Expanding aneurysm sac after prior EVAR, including an IBE device


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Good Afternoon,

I am looking for some assistance coding this procedure. Any help is greatly appreciated.:)

I am thinking maybe 34718, 34713 50, 34712, but have not used 34718 yet.

INDICATION: Expanding aneurysm sac after prior EVAR

Procedures performed:
1. Ultrasound-guided access to right and left common femoral artery
2. Perclose placement, bilateral femoral arteries
3. Iliac branch device 23 x 12 x 10 placement in the right iliac system
4. Aortic cuff placement, 32
5. And anchor placement x6
6. Aortogram, radiologic supervision and interpretation
7. Selective catheterization of branches of internal iliac artery and selective angiogram of internal iliac artery branches with radiologic supervision and interpretation
8. Perclose assisted closure of 16 French sheath on the right and 12 French sheath on the left

Anesthesia: General
Fluoroscopy time 54 minutes
Contrast: 105 cc

Procedure in detail:
Patient was brought to the operating room placed on the operating table spelled position. He was prepped and draped in the typical sterile fashion. Timeout was performed. Patient received preoperative antibiotics. Ultrasound-guided access of right and left common femoral artery was performed. Micropuncture needle and wire were placed in the vessel under direct guidance and visualize inside the vessel in ultrasound. Then Bentson wire was placed bilaterally. The vessel is predilated with 7 French dilator and 2 preclosed replacement groin. Patient was fully heparinized with 8000 units of heparin. We then inserted an 11 French sheath on both sides under direct ultrasound guidance. We exchanged the wire in the right groin to Lundquist wire over catheter. We then placed a 16 French sheath in the right groin. We upsized the left groin to a 12 French sheath. We then used a glide wire through the right groin and snared it to the left. This we obtained a through and through wire. We then advanced a 23 x 12 x 10 IDE device over 2 wires into the right groin and deployed the proximal cuff into the pre-existing iliac limb. We then advanced a 12 French sheath over a 2 and through wire into the iliac branch. We used the Glidewire and glide catheter to select branches of the internal iliac artery. We then exchanged a wire to an Amplatz with 1 cm floppy tip and placed to 11 x 59 mm VBX stents from the internal iliac artery into the gate of the bifurcated device. We then fully deployed the bifurcated device and used to Cota balloon to PTA the device. We then performed an iliac angiogram showing no endoleak and good opposition of the stents. 12 French sheath into and through wire were then removed, and the sheath was replaced into the left iliac system. We used that sheath the place a sauce catheter in the left renal artery. We then advanced a 32 mm our to cough through the right iliac system and after correcting the parallax deployed at right under the renal artery. Coronal balloon was used to angioplasty the cough. We then used a 28 aphthous device in place 6 and the anchor circumferentially around the aortic cuff. After that was completed in angiogram was performed showing good apposition of all the pieces of the stent graft and no evidence of type 1a or b endoleak. There was no filling of the residual aneurysm sac. After that all the sheaths and wires were removed and the arteriotomies were closed using Perclose devices. No bleeding was appreciated. The conclusion of the procedure patient had palpable pedal pulses. He tolerated the procedure well.

Conclusion, Successful deployment of the right iliac IBE, aortic cuff an endoanchor placement

Thank you

Jim Pawloski

True Blue
Ann Arbor
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I will agree with your codes, however you need to add 34710 for the delayed placement of proximal extension graft, and 34712 for the anchors.
Jim Pawloski, CIRCC