Help with Coding Peripheral


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Can I get some help coding this procedure.
1. Abdominal aortography at the renals
2. Abdominal aortography with limited run-offs
3. Right lower extremity runoff via left groin access
4. Left lower extremity distal runoffs via left groin access.
4. Catheter positioning in the Right SFA via the left femoral approach (4th order).
5. PTA of right SFA
6. DCB of right SFA
7. Stenting of right distal SFA
8. post dilation of stent in distal SFA
9. Manual hemostasis of left groin

Patient brought to the catrh LAB 3 where she was prepped and draped in the usual fashion. Micropuncture technique was used to insert the 6French sheath in the left femoral artery.

A 5-French pigtail was placed at the level of the abdominal aorta to perform abdominal angiography at the renals using digital subtraction and 24 cc contrast. Then the same catheter is positioned at the distal abdominal aorta using 16 mL of contrast.

Then the pigtail was exchanged to a rim and a glidewire was positioned in the right femoral distribution. At this point we proceeded by performingright lower extremity distal runoffs using serial injections of 5 mL per view in a digital subtraction mode with serial injections.

After PTA and stent, we exchanged to a 6 French short shgeath in LFA, and performed left lower extremity runoff using a bolus chase automated method using 25 cc contrtast.

We sutured the sheath for manual closure at conclusion.

1. The abdominal aorta is patent with diffuse calcifications of the mesenterics and aorta without a focal critical lesion. There is diffuse caclfied mild to moderate aortic atheromata.

2. The disatl abdominal aorta is heavily cacified with diffuse atehromata of mild caliber in the bifrucation extenting into the iliacs. The external iliac was patent bilaterally, as was the common iliacs and the internal iliacs. The femoral arteries appeared to have mild luminal irregularities without any focal high-grade stenosis up to the level of the bifurcation. The profunda femoral was patent bilaterally.

3. The right lower extremity runoff. The iliacs are calcifed and diffusel;y disease with mild to moderate calcifed plaquing. The SFA had serial mild to moderate luminal irregularities. The distal SFA has a 90% diffuse calcfiedi plaque noted. The popliteral is patent with mild diffuse calcified plaque and intact trifurcation with at least 1-vessel distal runoff.

4. The left lower extremity showed iliacs are calcifed and diffusely diseased with mild to moderate calcifed plaquing. The SFA had serial mild to moderate luminal irregularities. There was a 70% prxoimal SFA lesion and then a 90% mid SFA calcified plaque noted. The popliteral is patent with mild diffuse calcified plaque and intact trifurcation with at least 1-vessel distal runoff. The AT is occluded with distal reconstitution.

We exchanged to glide cathter from the rim and then used a Wholey wire across the right SFA lesion and then placed a Pinnacle Destination 6 Fr sheath into the right CFA. We used heparin 2000 units, then 2000 more units and the ACT was 191. We then gave 2000 more untis after ACT was 191. We then used a 4.0x20mm Evercross ballloon at 8 ATM and noted poor yielding and increaeed to 12ATM and then serially to 20 ATM when it yielded. Post angio did not show any perforation.

We then used a 5.0x40mm DCB across the lesion and deployed for 160 seconds at 10 ATM. We then used a 6x40mm Everflex self-expanding stent across the lesion and deployed across the leison. We then used a 5x40mm balloon to post dilate at 12 ATM distal x2 and then 12 ATM in teh mid x2 and then 10 and 12 ATM proximally.

We had excellent angiographic results. We used added Plavix to ASA after the procedure.

1. High grade SFA lesion on the right with significant tibial occlusive disease and non-healing ulcer in the right foot
2. Residual disease in left SFA and bilateral tibials
3. s/p PTA and DCB and stenting with self expanding stent of right SFA

1. We will admit for overnight observation given frailty and comorbidities
2. We will continue aggressive medical treatment. Emphasize smoking cessation and to continue medical treatment.
3. DAPT with ASA and Plavix
4. Will plan left SFA intervention in near future.
Pta/stent - pls help!

1. Insertion of sheath in the left femoral artery.
2. Advancement of the catheter across the bifurcation into the right common iliac artery and angiogram with runoff.
3. PTA and stent of 100% occluded distal right external iliac artery and proximal common femoral artery. This was done using a Viabahn stent 7 mm x 10 cm.
4. PTA and stent of the proximal right external iliac artery using a 7 x 57 EV3 balloon expandable stent.
5. Increased technical difficulty because of 100% occlusion, which was difficult to cross.

INDICATIONS: This is a young patient, who after cath and Angio-Seal developed claudication and was found to have total occlusion of the distal external iliac artery with collaterals reconstituting the common femoral artery via the internal iliac artery.

DETAILS OF PROCEDURE: Informed consent was obtained. The patient was brought to the cath lab. Left groin was prepped and draped in the usual fashion. Xylocaine 2% was infiltrated to obtain local anesthesia. Cannulization of the left femoral artery was obtained using modified Seldinger's technique on first attempt and size 6 sheath was introduced. A 6-French internal mammary artery catheter was then advanced across the bifurcation and angiogram was done. The patient was documented to have 100% occlusion of the distal external iliac artery and the entire external iliac artery had very diffuse narrowing.

The internal iliac artery was giving collaterals and reconstituted the common femoral artery.

Interventional procedure was started. The patient was given 5000 units of heparin intra-arterially and a 6-French crossover sheath was used. Then, a 5-French glide catheter was used and the occlusion was attempted to cross first with a 0.018 V18 wire. It did not cross. We then used a 5-French glide catheter and tried the Storq wire, which did not cross the occlusion. Then, used a Miracle Bros 6 guidewire and that was able to cross the occlusion. The glide catheter was then advanced over the wire and angiography done to make sure that I was in the true lumen. The PTA procedure was started. The occluded segment was dilated with a 5 x 6 balloon. Angiography was done and showed improvement. After careful review of the film, it was decided to stent the proximal CFA and external iliac artery with a 7 mm x 10 cm Viabahn stent .The 6 F cross over sheath was exchanged with 7 F sheath Wire was exchanged with 0.18 wire. Viahban stent was advanced and very carefully positioned and deployed. The proximal external iliac artery was stented using a 7 x 57 balloon expandable stent and both stents were overlapped. The stented segment was then dilated with the same balloon. Balloon was removed. Angiography revealed very good result with no residual stenosis. The patient had no complications. The 7-French crossover sheath was then exchanged with a 7-French short sheath, Procedure was completed. The patient was sent to recovery area in stable condition for sheath to be removed once ACT down. She had no complications
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