LUE U/S & Angioplasty LUE AV Graft Venous Anastomosis

nlbarnes

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Escondido, CA
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I think I'm short &/or incorrect on my codes. Please! I really use some help because it's been awhile for vascular. I'm putting this under IR.

35476
37252
36005
75978/75820

PROCEDURES:
1. Left upper extremity intravascular ultrasound.
2. Cutting balloon angioplasty of the left upper extremity AV graft
venous anastomosis.

DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient was taken to the
operating room, placed in supine position on the operating table.
Anesthesia was local with sedation. The left upper extremity was
prepped and draped in the usual sterile fashion. Because of the
patient's severe allergy to contrast, no contrast was given and we
used intravascular ultrasound to navigate as our guide to perform
upper extremity venogram. The AV graft was accessed under ultrasound
guidance with a micropuncture needle. Micropuncture wire was advanced
into the AV graft and exchanged for a 0.035 guidewire. A short 6-
French dialysis access sheath was placed. At that point, using
fluoroscopy, an angled Glidewire and a Kumpe catheter navigated
through the distal venous anastomotic obstruction and placed the wire
into the left innominate vein. We then exchanged for a 0.018
guidewire and placed the intravascular ultrasound. The intravascular
ultrasound was taken to the central veins. There was no evidence of
any significant stenosis based on intravascular ultrasound from the
innominate vein back to the proximal axillary vein. We did notice a
high-grade stenosis at the distal anastomosis of the Acuseal graft to
the axillary vein. The location of the anastomotic stenosis was
marked on the screen. We then used a 7 mm x 4 cm AngioSculpt cutting
balloon for angioplasty of the stenotic portion. There was an obvious
waist on the balloon upon initial inflation. We did 2 inflations at
this site. We then placed a 7 x 2 standard angioplasty balloon to
iron out the site. Upon completion, we then replaced the IVUS
catheter and the anastomotic stenosis was essentially resolved. There
was excellent flow through the distal anastomosis into the central
veins.

With that completed, we then removed our catheter and wires and with
the sheath and held pressure until hemostasis was achieved. The
patient tolerated the procedure well. There were no complications.
The patient was sent to the recovery room in stable condition. He can
resume dialysis on his usual schedule.
 
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