bhargavi
Guru
INDICATIONS
Severe lifestyle limiting right calf claudication and known peripheral vascular
disease.
PROCEDURES
Diagnostic abdominal aortogram.
Bilateral lower extremity digital subtraction angiography with run off.
Interventional procedure with right superficial femoral artery angioplasty from
the left common femoral artery access, retrograde approach, crossover technique.
DESCRIPTION OF PROCEDURE
After obtaining informed consent from the patient, a five French sheath was
placed into the left common femoral artery under fluoroscopic guidance. A five
French Contra catheter was advanced into the abdominal aorta. Abdominal
aortography was performed. The catheter was then withdrawn to the aortic
bifurcation and aortoiliac angiogram was then performed. Over a hydrophilic
wire, the Contra catheter was advanced selectively into the right common
femoral artery. Selective right lower extremity angiography with run off was
then performed. After identification of the subtotal occlusion of the right
superficial femoral artery in the previously distended segment, the original
five French sheath and Contra catheter was then exchanged over a support wire
for a six French by 45 centimeter destination sheath. The sheath was then
positioned into the right common femoral artery. The Magic Torque wire was
able to be advanced into the distal popliteal, after which a four French Glide
catheter was utilized in an exchange fashion to exchange the 0.035 Magic Torque
wire for a 0.014 Journey wire. This wire was advanced into the distal popliteal
and the Glide catheter was removed. Angioplasty was then performed with a 100
millimeters length 3.0 millimeters balloon. After initial balloon angioplasty,
the major waisting on this balloon was at the proximal lesion, proximal stented
segment and just above. The three millimeters balloon was then exchanged out
for a five millimeters balloon angioplasty was performed throughout the stented
segment, after which balloon angioplasty was performed, as well at the proximal
lesion, just at the origin of the stent. Finally, a five millimeters cutting
balloon was utilized to perform cutting balloon angioplasty of the superficial
femoral artery at the distal edge of the stent and just below. After
withdrawal of all of the balloon and wire, the angiographic result was
excellent with brisk three vessel run off, no significant residual stenosis
visible in the stented segment, no inflow or outflow limitations and no visible
thrombus or dissection. The sheath was then withdrawn to the left iliac system
and left lower extremity digital subtraction angiogram with run off was
performed. The sheath was then removed and hemostasis was obtained with manual
compression. No closure device was utilized. The patient had been given 3000
units of heparin at the initiation of the intervention. There were no
complications.
HEMODYNAMICS
The intraaortic pressure was 147/70.
ANGIOGRAPHY
Abdominal aortography revealed single patent bilateral renal arteries. The
abdominal aorta was patent. The aortic bifurcation was patent as was the
common internal and external iliac vessels bilaterally. Both common femoral
vessels were patent. On the right, the superficial femoral artery was widely
patent in its proximal segment, however, the stent in the mid segment
previously placed in November 2013, revealed a subtotal occlusion. There
appeared to be a subtotal discrete, occluded segment just at the proximal edge
of the stent, possibly a denovo lesion. Immediately thereafter, there appeared
to be patency of the proximal lumen of the stent. However, this rapidly
tapered and in the mid and distal segment of the stent was minimally visible.
Collaterals, however, did backfill and reconstitute the distal superficial
femoral artery with a patent popliteal and three vessel runoff. The deep,
femoral collateral vessel was large, well developed, and appeared to be patent
without significant disease. On the left, the common and deep femoral vessels
were widely patent. The left superficial femoral artery has a known chronic
occlusion involving its origin at the common femoral bifurcation, however, the
well developed large, deep femoral collateral vessel reconstitutes the distal
superficial femoral artery at the adductor canal with a patent popliteal and
three vessel run off on the left.
Intervention as described above, successful crossing and simple angioplasty to
involve cutting balloon angioplasty performed of the subtotal occlusion of the
right mid superficial femoral artery stented segment.
SUMMARY AND CONCLUSIONS
1. Lifestyle limiting recurrent right calf claudication.
2. Repeat intervention of the stented mid right superficial femoral artery
segment with possible treatment of a denovo lesion at the most proximal aspect
of the stented segment, minimal evidence in fact, for a significant in stent
restenosis with brisk outflow and now patent popliteal and three vessel run off
on the right.
3. Known unchanged chronic occlusion of the left superficial femoral artery
with very large, well developed, deep femoral collaterals, patent popliteal and
three vessel run off.
4. Patent aortoiliac inflow vessels bilaterally.
RECOMMENDATIONS
Aggressive risk factor modification and medical therapy.
attached is the report from physician performed pta fem/pop, abd arotagram and bilateral lower extremity in a cath lab in hospital. i would like to know if 36247 3rd is billable with 75625,75716,37224 as oops billing.
thanks in advance
Back to List
Severe lifestyle limiting right calf claudication and known peripheral vascular
disease.
