bhargavi
Guru
PROCEDURES
1. Abdominal aortogram
2. Celiac/SMA selective angiography.
3. Percutaneous intervention of SMA and POBA of celiac artery.
4. 6 French Mynx vascular closure for right femoral artery access
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Right groin was draped and prepped in the sterile fashion. Patient was premedicated with fentanyl and Versed. After injecting 2% lidocaine in the right groin, right common femoral artery was accessed using micropuncture needle and a 5 French sheath was inserted without any difficulty. 5 French IM catheter was advanced and abdominal aortogram was performed. Selective angiography of celiac trunk and SMA was performed. Patient was proceeded with percutaneous intervention of superior mesenteric artery and plain on balloon angioplasty of celiac trunk.
I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient. Start time 12:30 PM and end time was 2:20 PM. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.
ABDOMINAL AORTOGRAM
Abdominal aorta was patent with diffuse calcification and severe tortuosity.
Superior mesenteric artery angiogram
There was approximately 70% stenosis in the proximal segment with 40 to 50 mm of pressure gradient upon selective cannulation.
Celiac artery angiogram
There is approximately 80% ostial stenosis with patent mid to distal segment. Splenic and hepatic artery are patent.
PERCUTANEOUS INTERVENTION OF
6 French 25 cm bright tip sheath was advanced over a 0.035 J-wire and the proximal end of the sheath was placed in the distal abdominal aorta. 60 units/kg heparin was used for anticoagulation. Attempted selective cannulation of SMA and celiac trunk using 6 French IM catheter which was unsuccessful. Sos Omni select 3 catheter was advanced through the 6 French IM catheter and select trunk was selectively cannulated. Terumo run-through 300 cm wire was advanced into distal splenic artery. Balloon angioplasty of ostial celiac trunk was performed using 4.0 x 15 mm balloon. Subsequent angiogram revealed significant improvement in flow. Attempted deploying a 5.0 x 19 mm express SD stent which was unsuccessful. Attempted deploying resolute Onyx 5.0 x 18 mm stent which was also unsuccessful due to severe tortuosity. At this point we lost access to the celiac trunk as our guide and wires came out of the vessel. At this point we decided to abort the intervention of celiac trunk and fix the superior mesenteric artery. Omni SOS catheter was used for selective cannulation of SMA and Runthrough wire was advanced into distal vessel. Resolute Onyx 5.0 x 18 mm stent was deployed in proximal SMA and postdilated using stent balloon under high atmospheric pressure. Subsequent angiogram revealed significant improvement in the lesion of the superior mesenteric artery artery without perforation or significant dissection and a brisk antegrade flow.
IMPRESSION
1. Celiac trunk stenosis
2. SMA stenosis
Implants
SYSTEM CORONARY STENT EXTRA LARGE VESSEL 5MM 18MM RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT 140CM ACCEPTS .014IN GUIDEWIRE 5FR GUIDE CATHETER - SRONYX50018UX - LOG654968
thanks in advance
i am coming up with: 36245, 37246, 37236-xu . should i also use 75726?
1. Abdominal aortogram
2. Celiac/SMA selective angiography.
3. Percutaneous intervention of SMA and POBA of celiac artery.
4. 6 French Mynx vascular closure for right femoral artery access
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Right groin was draped and prepped in the sterile fashion. Patient was premedicated with fentanyl and Versed. After injecting 2% lidocaine in the right groin, right common femoral artery was accessed using micropuncture needle and a 5 French sheath was inserted without any difficulty. 5 French IM catheter was advanced and abdominal aortogram was performed. Selective angiography of celiac trunk and SMA was performed. Patient was proceeded with percutaneous intervention of superior mesenteric artery and plain on balloon angioplasty of celiac trunk.
I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient. Start time 12:30 PM and end time was 2:20 PM. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.
ABDOMINAL AORTOGRAM
Abdominal aorta was patent with diffuse calcification and severe tortuosity.
Superior mesenteric artery angiogram
There was approximately 70% stenosis in the proximal segment with 40 to 50 mm of pressure gradient upon selective cannulation.
Celiac artery angiogram
There is approximately 80% ostial stenosis with patent mid to distal segment. Splenic and hepatic artery are patent.
PERCUTANEOUS INTERVENTION OF
6 French 25 cm bright tip sheath was advanced over a 0.035 J-wire and the proximal end of the sheath was placed in the distal abdominal aorta. 60 units/kg heparin was used for anticoagulation. Attempted selective cannulation of SMA and celiac trunk using 6 French IM catheter which was unsuccessful. Sos Omni select 3 catheter was advanced through the 6 French IM catheter and select trunk was selectively cannulated. Terumo run-through 300 cm wire was advanced into distal splenic artery. Balloon angioplasty of ostial celiac trunk was performed using 4.0 x 15 mm balloon. Subsequent angiogram revealed significant improvement in flow. Attempted deploying a 5.0 x 19 mm express SD stent which was unsuccessful. Attempted deploying resolute Onyx 5.0 x 18 mm stent which was also unsuccessful due to severe tortuosity. At this point we lost access to the celiac trunk as our guide and wires came out of the vessel. At this point we decided to abort the intervention of celiac trunk and fix the superior mesenteric artery. Omni SOS catheter was used for selective cannulation of SMA and Runthrough wire was advanced into distal vessel. Resolute Onyx 5.0 x 18 mm stent was deployed in proximal SMA and postdilated using stent balloon under high atmospheric pressure. Subsequent angiogram revealed significant improvement in the lesion of the superior mesenteric artery artery without perforation or significant dissection and a brisk antegrade flow.
IMPRESSION
1. Celiac trunk stenosis
2. SMA stenosis
Implants
SYSTEM CORONARY STENT EXTRA LARGE VESSEL 5MM 18MM RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT 140CM ACCEPTS .014IN GUIDEWIRE 5FR GUIDE CATHETER - SRONYX50018UX - LOG654968
thanks in advance
i am coming up with: 36245, 37246, 37236-xu . should i also use 75726?