need help with celiac stenting

bhargavi

Networker
Messages
96
Best answers
0
This patient has a recent history of abdominal pain, postprandial, and noninvasive studies have found SMA occlusion and celiac artery stenosis.
*
He had attempted opening of the celiac artery from the left brachial approach recently which was unsuccessful due to severity of the stenosis and heavy calcification at the celiac ostium.
*
He now returns for planned left common femoral access retrograde engagement of the celiac artery and attempt at angioplasty and stenting
*
After obtaining informed consent for the patient a 6 French sheath was placed into the left common femoral vein under fluoroscopic guidance. A renal double curve 65 cm 6 French guiding catheter was then positioned into the aorta and aortography was performed. This catheter was then selectively placed into the ostium of the celiac and celiac artery selective angiography was performed. A 0.014 wire was then advanced into the distal branch, angioplasty was performed with a 4 mm balloon followed by placement of a single balloon expandable Boston Scientific stent, 6 mm x 18 mm, the stent was then postdilated to 18 atm with a 7 mm balloon for a final lumen between 7.5 and 8 mm. Gradient resolved and angiographic result was excellent.
*
Iliofemoral angiography revealed the sheath in the common femoral artery and closure was obtained with manual compression, no closure device was utilized. Patient was given 4000 units of heparin at the initiation of the intervention, activated clotting time at the end of the case was 176 seconds.
*
*
Diagnostic angiography:
*
Abdominal aortography revealed known patent renal arteries, ostial stenosis of the celiac, occlusion of the SMA.
*
Selective angiography of the celiac revealed ostial stenosis with a 60 mm gradient across the stenosis, beyond the proximal segment and ostium of the vessel was patent. Lateral stent fill the SMA with backfilling to the most proximal 1-2 cm from the origin at the aorta
*
*
*
Intervention:
*
As detailed above balloon expandable stent treatment was performed of the celiac stenosis, after balloon angioplasty, provisional stenting was performed due to recoil and dissection with excellent hemodynamic and angiographic result
*
*
*
Summary conclusion:
*
Celiac artery stenosis and known SMA occlusion with symptomatic mesenteric ischemia
*
Successful angioplasty of celiac artery stenosis with provisional stent placement excellent angiographic result.
*
*
Recommendation:
*
Patient will continue on antiplatelet therapy and close surveillance and follow-up. He is on long-term anticoagulation which is to be restarted in 48 hours.
Radiation Tracking

Grays (mGy) Fluoro Time (min)
4031 15.2
Contrast

Results

Implants

STENT BILIARY 6MM 18MM EXPRESS SD MONORAIL STAINLESS STEEL PREMOUNT BALLOON EXPAND DELIVERY SYSTEM 2 RADIOPAQUE MARKER 150CM ACCEPTS 5FR SHEATH 6FR GUIDE PTRA STERILE DISPOSABLE - S08714729484844 - LOG304466

Inventory item: STENT BILIARY 6MM 18MM EXPRESS SD MONORAIL STAINLESS STEEL PREMOUNT BALLOON EXPAND DELIVERY SYSTEM 2 RADIOPAQUE MARKER 150CM ACCEPTS 5FR SHEATH 6FR GUIDE PTRA STERILE DISPOSABLE Serial no.: 08714729484844 Model/Cat no.: 37912-61815
Implant name: STENT BILIARY 6MM 18MM EXPRESS SD MONORAIL STAINLESS STEEL PREMOUNT BALLOON EXPAND DELIVERY SYSTEM 2 RADIOPAQUE MARKER 150CM ACCEPTS 5FR SHEATH 6FR GUIDE PTRA STERILE DISPOSABLE - S08714729484844 - LOG304466 Laterality: Right Area: Arterial
Manufacturer: Boston Scientific Corp Action: Implanted Number used: 1
Description: celiac
thank you in advance
I am thinking 37236,75726
*
 

