Endoleak---Endovascular repair of AAA s/p EVAR endoleak


San Diego
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Can someone help with this. It's out of my wheelhouse. Thanks!


1. Bilateral open femoral artery exposure.
2. Endovascular aneurysm repair with placement of aortic-uni-iliac endogradt, non rupture.
3. Right common iliac artery embolization
4. Left to right femoral to femoral bypass

1. Bilateral open femoral artery exposure
2.Placement of catheter in abdominal aorta with aortogram.
3.Introduction of the main body device Medtronic Endurant II AUI 28 mm x 14mm x 102 mm from the left common femoral artery
4. Left limb 16 mm x 93 mm
5. Left limb extension 20 mm x 156 mm
6. Left to right femoral to femoral bypass with 8 mm Dacron graft

Bilateral oblique groin incises were created with a scalpel two finer breaths below the inguinal ligament. Electrocautery was utilized to dissect through the subcutaneous tissues to expose the inguinal ligament. The femoral sheath was identified and divided longitudinally to expose the common femoral artery. The proximal and distal common femoral arteries were then circumferentially encircled with silastic vessel loops.The left common fem artery was accessed with an 18g needle, Benton wire, and 9 french sheath. The bentson wire and KMP catheter was advanced into the suprarenal aorta to perform an aortogram.

The 14 french main body Medtronic Endurant II AUI device was placed on the left side. On the contralateral side, a pigtail catheter was inserted to the level of the renal arteries and an aortogram was performed. The main body device was then positioned just below the right renal artery and the endo graft was fully deployed. An aortogram was performed to confirm adequate position of the graft and patent right renal artery.

The left iliac limb was measured with the marked pigtail catheter and the location of the hypoastric artery was confirmed with a retrograde sheath arteriogram.The left iliac limb grafts were deployed just proximal to the left hypogastric artery wiht a 3xm uverlapof the previous left iliac limb. All overlap zones were confirmed wiht a Reliant balloon. Next, the previous placed right iliac limb was embolized with a 22 mm Amplatzer Ii plug thru a 12 French long sheath.

A complete aortogram was performed which confirmed excellent endograft position and patent right renal artery and hypogastric arteries bilaterally. No endoleak was detected. Bilateral common femoral arteries were then controlled proximally and distally with vascular clamps. A tunnel was created over both inguinal ligaments, anterior to fascia along the subcutanouse space, superior to pubis using blunt dissection. An 8,=mm Dacron graft passed thru the tunnel ensuring no kinking or twisting. A longitudinal arteriotomy was made on the left common femoral artery. No endarterectomy was required. ..then closure



thanks for your help!!


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I'm not sure I would code 34709 because it says the limbs were deployed just proximal to the left hypogastric artery.
You might also code add on code 34808 for the 22 mm Amplatzer Ii plug.

I hope this helps.