bhargavi
Guru
Conclusion
thanks in advance
should I do 36252, 37246-rt, 37236-lft, 75726? or I think 75726 is bundled in 37236?
This patient with recent accelerating severe hypertension on multiple antihypertensive medications with difficult to control blood pressure underwent noninvasive imaging which revealed a severe stenosis in the left renal artery, she subsequently underwent CT angiography which confirmed severe stenosis at the ostial segment of the single main left renal artery, patent right renal artery, renal digital subtraction angiography and possible intervention is requested for renal preservation and blood pressure control After obtaining informed consent for the patient a 6 French sheath was placed into the right common femoral artery. Diagnostic right and left selective renal arteriography was then performed, and after documentation of the severe stenosis in the proximal ostial segment of the left renal artery with gradient of greater than 50 mmHg, the initial diagnostic 6 French catheter was exchanged out for a 6 French guiding catheter, this was a LIMA guiding catheter which was then positioned in the ostium of the left renal artery and a 0.014 wire was advanced into the distal renal artery and angioplasty was performed with a 3 mm balloon followed by placement of a single Boston Scientific balloon expandable stent, Express SD, 5 mm x 19 mm length, deployed to high pressure, the entire stented segment was then postdilated with a 6 mm balloon to high pressure with final angiographic result excellent and resolution of gradient. After withdrawal of the wire and the balloon and final angiography, the sheath was utilized for a selective angiogram and was placed in the distal right common femoral artery, closure was then obtained with a Mynx closure device without complication. The patient did receive 3000 units of heparin at the initiation of the intervention and there were no complications. Hemodynamics: Central aortic pressure 140/80. There was a greater than 50 mm gradient across the ostial stenosis in the left renal artery with 6 French diagnostic catheter placed across. Digital subtraction angiography: There was a single right renal artery which had minimal ostial tapering no significant gradient, less than 20% ostial narrowing minimal calcification otherwise patent vessel Left renal artery was noted to have ostial stenosis of 80%, with significant gradient, there was moderate calcification at this ostial segment. The mid and distal left renal artery was patent. Intervention: As detailed above, angioplasty was performed of the left renal artery, due to residual stenosis and recoil stenting was performed with placement of a single stent as detailed above excellent angiographic result resolution of gradient no significant residual stenosis Summary conclusion: Severe ostial left renal artery stenosis atherosclerotic renal vascular disease with renovascular hypertension Successful angioplasty and balloon expandable stent treatment of the left renal artery ostial proximal stenosis |
thanks in advance
should I do 36252, 37246-rt, 37236-lft, 75726? or I think 75726 is bundled in 37236?