Jim Pawloski

True Blue
Messages
1,251
Location
Ann Arbor
Best answers
0
This patient has a recent history of abdominal pain, postprandial, and noninvasive studies have found SMA occlusion and celiac artery stenosis.
*
He had attempted opening of the celiac artery from the left brachial approach recently which was unsuccessful due to severity of the stenosis and heavy calcification at the celiac ostium.
*
He now returns for planned left common femoral access retrograde engagement of the celiac artery and attempt at angioplasty and stenting
*
After obtaining informed consent for the patient a 6 French sheath was placed into the left common femoral vein under fluoroscopic guidance. A renal double curve 65 cm 6 French guiding catheter was then positioned into the aorta and aortography was performed. This catheter was then selectively placed into the ostium of the celiac and celiac artery selective angiography was performed. A 0.014 wire was then advanced into the distal branch, angioplasty was performed with a 4 mm balloon followed by placement of a single balloon expandable Boston Scientific stent, 6 mm x 18 mm, the stent was then postdilated to 18 atm with a 7 mm balloon for a final lumen between 7.5 and 8 mm. Gradient resolved and angiographic result was excellent.
*
Iliofemoral angiography revealed the sheath in the common femoral artery and closure was obtained with manual compression, no closure device was utilized. Patient was given 4000 units of heparin at the initiation of the intervention, activated clotting time at the end of the case was 176 seconds.
*
*
Diagnostic angiography:
*
Abdominal aortography revealed known patent renal arteries, ostial stenosis of the celiac, occlusion of the SMA.
*
Selective angiography of the celiac revealed ostial stenosis with a 60 mm gradient across the stenosis, beyond the proximal segment and ostium of the vessel was patent. Lateral stent fill the SMA with backfilling to the most proximal 1-2 cm from the origin at the aorta
*
*
*
Intervention:
*
As detailed above balloon expandable stent treatment was performed of the celiac stenosis, after balloon angioplasty, provisional stenting was performed due to recoil and dissection with excellent hemodynamic and angiographic result
*
*
*
Summary conclusion:
*
Celiac artery stenosis and known SMA occlusion with symptomatic mesenteric ischemia
*
Successful angioplasty of celiac artery stenosis with provisional stent placement excellent angiographic result.
*
*
Recommendation:
*
Patient will continue on antiplatelet therapy and close surveillance and follow-up. He is on long-term anticoagulation which is to be restarted in 48 hours.
Radiation Tracking

Grays (mGy) Fluoro Time (min)
4031 15.2
Contrast

Results

Implants

STENT BILIARY 6MM 18MM EXPRESS SD MONORAIL STAINLESS STEEL PREMOUNT BALLOON EXPAND DELIVERY SYSTEM 2 RADIOPAQUE MARKER 150CM ACCEPTS 5FR SHEATH 6FR GUIDE PTRA STERILE DISPOSABLE - S08714729484844 - LOG304466

Inventory item: STENT BILIARY 6MM 18MM EXPRESS SD MONORAIL STAINLESS STEEL PREMOUNT BALLOON EXPAND DELIVERY SYSTEM 2 RADIOPAQUE MARKER 150CM ACCEPTS 5FR SHEATH 6FR GUIDE PTRA STERILE DISPOSABLE Serial no.: 08714729484844 Model/Cat no.: 37912-61815
Implant name: STENT BILIARY 6MM 18MM EXPRESS SD MONORAIL STAINLESS STEEL PREMOUNT BALLOON EXPAND DELIVERY SYSTEM 2 RADIOPAQUE MARKER 150CM ACCEPTS 5FR SHEATH 6FR GUIDE PTRA STERILE DISPOSABLE - S08714729484844 - LOG304466 Laterality: Right Area: Arterial
Manufacturer: Boston Scientific Corp Action: Implanted Number used: 1
Description: celiac
thank you in advance
I am thinking 37236,75726
*
You already have a previous diagnostic exam, so you can't bill 75726. All you have is 37246.
HTH,
Jim Pawloski, CIRCC
 
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