I am new at Cardiology coding and I need some help with the following procedure. This was done all on the same day on the same patient.
PROCEDURES:
1. Right femoral retrograde arteriotomy and placement of a 6-French 11 cm sheath. The tissue was very fibrotic, requiring pre-dilation with large dilators and use of an Amplatz Super Stiff wire to pass the 6-French sheath.
2. Very proximal subclavian angiogram with runoff to the proximal brachial artery.
3. Selective left brachial arteriogram with runoff primarily through the AV fistula.
4. Selective angiography of the forearm vessels with runoff to the hand.
5. Intra-arterial thrombolytic therapy in the distal brachial artery (TPA).
6. Sheath and catheter sutured in place.
FINDINGS:
1. Left subclavian and axillary arteries are normal.
2. Left brachial artery is normal.
3. Left ulnar artery is open to the palmar arch with significant calcification throughout its course, but no significant stenosis.
4. Left radial artery is very spasmogenic, but patent to the arch with good diameter and smooth borders.
5. There is no flow into the digits. Virtually no vessels at all were seen beyond the rudimentary palmar arch, even after nitroglycerin. The radial artery also did not opacify until after intra-arterial nitroglycerin.
6. The AV fistula has a couple areas of aneurysm, but remains patent with good flows and no apparent stenosis in the lower half of the cephalic vein.
PROCEDURES:
1. Selective right brachial angiogram through the existing multipurpose catheter through the 6-French right femoral sheath.
2. Selective left hand angiogram through the existing catheter.
3. Removal of the multipurpose sheath from the left brachial artery.
4. A 6-French femoral sheath sutured in place.
FINDINGS:
1. Ulnar and radial arteries remain patent with smooth borders.
2. The palmar arcade is visible and there are now some digital branches going toward the fingers.
3. Extremely brisk flow into the fistula limits the blood supply to the hand. We had to have absolute complete compression of the fistula in order to get some filling of the radial and ulnar arteries.
PROCEDURES:
1. Right femoral retrograde arteriotomy and placement of a 6-French 11 cm sheath. The tissue was very fibrotic, requiring pre-dilation with large dilators and use of an Amplatz Super Stiff wire to pass the 6-French sheath.
2. Very proximal subclavian angiogram with runoff to the proximal brachial artery.
3. Selective left brachial arteriogram with runoff primarily through the AV fistula.
4. Selective angiography of the forearm vessels with runoff to the hand.
5. Intra-arterial thrombolytic therapy in the distal brachial artery (TPA).
6. Sheath and catheter sutured in place.
FINDINGS:
1. Left subclavian and axillary arteries are normal.
2. Left brachial artery is normal.
3. Left ulnar artery is open to the palmar arch with significant calcification throughout its course, but no significant stenosis.
4. Left radial artery is very spasmogenic, but patent to the arch with good diameter and smooth borders.
5. There is no flow into the digits. Virtually no vessels at all were seen beyond the rudimentary palmar arch, even after nitroglycerin. The radial artery also did not opacify until after intra-arterial nitroglycerin.
6. The AV fistula has a couple areas of aneurysm, but remains patent with good flows and no apparent stenosis in the lower half of the cephalic vein.
PROCEDURES:
1. Selective right brachial angiogram through the existing multipurpose catheter through the 6-French right femoral sheath.
2. Selective left hand angiogram through the existing catheter.
3. Removal of the multipurpose sheath from the left brachial artery.
4. A 6-French femoral sheath sutured in place.
FINDINGS:
1. Ulnar and radial arteries remain patent with smooth borders.
2. The palmar arcade is visible and there are now some digital branches going toward the fingers.
3. Extremely brisk flow into the fistula limits the blood supply to the hand. We had to have absolute complete compression of the fistula in order to get some filling of the radial and ulnar arteries.