claning
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Help! this is my first time for one of these procedures.... I can't tell if the doctor has confusing dictation, or it's just me. I got 33880 (62?) 75956/26, 37252, 37253 & 36200. What do the experts think? thanks for any and all input!
DIAGNOSIS: POST-OPERATIVE Type B aortic dissection.
DIAGNOSIS:
SURGEONS: K....
ESTIMATED BLOOD 200cc
LOSS:
DESCRIPTION: Informed consent was obtained . The patient was brought to the operative suite where
Dr. Koumjian performed right common femoral artery exposure. No common femoral
artery was punctured percutaneously and a 6 French sheath was placed. Catheter and
guidewire techniques were manipulated used to manipulate a Glidewire into the true
lumen of the thoracic aorta over which a pigtail catheter was advanced and positioned
within the ascending aorta.
A 10 French sheath was placed into the exposed right common femoral artery. Catheter
and guidewire techniques were used to manipulate a Glidewire into the false lumen of
the thoracic aorta. Over this wire, the intravascular ultrasound catheter was advanced in
interrogation of the false lumen was performed. This confirms that the Glidewire does
not enter and exit through fenestrations. Also confirmed with the luminal diameter of
the false and true lumina and position of the takeoff of the left subclavian artery. This
catheter was then exchanged for a Berenstein catheter which was used to select the left
subclavian artery. An angiogram was performed to document the position of the left
common carotid to left subclavian artery bypass. Next, a over exchange wire, a 7
French destination sheath was passed into the proximal left subclavian artery. Through
this sheath, 2 tandem 16 mm Amplatz or plugs were placed into the proximal left
subclavian artery successfully occluding both true and false lumen of this vessel.
Next, the destination sheath was exchanged over a guidewire for a Berenstein catheter
which was used to select the true lumen from the right common femoral artery. Over a
guidewire, intravascular ultrasound was passed through the true lumen and used to
interrogate the luminal diameter of the true lumen at the level of the aortic arch which
measured approximately 28 mm.
Next, a Lunderquist wire was advanced through the intravascular ultrasound catheter
which was then removed and exchanged for the delivery system of a Valiant endograft
measuring 28 x 28 x 150 mm. A thoracic aortogram was performed to delineate the
takeoff of the left common and innominate arteries which takeoff of a common bovine
trunk. The endograft was deployed such that the proximal fabric lies immediately distal
to the takeoff of the bovine trunk. This endograft was then deployed in its entirety.
The pigtail catheter was then straightened and replaced into the lumen of the recently
placed endograft and a distal thoracic aortogram was performed to take to delineate the
takeoff of the celiac artery. Next, over the right-sided Lunderquist wire the delivery
system for a Valiant endograft measuring 28 x 24 x 150 mm was advanced and
positioned into the distal portion of the previously placed endograft and deployed in the
usual fashion such that the distal fabric lies significantly proximal to the takeoff of the
celiac axis.
ANGIOGRAPHIC FINDINGS:
Next, the pigtail catheter was advanced through the endograft and positioned within the
ascending aorta for a final thoracic aortogram, the results of which demonstrates
satisfactory exclusion of a type B dissection false lumen. There is maintenance of
excellent flow through the bovine trunk. There is opacification of a widely patent left
common carotid artery to left subclavian artery bypass graft there is filling of the distal
left subclavian artery. There is satisfactory occlusion of the embolized proximal left
subclavian artery. There is no evidence of endoleak.
The left common femoral artery sheath was removed and the left common femoral
arteriotomy was closed with a starclose device.
Dr. Koumjian close the right common femoral artery or in the groin. The patient was
taken to the recovery room in stable condition.
CONCLUSION: Successful restoration of luminal diameter of the true lumen which was compromised
secondary to a type B aortic dissection and widening false lumen via placement of
modular thoracic endografts as detailed above.
Billing codes: 34812-62, 36200, 36215, 33880-62, 75956-26, 37252, 37242.
DIAGNOSIS: POST-OPERATIVE Type B aortic dissection.
DIAGNOSIS:
SURGEONS: K....
ESTIMATED BLOOD 200cc
LOSS:
DESCRIPTION: Informed consent was obtained . The patient was brought to the operative suite where
Dr. Koumjian performed right common femoral artery exposure. No common femoral
artery was punctured percutaneously and a 6 French sheath was placed. Catheter and
guidewire techniques were manipulated used to manipulate a Glidewire into the true
lumen of the thoracic aorta over which a pigtail catheter was advanced and positioned
within the ascending aorta.
A 10 French sheath was placed into the exposed right common femoral artery. Catheter
and guidewire techniques were used to manipulate a Glidewire into the false lumen of
the thoracic aorta. Over this wire, the intravascular ultrasound catheter was advanced in
interrogation of the false lumen was performed. This confirms that the Glidewire does
not enter and exit through fenestrations. Also confirmed with the luminal diameter of
the false and true lumina and position of the takeoff of the left subclavian artery. This
catheter was then exchanged for a Berenstein catheter which was used to select the left
subclavian artery. An angiogram was performed to document the position of the left
common carotid to left subclavian artery bypass. Next, a over exchange wire, a 7
French destination sheath was passed into the proximal left subclavian artery. Through
this sheath, 2 tandem 16 mm Amplatz or plugs were placed into the proximal left
subclavian artery successfully occluding both true and false lumen of this vessel.
Next, the destination sheath was exchanged over a guidewire for a Berenstein catheter
which was used to select the true lumen from the right common femoral artery. Over a
guidewire, intravascular ultrasound was passed through the true lumen and used to
interrogate the luminal diameter of the true lumen at the level of the aortic arch which
measured approximately 28 mm.
Next, a Lunderquist wire was advanced through the intravascular ultrasound catheter
which was then removed and exchanged for the delivery system of a Valiant endograft
measuring 28 x 28 x 150 mm. A thoracic aortogram was performed to delineate the
takeoff of the left common and innominate arteries which takeoff of a common bovine
trunk. The endograft was deployed such that the proximal fabric lies immediately distal
to the takeoff of the bovine trunk. This endograft was then deployed in its entirety.
The pigtail catheter was then straightened and replaced into the lumen of the recently
placed endograft and a distal thoracic aortogram was performed to take to delineate the
takeoff of the celiac artery. Next, over the right-sided Lunderquist wire the delivery
system for a Valiant endograft measuring 28 x 24 x 150 mm was advanced and
positioned into the distal portion of the previously placed endograft and deployed in the
usual fashion such that the distal fabric lies significantly proximal to the takeoff of the
celiac axis.
ANGIOGRAPHIC FINDINGS:
Next, the pigtail catheter was advanced through the endograft and positioned within the
ascending aorta for a final thoracic aortogram, the results of which demonstrates
satisfactory exclusion of a type B dissection false lumen. There is maintenance of
excellent flow through the bovine trunk. There is opacification of a widely patent left
common carotid artery to left subclavian artery bypass graft there is filling of the distal
left subclavian artery. There is satisfactory occlusion of the embolized proximal left
subclavian artery. There is no evidence of endoleak.
The left common femoral artery sheath was removed and the left common femoral
arteriotomy was closed with a starclose device.
Dr. Koumjian close the right common femoral artery or in the groin. The patient was
taken to the recovery room in stable condition.
CONCLUSION: Successful restoration of luminal diameter of the true lumen which was compromised
secondary to a type B aortic dissection and widening false lumen via placement of
modular thoracic endografts as detailed above.
Billing codes: 34812-62, 36200, 36215, 33880-62, 75956-26, 37252, 37242.
