Jim Pawloski
True Blue
I need an opinion for codes of case below
Examination: CT guided embolization of a type II endoleak
Clinical History: 79-year-old male status post aortic endovascular stent graft
repair for a abdominal aortic aneurysm. Serial CAT scans demonstrates a type
II endoleak. Two attempts were made to embolize the endoleak via the
endovascular approach which was unsuccessful.
Access site: Left posterior flank.
Sedation: General anesthesia.
Contrast: 10 cc of Isovue.
Complications: None.
Technique:
The procedure, with the risk and benefits, were discussed with the patient.
Informed and written consent were obtained and placed placed in the patient's
chart.
The patient was brought to the CAT scan suite and placed on the gantry. The
patient was administered general anesthesia by the anesthesiology team.
Following endotracheal intubation, the patient was positioned in a right
lateral recumbent position.
A radiopaque grid was placed over the left posterior flank. Contiguous 3 mm
axial images were obtained from the proximal endovascular aortic stent to the
iliac crest. This exam is limited due to no oral or intravenous contrast. The
purpose of this limited CT scan was to localize an access site for CT guided
embolization.
The access site was chosen from the transaxial CT images. The left posterior
flank was prepped and draped in the normal sterile fashion. A small
dermatotomy was made with an 11 blade scalpel. An 18-gauge 20 cm Chiba needle
was advanced into the aneurysm sac utilizing CT fluoroscopy.
Once the needle was within the aneurysm sac, a small amount of contrast was
injected during fluoroscopy demonstrating filling of the aneurysm sac with
outflow through a lumbar artery. The amount of contrast used to opacify the
aneurysm sac was approximately 3 cc.
At this time, 1 cc of n- Butyl cyanoacrylate (Tru-fill glue) was mixed with 2
cc of Ethiodol. The 3cc of the mixture was injected through the 18-gauge
needle under direct fluoroscopy. Following embolization of the aneurysm sac,
the needle was removed. A sterile dressing was placed.
A limited CT scan was performed through the abdomen to evaluate embolization
of the aneurysm sac.
The patient tolerated the procedure well and left the angiography suite and
stable condition.
Findings:
Limited CT scan of the abdomen demonstrates the patient is status post aortic
endovascular stent graft placement. Injection of contrast in the aneurysm sac
demonstrates a patent type II endoleak with outflow through the lumbar artery.
Following embolization, there is increased density opacifying the aneurysm sac
and outflow artery. There is no evidence of extravasated contrast or
bleeding.
Impression:
1. Successful CT guided embolization of a type II endoleak with N-Butyl
cyanoacrylate (Tru-Fill glue)
2. The patient is scheduled for a 4 weeks triple phase CTA to evaluate for
endoleak and will follow-up in the interventional clinic for the results.
I think 36160, 76380, 37204, 75984. Would you use a fluoro charge, since fluoroscopy was used in the CT scanner. What do you think?
Thanks,
Jim Pawloski, CIRCC
Examination: CT guided embolization of a type II endoleak
Clinical History: 79-year-old male status post aortic endovascular stent graft
repair for a abdominal aortic aneurysm. Serial CAT scans demonstrates a type
II endoleak. Two attempts were made to embolize the endoleak via the
endovascular approach which was unsuccessful.
Access site: Left posterior flank.
Sedation: General anesthesia.
Contrast: 10 cc of Isovue.
Complications: None.
Technique:
The procedure, with the risk and benefits, were discussed with the patient.
Informed and written consent were obtained and placed placed in the patient's
chart.
The patient was brought to the CAT scan suite and placed on the gantry. The
patient was administered general anesthesia by the anesthesiology team.
Following endotracheal intubation, the patient was positioned in a right
lateral recumbent position.
A radiopaque grid was placed over the left posterior flank. Contiguous 3 mm
axial images were obtained from the proximal endovascular aortic stent to the
iliac crest. This exam is limited due to no oral or intravenous contrast. The
purpose of this limited CT scan was to localize an access site for CT guided
embolization.
The access site was chosen from the transaxial CT images. The left posterior
flank was prepped and draped in the normal sterile fashion. A small
dermatotomy was made with an 11 blade scalpel. An 18-gauge 20 cm Chiba needle
was advanced into the aneurysm sac utilizing CT fluoroscopy.
Once the needle was within the aneurysm sac, a small amount of contrast was
injected during fluoroscopy demonstrating filling of the aneurysm sac with
outflow through a lumbar artery. The amount of contrast used to opacify the
aneurysm sac was approximately 3 cc.
At this time, 1 cc of n- Butyl cyanoacrylate (Tru-fill glue) was mixed with 2
cc of Ethiodol. The 3cc of the mixture was injected through the 18-gauge
needle under direct fluoroscopy. Following embolization of the aneurysm sac,
the needle was removed. A sterile dressing was placed.
A limited CT scan was performed through the abdomen to evaluate embolization
of the aneurysm sac.
The patient tolerated the procedure well and left the angiography suite and
stable condition.
Findings:
Limited CT scan of the abdomen demonstrates the patient is status post aortic
endovascular stent graft placement. Injection of contrast in the aneurysm sac
demonstrates a patent type II endoleak with outflow through the lumbar artery.
Following embolization, there is increased density opacifying the aneurysm sac
and outflow artery. There is no evidence of extravasated contrast or
bleeding.
Impression:
1. Successful CT guided embolization of a type II endoleak with N-Butyl
cyanoacrylate (Tru-Fill glue)
2. The patient is scheduled for a 4 weeks triple phase CTA to evaluate for
endoleak and will follow-up in the interventional clinic for the results.
I think 36160, 76380, 37204, 75984. Would you use a fluoro charge, since fluoroscopy was used in the CT scanner. What do you think?
Thanks,
Jim Pawloski, CIRCC
