I need some help with the brachial artery exposure part of the below OP note. Could 34834-52 be used since there was no deployment of prothesis, or would an unlisted code need to be used. Thanks in advance for the help on this.
Preop Dx: Suspected mesenteric ischemia
Postop Dx: Moderate mesenteric artery disease
Other DX: End-stage renal disease, Peripheral arterial disease, Diabetes Mellitus
Procedures: 1) Aortogram with interpretation 2) Open left brachial artery exposure and repair
Catherizations: Aorta from left brachial approach
Indications: This patient with chronic recurrent abdominal pain. He does have dialysis-dependant renal failure and diabetes. His workup revealed mesenteric artery disease in both the celiac and the SMA. We scheduled this procedure to determine if he would benefit from mesenteric artery revascularization.
Findings: The aorta is unremarkable. The celiac is widely patent. The SMA has about a 50% stenosis, but brisk flow and no evidence of distal disease. The IMA is not visualized.
OPERATIVE PROCEDURE:
The patient gave informed consent and was taken to the endovascular lab. I decided to go with a brachial cut-down because he does have a fistula in the left arm, and I did not want to find that I could not get access from the groin and neeeded to get unplanned left arm access. We went ahead and gave him general endotracheal anesthesia. We prepped and draped his left upper extremity and give him IV antibiotics. I made a small longitudinal incision over the brachial artery away from his fistula. The artery was controlled with Vesseloops. He was given heparin. I cannulated the artery with a 7-French sheath and advanced a stork wire under fluoroscopy into the aorta. I used a Omni Flush catheter to selectively catheterize down the descending thoracic aorta. The Omni Flush was advanced to the T12 level. I then did a series of aortograms at various obliquities. We had a hard time getting a true lateral until I actually had to disassemble the arm board and bring his arm to the side of the table. With this, I was able to get a good lateral angiogram and prove that the vessels were not terrible diseased. I decided not to intervene. THe catheter was straightened over a wire and removed. The shealth was removed and the artery repaired with 6-0 Prolene sutures. There is an excellent distal pulse. I irrigated out the wound and checked again for hemostasis then closed with mutliple layers of 3-0 Vicryl followed by a running 4-0 Monocryl subcuticular stitch and steri-strips. A steril dressing was placed. He was extubated and taken to recovery in stable condition. Estimated blood loss was 20 mL. Contrast was 35 mL of Visipaque and fluoro time was 3.1 minutes.
Preop Dx: Suspected mesenteric ischemia
Postop Dx: Moderate mesenteric artery disease
Other DX: End-stage renal disease, Peripheral arterial disease, Diabetes Mellitus
Procedures: 1) Aortogram with interpretation 2) Open left brachial artery exposure and repair
Catherizations: Aorta from left brachial approach
Indications: This patient with chronic recurrent abdominal pain. He does have dialysis-dependant renal failure and diabetes. His workup revealed mesenteric artery disease in both the celiac and the SMA. We scheduled this procedure to determine if he would benefit from mesenteric artery revascularization.
Findings: The aorta is unremarkable. The celiac is widely patent. The SMA has about a 50% stenosis, but brisk flow and no evidence of distal disease. The IMA is not visualized.
OPERATIVE PROCEDURE:
The patient gave informed consent and was taken to the endovascular lab. I decided to go with a brachial cut-down because he does have a fistula in the left arm, and I did not want to find that I could not get access from the groin and neeeded to get unplanned left arm access. We went ahead and gave him general endotracheal anesthesia. We prepped and draped his left upper extremity and give him IV antibiotics. I made a small longitudinal incision over the brachial artery away from his fistula. The artery was controlled with Vesseloops. He was given heparin. I cannulated the artery with a 7-French sheath and advanced a stork wire under fluoroscopy into the aorta. I used a Omni Flush catheter to selectively catheterize down the descending thoracic aorta. The Omni Flush was advanced to the T12 level. I then did a series of aortograms at various obliquities. We had a hard time getting a true lateral until I actually had to disassemble the arm board and bring his arm to the side of the table. With this, I was able to get a good lateral angiogram and prove that the vessels were not terrible diseased. I decided not to intervene. THe catheter was straightened over a wire and removed. The shealth was removed and the artery repaired with 6-0 Prolene sutures. There is an excellent distal pulse. I irrigated out the wound and checked again for hemostasis then closed with mutliple layers of 3-0 Vicryl followed by a running 4-0 Monocryl subcuticular stitch and steri-strips. A steril dressing was placed. He was extubated and taken to recovery in stable condition. Estimated blood loss was 20 mL. Contrast was 35 mL of Visipaque and fluoro time was 3.1 minutes.