bostonmom
Networker
Hello, I am new to coding angiograms and would like some help with the following report:
Patient is a 20 y.o. male who underwent maxillofacial surgery today. Postprocedure significant oral bleeding was noted. Oromaxillofacial surgery team reached out to us for embolization. Patient at this stage was critically ill and having active oral bleeding. Procedure was carried out on emergent basis.
Procedure: Patient was identified and brought to the neuro IR suite. Patient was placed supine on the angio table. Bilateral groins were shaved, prepped and the patient was draped in the usual sterile manner. Anesthesia team was in attendance through the course of the procedure. Using modified Seldinger technique a 6 French sheath was advanced in the right common femoral artery. Through this sheath we now advanced a 5 French Simmons 2 catheter over an 035 wire into the right common carotid artery. Selective catheterization angiography of the right common carotid, right external carotid, left common carotid, left external carotid and right common femoral arteries were performed. Filming was done in AP, lateral and oblique projections using digital format. Angiographic runs from the right common carotid artery showed presence of a pseudoaneurysm being filled by the terminal branches of the right internal maxillary artery. At this stage the right external carotid artery was selected. Through the diagnostic catheter itself we now advanced a rapid transit micro catheter over a synchro micro wire into the distal segment of the right internal maxillary artery. Micro catheter angiographic runs showed persistent filling of the pseudoaneurysm. At this stage Onyx 18 embolization of this pseudoaneurysm was carried out. Post embolization angiographic runs now showed that the pseudoaneurysm no longer fills. No active contrast extravasation noted anymore. We then selected the left external carotid artery and performed angiographic runs. The left external carotid artery and its branches opacified normally. Clinically patient's bleeding has resolved as well.
At the end of the procedure the catheter and sheath were removed. Groin was closed using the Mynx device. There was no undue bleeding. There were no immediate complications. The patient is en route to recovery unit. Patient is now hemodynamically stable.
**
Left Common Carotid Artery Angiogram: The left common carotid artery angiogram shows normal opacification of the common carotid artery up to the level of its bifurcation. Left common carotid artery at its bifurcation fills normally.The left internal carotid artery is filling well through its cervical the high central and ascending petrous, cavernous and supraclinoid courses. Intracranially the left anterior and middle cerebral artery and distal branches fill well. No active contrast extravasation noted. The left external carotid artery angiogram showed that the left carotid artery and its branches fill well with normal supply to head and face.
**
Right Common Carotid Artery Angiogram: The right common carotid artery angiogram shows normal opacification of the right common carotid artery up to the level of its bifurcation. The right common carotid artery its bifurcation fills normally. The right internal carotid artery fills normally through its cervical, horizontal and ascending petrous, cavernous and supraclinoid segments. Right middle cerebral artery and its distal branches fill normally. The right anterior cerebral artery and its distal branches fill normally.
Right External Carotid Artery Angiogram: The right external carotid artery angiogram showed opacification of his pseudoaneurysm with some contrast extravasation with supply from terminal branches of the right internal maxillary artery. Post onyx embolization the pseudoaneurysm no longer fills. No active contrast extravasation noted at that stage.
Right Common Femoral Artery Angiogram: The right common femoral artery angiogram shows normal opacification of the right common femoral artery and its branches with normal runoff to the distal extremity.
Impression: Nicholas A Duncan underwent diagnostic cerebral angiography and Onyx 18 embolization of a ruptured pseudoaneurysm emanating from terminal right internal maxillary artery. At the end of this procedure successful embolization was accomplished. There have been no immediate complications. *
Patient is now hemodynamically stable.
Can someone help me with this, please?
Patient is a 20 y.o. male who underwent maxillofacial surgery today. Postprocedure significant oral bleeding was noted. Oromaxillofacial surgery team reached out to us for embolization. Patient at this stage was critically ill and having active oral bleeding. Procedure was carried out on emergent basis.
Procedure: Patient was identified and brought to the neuro IR suite. Patient was placed supine on the angio table. Bilateral groins were shaved, prepped and the patient was draped in the usual sterile manner. Anesthesia team was in attendance through the course of the procedure. Using modified Seldinger technique a 6 French sheath was advanced in the right common femoral artery. Through this sheath we now advanced a 5 French Simmons 2 catheter over an 035 wire into the right common carotid artery. Selective catheterization angiography of the right common carotid, right external carotid, left common carotid, left external carotid and right common femoral arteries were performed. Filming was done in AP, lateral and oblique projections using digital format. Angiographic runs from the right common carotid artery showed presence of a pseudoaneurysm being filled by the terminal branches of the right internal maxillary artery. At this stage the right external carotid artery was selected. Through the diagnostic catheter itself we now advanced a rapid transit micro catheter over a synchro micro wire into the distal segment of the right internal maxillary artery. Micro catheter angiographic runs showed persistent filling of the pseudoaneurysm. At this stage Onyx 18 embolization of this pseudoaneurysm was carried out. Post embolization angiographic runs now showed that the pseudoaneurysm no longer fills. No active contrast extravasation noted anymore. We then selected the left external carotid artery and performed angiographic runs. The left external carotid artery and its branches opacified normally. Clinically patient's bleeding has resolved as well.
At the end of the procedure the catheter and sheath were removed. Groin was closed using the Mynx device. There was no undue bleeding. There were no immediate complications. The patient is en route to recovery unit. Patient is now hemodynamically stable.
**
Left Common Carotid Artery Angiogram: The left common carotid artery angiogram shows normal opacification of the common carotid artery up to the level of its bifurcation. Left common carotid artery at its bifurcation fills normally.The left internal carotid artery is filling well through its cervical the high central and ascending petrous, cavernous and supraclinoid courses. Intracranially the left anterior and middle cerebral artery and distal branches fill well. No active contrast extravasation noted. The left external carotid artery angiogram showed that the left carotid artery and its branches fill well with normal supply to head and face.
**
Right Common Carotid Artery Angiogram: The right common carotid artery angiogram shows normal opacification of the right common carotid artery up to the level of its bifurcation. The right common carotid artery its bifurcation fills normally. The right internal carotid artery fills normally through its cervical, horizontal and ascending petrous, cavernous and supraclinoid segments. Right middle cerebral artery and its distal branches fill normally. The right anterior cerebral artery and its distal branches fill normally.
Right External Carotid Artery Angiogram: The right external carotid artery angiogram showed opacification of his pseudoaneurysm with some contrast extravasation with supply from terminal branches of the right internal maxillary artery. Post onyx embolization the pseudoaneurysm no longer fills. No active contrast extravasation noted at that stage.
Right Common Femoral Artery Angiogram: The right common femoral artery angiogram shows normal opacification of the right common femoral artery and its branches with normal runoff to the distal extremity.
Impression: Nicholas A Duncan underwent diagnostic cerebral angiography and Onyx 18 embolization of a ruptured pseudoaneurysm emanating from terminal right internal maxillary artery. At the end of this procedure successful embolization was accomplished. There have been no immediate complications. *
Patient is now hemodynamically stable.
Can someone help me with this, please?