Question Endovascular repair of aortobililiac aneurysm with WL Gore IBD

SPECIALTYCODING

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Good Morning,

Looking for assistance in coding this procedure. I am looking at 34705, 34717 Rt, 34713 50. Not sure about using the 34717 for the IBE device.


Surgeon:
.

ASSISTANT:


Fellow: .

Dr. assistance was requested due to complex the case and lack of
fellow the appropriate training level to participate

PROCEDURE: Endovascular repair of aortobiiliac aneurysm with WL Gore iliac
branch device. 23 mm IBE on the right with a 12 x 7 iliac branch on the
right into the internal iliac. 31 mm main body place from the patient's
left. 27 x 12 bell bottom bridge on the right in a 27 x 12 bell bottom limb
of the left common iliac..

PREOPERATIVE DIAGNOSIS:
Abdominal aortic and bilateral common iliac artery aneurysms

POSTOPERATIVE DIAGNOSIS:
Same

FLUORO TIME:
165 cc Omnipaque 300

CONTRAST:
24.7 minutes

INDICATION FOR PROCEDURE:
Patient with bilateral common iliac artery aneurysms as well as a small
abdominal aortic aneurysm. His right common iliac artery is now over 3 cm
and meets criteria for repair. He appears to have anatomy that is amenable
to endovascular repair with iliac branch device.

FINDINGS:
Excellent repair of a small abdominal aortic and bilateral common iliac
artery aneurysms.

PROCEDURE IN DETAIL:
After consent was obtained the patient was taken the anterior suite spinal
anesthesia was achieved the abdomen and groins were then prepped and
draped in usual fashion. Under ultrasound guidance bilateral femoral
retrograde access was achieved. We preclosed both groins with 2
proglide's. On the left we placed a 12 French sheath which is the flex
sheath. On the right a 16 French sheath was placed. Dr. and Dr.
stood on the patient's left and I stood on the patient's right. The
patient was given systemic heparin. From the left a trilobed snare was
placed and from the right an angled Glidewire was advanced and the wire
was snared. From the right we then advanced R aortic wire. A 23 mm IBE was
advanced to the right femoral sheath taking care to avoid wirewrapped. We
then deployed the proximal portion artery device after confirming presents
and position of her internal iliac on the right. From the left the Flex
sheath was advanced up and over. Angle glide catheter was advanced and the
right internal iliac artery was cannulated. Catheter position was
confirmed angiographically. We then exchanged for a 1 cm floppy tip
Amplatz wire and advanced are 12 x 7 iliac branch from the left into the
right internal iliac artery. This was postdilated with a 12 mm balloon. We
completed deployment of the ipsilateral portion of the IBE device and
angioplastied with the molding and occlusion balloon including kissing
balloons at the level of the iliac branch device.

Completion imaging was achieved which shows prompt flow into are internal
branch. The left femoral sheath was then upsized to a 18 French sheath.
From the right eye advanced a pigtail catheter to the level of the renal
arteries. We advanced a 31 mm main body from the left femoral sheath to
the level of the renal arteries and deployed immediately below the lowest
which is the left renal artery. From the right I then cannulated the
contralateral gate. We then advanced a marker pigtail catheter to measure
length in a 27 x 12 bridge piece was placed into the iliac branch device
main body. Excellent overlap was achieved. We then extended the left with
the 27 x 12 bell bottom landing this above the left internal iliac artery.
We angioplastied proximal and distal seal zones as well as all overlaps.
Completion imaging was achieved which shows prompt flow to both renal
arteries with no evidence of endoleak. There is prompt flow down both
limbs including the right internal iliac artery. We then achieved
hemostasis with are proglide's and the skin was reapproximated with
Monocryl.

CONCLUSIONS:
Successful exclusion of small abdominal aortic and bilateral common iliac
artery aneurysms with iliac branch device on the right and bell bottom
limb on the left.

Thank you for any assistance :)
 

Jim Pawloski

True Blue
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Ann Arbor
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I reviewed this case, and I would agree with including 34717 code. A bifurcated stent graft was placed at the internal/external iliac bifurcation.
HTH,
Jim Pawloski, CIRCC
 
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