Left arm fistulogram, brachiocephalic venography, venous angioplasty of the fistula

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I could really use some assistance on this. Not my specialty. I have codes 35475 x 2, 36147 & 76499. The retrograde arteriography has me stumped the most. Thanks



PREOPERATIVE DIAGNOSIS: Left arm basilic vein transposition multiple pseudoaneurysms with venous outflow stenosis.

POSTOPERATIVE DIAGNOSIS: Left arm basilic vein transposition multiple pseudoaneurysms with venous outflow stenosis.


OPERATION: Insertion of a needle, left arm fistula fistulogram, brachiocephalic venography, venous angioplasty of the fistula and subclavian vein, retrograde arteriography.

PROCEDURE: Patient was brought awake to the operating room. He was induced under IV sedation without any complication. The left upper extremity was scrubbed and prepped and draped. The patient had a basilic vein transposition AV fistula with multiple pseudoaneurysms. The area overlying the graft was instilled with 1% Xylocaine. A micropuncture needle was inserted, followed by guidewire, followed by a #3 sheath. A fistulogram was then done in the usual manner. It showed the patient to have multiple pseudoaneurysms with mid vein stenosis and subclavian stenosis. This was crossed with a Glidewire for a #8 sheath and followed with a 8 x 4 balloon. The area was ballooned at 12 atmospheric pressures for 2 minutes and subclavian vein same. Completion angiography showed acceptable results. Retrograde arteriography showed a large pseudoaneurysm extending all the way to the arterial suture line. The sheath was removed, and the site was closed with 3-0 nylon mattress suture. Dressing applied. The patient tolerated the procedure well and left the operating room in good condition.

ESTIMATED BLOOD LOSS: Zero.

COMPLICATIONS: None.
 

Jim Pawloski

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I could really use some assistance on this. Not my specialty. I have codes 35475 x 2, 36147 & 76499. The retrograde arteriography has me stumped the most. Thanks



PREOPERATIVE DIAGNOSIS: Left arm basilic vein transposition multiple pseudoaneurysms with venous outflow stenosis.

POSTOPERATIVE DIAGNOSIS: Left arm basilic vein transposition multiple pseudoaneurysms with venous outflow stenosis.


OPERATION: Insertion of a needle, left arm fistula fistulogram, brachiocephalic venography, venous angioplasty of the fistula and subclavian vein, retrograde arteriography.

PROCEDURE: Patient was brought awake to the operating room. He was induced under IV sedation without any complication. The left upper extremity was scrubbed and prepped and draped. The patient had a basilic vein transposition AV fistula with multiple pseudoaneurysms. The area overlying the graft was instilled with 1% Xylocaine. A micropuncture needle was inserted, followed by guidewire, followed by a #3 sheath. A fistulogram was then done in the usual manner. It showed the patient to have multiple pseudoaneurysms with mid vein stenosis and subclavian stenosis. This was crossed with a Glidewire for a #8 sheath and followed with a 8 x 4 balloon. The area was ballooned at 12 atmospheric pressures for 2 minutes and subclavian vein same. Completion angiography showed acceptable results. Retrograde arteriography showed a large pseudoaneurysm extending all the way to the arterial suture line. The sheath was removed, and the site was closed with 3-0 nylon mattress suture. Dressing applied. The patient tolerated the procedure well and left the operating room in good condition.

ESTIMATED BLOOD LOSS: Zero.

COMPLICATIONS: None.

The retrograde imaging is part of the fistulogram and is not billed separately.
Jim Pawloski, CIRCC
 
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