheath was advanced over 0.35 wire. Contra flush catheter was advanced into abdominal aorta. Aortogram with bilateral runoff was done. Findings normal proximal aorta or renal arteries 50% stenosis of right iliac artery, normal common femoral arteries, 90% stenosis of left superficial femoral artery two vessel runoff. Selective catheter placement was done over bifurcation into left femoral artery. 45cm 6fr sheath was advanced over bifurcation. Patient was given 6000 units of heparin and using 4fr glide catheter and glide wire superficial femoral artery was cannulated and stenosis were crossed. Wire was exchanged for 0.14 grand slam wire. Angioplasty was done with 4x80 balloon. Post angioplasty drug eluding balloon 6x60 was used up to 8 atm. Complation angiogram showed excellent flow and no signifaicant stenosis. Patient right groin was closed with angioseal.
Case #4 Done 4/06/17
Procedures Performed:
Aortogram with bilateral lower extremity runoff (75630-26)
Atherectomy of left femoral artery, popliteal artery and anterior tibial artery (37225)
Angioplasty of left superficial femoral artery and politeal artery 4x150 drug eluding balloon (37226)
Angioplasty of anterior tibial artery (37228)
sono guided access (76937-26)
Technique/Procedure:
Patient was sterile prepped as usual. Right common femoral artery was cannulated using sonographic guidance and direct needle visualization. 6fr sheath was placed over 0.35 wire. Contra flush catheter was advanced into abdominal aorta and angiogram was obtained with findings of normal abdominal aorta and renal arteries. Normal bilateral iliac arteries. Normal left femoral artery with two vessels runoff occlusion of left superficial femoral artery, occluded posterior tibial and peroneal artery and stenosis of anterior tibial patent to foot. Selective catheter was advanced over bifurcation into left left superficial femoral artery and 45cm 6fr sheath was advanced and parked into left superficial femoral artery. Patient was given 5000 units of heparin and using 4fr glide catheter and 0.14 victory wire occlusion was crossed. Atherectomy was done with silverhawk EXL on femoral popliteal artery and anterior tibial artery. Post atherectomy angioplasty on anterior tibial artery was angioplasty with 2.5x300 balloon. Femoral and popliteal artery angioplasty was done with 4x120 drug eluding balloon for 8th and 3 min. Completion angiogram showed excellent flow and no residual stenosis right femoral artery closed with angioseal.