bhargavi
Guru
56-year-old female with severe bilateral buttocks and thigh claudications found to have severe stenosis in the distal aorta brought in for abdominal aortogram and possible intervention to the distal aorta. Procedure, risks, benefits, alternative options were explained. Risks including bleeding, infection, cerebrovascular accident, myocardial infarction, death, and arrhythmia were all explained patient was agreeable. He was brought into the cardiac cath lab where conscious sedation (moderate sedation) was performed by myself using Versed and fentanyl. Conscious sedation was started 9:18 AM and monitoring period Ended 9:32 AM. I was present throughout this whole entire period With the patient. Both groins were prepped and draped in the usual fashion. 2% lidocaine was used to anesthesize the skin. Using modified Seldinger technique, a 5 French sheath was inserted in the right femoral artery. Eventually this was exchanged for a long 6 French sheath that was advanced to the distal aorta. A 5 French calibrated pigtail catheter was used to perform the abdominal aortogram. I also crossed over from right to left for selective left lower extremity angiogram seeing a rim catheter
Finding:
1: The abdominal aorta has severe infrarenal abdominal aortic disease. Start shortly after the origin of the renals. Above the bifurcation, there is a focal area of 80% stenosis with significant gradient. There is no involvement of the origin of the bilateral common iliac as initially thought.
2: The bilateral common iliac, external iliac, internal iliac and common femoral arteries are patent. There is less than 30% stenosis in the origin of the left common iliac artery
3: Left lower extremity done via selective catheterization with advancement of the rim catheter to the proximal left superficial femoral artery runoff showed patent left superficial femoral artery, popliteal artery and three-vessel distal runoff
4: The right lower extremity runoff done nonselectively showed patent right superficial femoral artery, popliteal, and three-vessel distal runoff
Impression: Severe infrarenal abdominal aortic disease with no iliac or below inguinal ligament disease
Intervention: A Magic torque wire was able to cross through the stenosis in the distal abdominal aorta. Measurement of the infrarenal abdominal aorta using the calibrated pigtail as a guide showed the area of the aorta at the stenosis level is no more than 10 mm. This area was treated with a 7 mm balloon however there was still significant residual stenosis and gradient. This area was then covered with insertion of 9x25 mm balloon expandable stent with excellent result and no residual stenosis and no residual gradient
thanks in advance
should I do 37236, 75710-xu, lft?
Finding:
1: The abdominal aorta has severe infrarenal abdominal aortic disease. Start shortly after the origin of the renals. Above the bifurcation, there is a focal area of 80% stenosis with significant gradient. There is no involvement of the origin of the bilateral common iliac as initially thought.
2: The bilateral common iliac, external iliac, internal iliac and common femoral arteries are patent. There is less than 30% stenosis in the origin of the left common iliac artery
3: Left lower extremity done via selective catheterization with advancement of the rim catheter to the proximal left superficial femoral artery runoff showed patent left superficial femoral artery, popliteal artery and three-vessel distal runoff
4: The right lower extremity runoff done nonselectively showed patent right superficial femoral artery, popliteal, and three-vessel distal runoff
Impression: Severe infrarenal abdominal aortic disease with no iliac or below inguinal ligament disease
Intervention: A Magic torque wire was able to cross through the stenosis in the distal abdominal aorta. Measurement of the infrarenal abdominal aorta using the calibrated pigtail as a guide showed the area of the aorta at the stenosis level is no more than 10 mm. This area was treated with a 7 mm balloon however there was still significant residual stenosis and gradient. This area was then covered with insertion of 9x25 mm balloon expandable stent with excellent result and no residual stenosis and no residual gradient
thanks in advance
should I do 37236, 75710-xu, lft?