bhargavi
Guru
PROCEDURES
1. Graft angiogram
2. Right iliofemoral angiogram
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Right groin was draped and prepped in a sterile fashion. Patient was premedicated with 0.5 mg Versed and 50 mcg fentanyl. After injecting 2% lidocaine, right common femoral artery was accessed using micropuncture with some difficulty. Right iliofemoral angiogram was performed which showed high-grade stenosis of right external iliac artery and diffuse calcific disease with aneurysmal dilatation of right common and internal iliac artery. Using zip wire, high-grade stenosis of right common iliac artery was successfully crossed with some difficulty. Magic torque wire was exchanged and 25 cm long sheath was advanced. 6 French FL 4 catheter was used to cannulate LIMA to LAD. Native coronaries were not calculated as patient is known to have occluded RCA and LAD as well as vein graft to RCA from before. Native circumflex artery appeared very calcific on fluoroscopy and did not engage selectively. Overall patient tolerated procedure well. Sheath was pulled and manual pressure was applied for 15 minutes with good hemostasis. Also FemoStop was placed for persistent hemostasis.
GRAFT ANGIOGRAM
LIMA to LAD was widely patent with good distal runoff into LAD. Stent was noted at the anastomosis of LIMA to LAD which was widely patent. No significant disease was noted in LAD beyond anastomosis. LAD was also feeling distal RCA with collaterals.
RIGHT ILIOFEMORAL ANGIOGRAM
Right common femoral artery was was heavily calcified with mild to moderate diffuse disease. Right external iliac artery was heavily calcified with 90% stenosis. Internal neck artery was calcified with moderate proximal disease followed by aneurysmal dilatation. Right common iliac artery was calcified with aneurysmal dilatation.
Left iliac artery was flush occluded at the origin.
IMPRESSION
1. Widely patent LIMA to LAD with patent stent at the anastomosis of LIMA to LAD.
2. Chronically occluded RCA with collaterals from distal LAD.
3. High-grade stenosis of right external iliac artery.
4. 100% occluded left iliac artery
RECOMMENDATIONS
Continue aggressive medical treatment.
LIMA is patent with patent stent.
Patient has extensive PAD. Not a good candidate for revascularization.
since no left heart cath and no coronaries done what should i code for graft angio and ileofemoral angio?
should i just code unlisted procedure?
thanks in advance
1. Graft angiogram
2. Right iliofemoral angiogram
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Right groin was draped and prepped in a sterile fashion. Patient was premedicated with 0.5 mg Versed and 50 mcg fentanyl. After injecting 2% lidocaine, right common femoral artery was accessed using micropuncture with some difficulty. Right iliofemoral angiogram was performed which showed high-grade stenosis of right external iliac artery and diffuse calcific disease with aneurysmal dilatation of right common and internal iliac artery. Using zip wire, high-grade stenosis of right common iliac artery was successfully crossed with some difficulty. Magic torque wire was exchanged and 25 cm long sheath was advanced. 6 French FL 4 catheter was used to cannulate LIMA to LAD. Native coronaries were not calculated as patient is known to have occluded RCA and LAD as well as vein graft to RCA from before. Native circumflex artery appeared very calcific on fluoroscopy and did not engage selectively. Overall patient tolerated procedure well. Sheath was pulled and manual pressure was applied for 15 minutes with good hemostasis. Also FemoStop was placed for persistent hemostasis.
GRAFT ANGIOGRAM
LIMA to LAD was widely patent with good distal runoff into LAD. Stent was noted at the anastomosis of LIMA to LAD which was widely patent. No significant disease was noted in LAD beyond anastomosis. LAD was also feeling distal RCA with collaterals.
RIGHT ILIOFEMORAL ANGIOGRAM
Right common femoral artery was was heavily calcified with mild to moderate diffuse disease. Right external iliac artery was heavily calcified with 90% stenosis. Internal neck artery was calcified with moderate proximal disease followed by aneurysmal dilatation. Right common iliac artery was calcified with aneurysmal dilatation.
Left iliac artery was flush occluded at the origin.
IMPRESSION
1. Widely patent LIMA to LAD with patent stent at the anastomosis of LIMA to LAD.
2. Chronically occluded RCA with collaterals from distal LAD.
3. High-grade stenosis of right external iliac artery.
4. 100% occluded left iliac artery
RECOMMENDATIONS
Continue aggressive medical treatment.
LIMA is patent with patent stent.
Patient has extensive PAD. Not a good candidate for revascularization.
since no left heart cath and no coronaries done what should i code for graft angio and ileofemoral angio?
should i just code unlisted procedure?
thanks in advance