bhargavi
Guru
Indications
Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs (CMS-HCC) [I70.213 (ICD-10-CM)]
Conclusion
PROCEDURES
1. Right radial access
2. Aortic arch angiogram.
3. Right subclavian angiogram.
PROCEDURE NOTE
Informed consent was obtained after explaining the risks and benefits to the patient. Right wrist was draped and prepped in the sterile fashion. Patient was premedicated with 1 mg Versed and 50 mcg fentanyl IV. After injecting 2% lidocaine and the right wrist, right radial artery was accessed using micropuncture needle without difficulty. 4000 units of heparin, 200 µg nitroglycerin, 2.5 mg of verapamil were given through radial sheath. 6 French FR 4 catheter was advanced with the help of 0.035 Zip wire and catheter was advanced into the ascending aorta. Nonselective right subclavian and right carotid angiogram was performed from aortic arch initially using same FR4 catheter. 6 French angled pigtail catheter was advanced and aortic arch angiogram was performed. Patient remained hemodynamically stable and tolerated procedure well. Radial sheath was pulled and transradial band was applied with good hemostasis.
AORTIC ANGIOGRAM
The aortic arch was without significant disease. Right innominate artery was large in caliber with no significant disease. Right common carotid artery was large in caliber and angiographically normal. Right subclavian artery was calcified at the origin with 80-90% eccentric calcified lesion almost involving the origin of right vertebral artery. Right subclavian artery after the lesion also had poststenotic dilatation.
IMPRESSION
1. High-grade calcific stenosis involving origin of right subclavian artery.
RECOMMENDATIONS
Patient has high-grade stenosis of very proximal right subclavian artery. Percutaneous intervention of right subclavian artery may be tricky and somewhat high risk considering lesion is very close to the origin of right common carotid artery. Discussed various options of further management. After long discussion with the patient and family, will refer him to vascular surgery for an opinion. Family is in agreement with the plan.
I know 36222-36225 are for selective cath and the physician said nonselective so can I do 36221?
thank you in advance
Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs (CMS-HCC) [I70.213 (ICD-10-CM)]
Conclusion
PROCEDURES
1. Right radial access
2. Aortic arch angiogram.
3. Right subclavian angiogram.
PROCEDURE NOTE
Informed consent was obtained after explaining the risks and benefits to the patient. Right wrist was draped and prepped in the sterile fashion. Patient was premedicated with 1 mg Versed and 50 mcg fentanyl IV. After injecting 2% lidocaine and the right wrist, right radial artery was accessed using micropuncture needle without difficulty. 4000 units of heparin, 200 µg nitroglycerin, 2.5 mg of verapamil were given through radial sheath. 6 French FR 4 catheter was advanced with the help of 0.035 Zip wire and catheter was advanced into the ascending aorta. Nonselective right subclavian and right carotid angiogram was performed from aortic arch initially using same FR4 catheter. 6 French angled pigtail catheter was advanced and aortic arch angiogram was performed. Patient remained hemodynamically stable and tolerated procedure well. Radial sheath was pulled and transradial band was applied with good hemostasis.
AORTIC ANGIOGRAM
The aortic arch was without significant disease. Right innominate artery was large in caliber with no significant disease. Right common carotid artery was large in caliber and angiographically normal. Right subclavian artery was calcified at the origin with 80-90% eccentric calcified lesion almost involving the origin of right vertebral artery. Right subclavian artery after the lesion also had poststenotic dilatation.
IMPRESSION
1. High-grade calcific stenosis involving origin of right subclavian artery.
RECOMMENDATIONS
Patient has high-grade stenosis of very proximal right subclavian artery. Percutaneous intervention of right subclavian artery may be tricky and somewhat high risk considering lesion is very close to the origin of right common carotid artery. Discussed various options of further management. After long discussion with the patient and family, will refer him to vascular surgery for an opinion. Family is in agreement with the plan.
I know 36222-36225 are for selective cath and the physician said nonselective so can I do 36221?
thank you in advance