nlbarnes
Expert
34900-50
34825
34826
75625
76937 x 2
77002? per coding companion?
Also, coding companion states "intro of guide wires (36200, 36215-36218) are also reported separately. I need help with that as well.
OPERATIVE PROCEDURE
Bilateral common femoral
arterial access was obtained under ultrasound guidance. Using
micropuncture catheter kits bilateral fluoroscopy of those groins
confirmed common femoral access. 6-French sheaths were advanced over
a J wires into the common femoral access bilaterally. Bilateral
common femoral arteriotomies were pre-closed with ProGlide Perclose
devices x2 in both groins. 8-French sheaths were placed into both
groins. The patient was heparinized to a goal ACT of 250 and this was
checked every half an hour for re-dosing to maintain an ACT greater
than 250 through the duration of the case. The left iliac branch
device was deployed first over a stiff Amplatz wire through a 16-
French DrySeal sheath. The left iliac branch device was then
cannulated with a 12-French sheath from the right groin, snared and
brought up over into the hypogastric artery case. A 7 x 14.5 mm limb
was then deployed into the left hypogastric to cover the left
hypogastric artery aneurysm. This was then extended with an
additional 7 x 14.5 extension. Confirmation fluoroscopy demonstrated
excellent seal of the hypogastric with preservation of outflow
branches. The external iliac limb was deployed without complication.
Having successfully deployed the left iliac branch device the right 12-
French sheath was then up-sized to a 16-French sheath and the right
iliac branch device was deployed through the 16-French sheath. A 12-
French sheath was snared from the left hand side and brought up into
the right iliac branch device once deployed. The right hypogastric
artery was cannulated and a 7 x 16 limb extension was deployed into
the right hypogastric artery, followed by secondary extension also
measuring 7 x 16. Confirmation fluoroscopy demonstrated excellent
deployment with preservation of the outflow branches and exclusion of
the right hypogastric artery aneurysm. Both of the limb extensions on
the right and left hand side into the hypogastric artery required
deployment over stiff wires and both were moderately technically
challenging. However, at deployment of the right iliac extension of
the right iliac device, we had successfully excluded both common iliac
and internal hypogastric artery aneurysms bilaterally. At this time,
we turned our attention to the infrarenal abdominal aortic aneurysm.
An aortogram at the level of the renals was obtained. A Gore Excluder
measuring 26 at the aortic neck was deployed and then readjusted
accounting for parallax to a level approximately 4 mm below the renal
arteries. Once deployed, 2 bell-bottom limbs were deployed from the
main body graft into the bilateral iliac branch devices with left bell-
bottom measuring 10 x 27 and right bell-bottom measuring 12 x 27 mm.
These were deployed without complication. Confirmation fluoroscopy at
completion of deployment of the bell-bottom limbs into the iliac
branch devices demonstrated a type 1A endoleak and approximately 5 mm
of space between the top of the main body graft and the renal
arteries. An aortic cuff was deployed measuring 26 mm x 3.3 cm to
extend the main body seal to the level of the renal arteries. This
was post deployed, inflated with a Q50 balloon and this demonstrated
excellent seal on completion angiogram with no evidence of type 1A,
Type 1B, type 2 or type 3 endoleak on completion angiogram. At this
time, satisfied with exclusion of all of the patient's aneurysms the
wires and sheaths were withdrawn and the arteriotomies were closed
701889320_03_15
34825
34826
75625
76937 x 2
77002? per coding companion?
Also, coding companion states "intro of guide wires (36200, 36215-36218) are also reported separately. I need help with that as well.
OPERATIVE PROCEDURE
Bilateral common femoral
arterial access was obtained under ultrasound guidance. Using
micropuncture catheter kits bilateral fluoroscopy of those groins
confirmed common femoral access. 6-French sheaths were advanced over
a J wires into the common femoral access bilaterally. Bilateral
common femoral arteriotomies were pre-closed with ProGlide Perclose
devices x2 in both groins. 8-French sheaths were placed into both
groins. The patient was heparinized to a goal ACT of 250 and this was
checked every half an hour for re-dosing to maintain an ACT greater
than 250 through the duration of the case. The left iliac branch
device was deployed first over a stiff Amplatz wire through a 16-
French DrySeal sheath. The left iliac branch device was then
cannulated with a 12-French sheath from the right groin, snared and
brought up over into the hypogastric artery case. A 7 x 14.5 mm limb
was then deployed into the left hypogastric to cover the left
hypogastric artery aneurysm. This was then extended with an
additional 7 x 14.5 extension. Confirmation fluoroscopy demonstrated
excellent seal of the hypogastric with preservation of outflow
branches. The external iliac limb was deployed without complication.
Having successfully deployed the left iliac branch device the right 12-
French sheath was then up-sized to a 16-French sheath and the right
iliac branch device was deployed through the 16-French sheath. A 12-
French sheath was snared from the left hand side and brought up into
the right iliac branch device once deployed. The right hypogastric
artery was cannulated and a 7 x 16 limb extension was deployed into
the right hypogastric artery, followed by secondary extension also
measuring 7 x 16. Confirmation fluoroscopy demonstrated excellent
deployment with preservation of the outflow branches and exclusion of
the right hypogastric artery aneurysm. Both of the limb extensions on
the right and left hand side into the hypogastric artery required
deployment over stiff wires and both were moderately technically
challenging. However, at deployment of the right iliac extension of
the right iliac device, we had successfully excluded both common iliac
and internal hypogastric artery aneurysms bilaterally. At this time,
we turned our attention to the infrarenal abdominal aortic aneurysm.
An aortogram at the level of the renals was obtained. A Gore Excluder
measuring 26 at the aortic neck was deployed and then readjusted
accounting for parallax to a level approximately 4 mm below the renal
arteries. Once deployed, 2 bell-bottom limbs were deployed from the
main body graft into the bilateral iliac branch devices with left bell-
bottom measuring 10 x 27 and right bell-bottom measuring 12 x 27 mm.
These were deployed without complication. Confirmation fluoroscopy at
completion of deployment of the bell-bottom limbs into the iliac
branch devices demonstrated a type 1A endoleak and approximately 5 mm
of space between the top of the main body graft and the renal
arteries. An aortic cuff was deployed measuring 26 mm x 3.3 cm to
extend the main body seal to the level of the renal arteries. This
was post deployed, inflated with a Q50 balloon and this demonstrated
excellent seal on completion angiogram with no evidence of type 1A,
Type 1B, type 2 or type 3 endoleak on completion angiogram. At this
time, satisfied with exclusion of all of the patient's aneurysms the
wires and sheaths were withdrawn and the arteriotomies were closed
701889320_03_15