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Can someone help me with the coding on this?
Procedure Details:
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. patient was brought to the cath lab after IV hydration was begun and oral premedication was given. Patient was further sedated with fentanyl and versed. Patient was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 6 French sheath was placed in the femoral artery. Angiography of the distal aorta and the iliac vessels extending into the common femoral arteries was performed using a pigtail catheter. Selective angio at multiple levels from the right common femoral artery all the way to the vessels of the right foot was performed through an ejection into the right femoral arterial sheath using digital subtraction angiography. A 6-french sheath left internal mammary artery catheter was then placed at the proximal left common iliac artery and angiography of the left lower extremity from the common femoral artery all the way to the left foot was performed at multiple levels using digital subtraction angiography by injecting contrast through this catheter.
The findings of lower extremity angiography. We proceeded with PTA of the distal left superficial femoral artery and PTA and stenting of the left external iliac artery.
INITIAL FINDINGS
The distal aorta had mild disease. Both common iliac arteries and internal iliac arteries were patent with mild disease.
The right external iliac artery had 40-50% stenosis, which was not hemodynamically significant. As there was less than a 10mm gradient noted across the lesion as a glide catheter was passed across it from the common iliac artery all the way down to the level of the common femoral artery. The right common femoral artery was patent with patency of the right superficial femoral artery, which had no more than 50% stenosis and moderate disease at multiple levels. The right popliteal artery was patent. The right tibial peroneall trunk had severe disease with 80% stenosis, but gave rise to a patent peroneal and posterior tibial arteries. The anterior tibial artery was patent.
The left external iliac artery had 90% stenosis in its midportion. The left common femoral artery was patent. The left superficial femoral artery has mild disease throughout, but there was a discrete 90% stenosis in its distal portion. The left popliteal artery was patent. The left anterior tibial artery had sever disease involving the left posterior tibial and peroneal arteries had mild to moderate disease.
Left external iliac and left superficial femoral artery intervention:
Heparin bolus was given. A 0.035 glide advantage wire was advanced to the distal infrapopliteal vessels through the left interal mammary artery catheter and the left mammary artery was removed and the right short femoral arterial sheath was replaced with a 45 cm sheath, which was lodged in the proxima left external carotid artery. The advantage glide wire was then replaced with a 0.014 Sparta core wire. The distal left superficial femoartery was treated first with a 5.0x20mm balloon which was used to inflate the lesion with multiple inflations at up to 10atm. The same balloon was then used a basket, platelets the left external iliac artery. Repeat angio revealed evidence of at least 60% stenosis. The lesion was then treated with a 6.0x20mm balloon inflated at 10atm. Repeat angio revealed of over 50% residual stenosis, so the lesion was then treated with an 8.0x20mm self expanding stent. Final angio revealed evidence of no residual stenosis within the left external iliac artery and a residual stenosis within the distal left superficial femoral artery. There was excellent flow along the vessel. At the end of the procedure, the longs sheath was replaced with a short sheath and hemostasis to the right groin was to eb achieved using local once the act is less than 150. Patient tolerated the procedure well and left the cath lab in stable condition.
Procedure Details:
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. patient was brought to the cath lab after IV hydration was begun and oral premedication was given. Patient was further sedated with fentanyl and versed. Patient was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 6 French sheath was placed in the femoral artery. Angiography of the distal aorta and the iliac vessels extending into the common femoral arteries was performed using a pigtail catheter. Selective angio at multiple levels from the right common femoral artery all the way to the vessels of the right foot was performed through an ejection into the right femoral arterial sheath using digital subtraction angiography. A 6-french sheath left internal mammary artery catheter was then placed at the proximal left common iliac artery and angiography of the left lower extremity from the common femoral artery all the way to the left foot was performed at multiple levels using digital subtraction angiography by injecting contrast through this catheter.
The findings of lower extremity angiography. We proceeded with PTA of the distal left superficial femoral artery and PTA and stenting of the left external iliac artery.
INITIAL FINDINGS
The distal aorta had mild disease. Both common iliac arteries and internal iliac arteries were patent with mild disease.
The right external iliac artery had 40-50% stenosis, which was not hemodynamically significant. As there was less than a 10mm gradient noted across the lesion as a glide catheter was passed across it from the common iliac artery all the way down to the level of the common femoral artery. The right common femoral artery was patent with patency of the right superficial femoral artery, which had no more than 50% stenosis and moderate disease at multiple levels. The right popliteal artery was patent. The right tibial peroneall trunk had severe disease with 80% stenosis, but gave rise to a patent peroneal and posterior tibial arteries. The anterior tibial artery was patent.
The left external iliac artery had 90% stenosis in its midportion. The left common femoral artery was patent. The left superficial femoral artery has mild disease throughout, but there was a discrete 90% stenosis in its distal portion. The left popliteal artery was patent. The left anterior tibial artery had sever disease involving the left posterior tibial and peroneal arteries had mild to moderate disease.
Left external iliac and left superficial femoral artery intervention:
Heparin bolus was given. A 0.035 glide advantage wire was advanced to the distal infrapopliteal vessels through the left interal mammary artery catheter and the left mammary artery was removed and the right short femoral arterial sheath was replaced with a 45 cm sheath, which was lodged in the proxima left external carotid artery. The advantage glide wire was then replaced with a 0.014 Sparta core wire. The distal left superficial femoartery was treated first with a 5.0x20mm balloon which was used to inflate the lesion with multiple inflations at up to 10atm. The same balloon was then used a basket, platelets the left external iliac artery. Repeat angio revealed evidence of at least 60% stenosis. The lesion was then treated with a 6.0x20mm balloon inflated at 10atm. Repeat angio revealed of over 50% residual stenosis, so the lesion was then treated with an 8.0x20mm self expanding stent. Final angio revealed evidence of no residual stenosis within the left external iliac artery and a residual stenosis within the distal left superficial femoral artery. There was excellent flow along the vessel. At the end of the procedure, the longs sheath was replaced with a short sheath and hemostasis to the right groin was to eb achieved using local once the act is less than 150. Patient tolerated the procedure well and left the cath lab in stable condition.