PROCEDURES
Diagnostic abdominal aortogram.
Bilateral lower extremity digital subtraction angiography with run off.
Interventional procedure with right superficial femoral artery angioplasty from
the left common femoral artery access, retrograde approach, crossover technique.
DESCRIPTION OF PROCEDURE
After obtaining informed consent from the patient, a five French sheath was
placed into the left common femoral artery under fluoroscopic guidance. A five
French Contra catheter was advanced into the abdominal aorta. Abdominal
aortography was performed. The catheter was then withdrawn to the aortic
bifurcation and aortoiliac angiogram was then performed. Over a hydrophilic
wire, the Contra catheter was advanced selectively into the right common
femoral artery. Selective right lower extremity angiography with run off was
then performed. After identification of the subtotal occlusion of the right
superficial femoral artery in the previously distended segment, the original
five French sheath and Contra catheter was then exchanged over a support wire
for a six French by 45 centimeter destination sheath. The sheath was then
positioned into the right common femoral artery. The Magic Torque wire was
able to be advanced into the distal popliteal, after which a four French Glide
catheter was utilized in an exchange fashion to exchange the 0.035 Magic Torque
wire for a 0.014 Journey wire. This wire was advanced into the distal popliteal
and the Glide catheter was removed. Angioplasty was then performed with a 100
millimeters length 3.0 millimeters balloon. After initial balloon angioplasty,
the major waisting on this balloon was at the proximal lesion, proximal stented
segment and just above. The three millimeters balloon was then exchanged out
for a five millimeters balloon angioplasty was performed throughout the stented
segment, after which balloon angioplasty was performed, as well at the proximal
lesion, just at the origin of the stent. Finally, a five millimeters cutting
balloon was utilized to perform cutting balloon angioplasty of the superficial
femoral artery at the distal edge of the stent and just below. After
withdrawal of all of the balloon and wire, the angiographic result was
excellent with brisk three vessel run off, no significant residual stenosis
visible in the stented segment, no inflow or outflow limitations and no visible
thrombus or dissection. The sheath was then withdrawn to the left iliac system
and left lower extremity digital subtraction angiogram with run off was
performed. The sheath was then removed and hemostasis was obtained with manual
compression. No closure device was utilized. The patient had been given 3000
units of heparin at the initiation of the intervention. There were no
complications.
HEMODYNAMICS
The intraaortic pressure was 147/70.
ANGIOGRAPHY
Abdominal aortography revealed single patent bilateral renal arteries. The
abdominal aorta was patent. The aortic bifurcation was patent as was the
common internal and external iliac vessels bilaterally. Both common femoral
vessels were patent. On the right, the superficial femoral artery was widely
patent in its proximal segment, however, the stent in the mid segment
previously placed in November 2013, revealed a subtotal occlusion. There
appeared to be a subtotal discrete, occluded segment just at the proximal edge
of the stent, possibly a denovo lesion. Immediately thereafter, there appeared
to be patency of the proximal lumen of the stent. However, this rapidly
tapered and in the mid and distal segment of the stent was minimally visible.
Collaterals, however, did backfill and reconstitute the distal superficial
femoral artery with a patent popliteal and three vessel runoff. The deep,
femoral collateral vessel was large, well developed, and appeared to be patent
without significant disease. On the left, the common and deep femoral vessels
were widely patent. The left superficial femoral artery has a known chronic
occlusion involving its origin at the common femoral bifurcation, however, the
well developed large, deep femoral collateral vessel reconstitutes the distal
superficial femoral artery at the adductor canal with a patent popliteal and
three vessel run off on the left.
Intervention as described above, successful crossing and simple angioplasty to
involve cutting balloon angioplasty performed of the subtotal occlusion of the
right mid superficial femoral artery stented segment.
SUMMARY AND CONCLUSIONS
1. Lifestyle limiting recurrent right calf claudication.
2. Repeat intervention of the stented mid right superficial femoral artery
segment with possible treatment of a denovo lesion at the most proximal aspect
of the stented segment, minimal evidence in fact, for a significant in stent
restenosis with brisk outflow and now patent popliteal and three vessel run off
on the right.
3. Known unchanged chronic occlusion of the left superficial femoral artery
with very large, well developed, deep femoral collaterals, patent popliteal and
three vessel run off.
4. Patent aortoiliac inflow vessels bilaterally.
RECOMMENDATIONS
Aggressive risk factor modification and medical therapy.
attached is the report from physician performed pta fem/pop, abd arotagram and bilateral lower extremity in a cath lab in hospital. i would like to know if 36247 3rd is billable with 75625,75716,37224 as oops billing.
thanks in advance
Back to List
