Agrant77
New
Dr first performed 36902. But I am having trouble with the 2nd part, "OPEN BAND LIGATION OF TRIBUTARY VEIN". Normally we use 37607 for ligation/banding of angioaccess AVF, but this is the leg? I am lost
Procedure Details: Micropuncture technique was used to cannulate the access, a guide wire was placed. Seldinger exchange allowed introducer working sheath introduction to cannulate access for flow evaluation with fluoroscopy.
SHEATH:
1.7 French and retrograde
VENOGRAM OF ACCESS, EXTREMITY, AND CENTRAL VEINS:
Utilizing the working sheath, dilute radiocontrast and sequential flouroscopic images were obtained from the SVC to the working sheath. A retrograde arteriogram was then performed with balloon outflow occlusion allowing visualization of the arterial anastomosis.
All visualized vessels were normal except those mentioned
Open band ligation of venous tributary details:
Tributary vein as found on angiographic imaging to be carry over 50% of fistula flow. An appropriate skin incision was made overlying the proximal aspect of the vein as it branched from the fistula. Careful blunt dissection was carried out to identify the vessel using a right-angled clamp. The vein was then encircled with a 7-0 GoreTex suture and ligated. Skin incision was then closed with deep dermal 3-0 Monocryl and covered with Dermabond.
Procedure Details: Micropuncture technique was used to cannulate the access, a guide wire was placed. Seldinger exchange allowed introducer working sheath introduction to cannulate access for flow evaluation with fluoroscopy.
SHEATH:
1.7 French and retrograde
VENOGRAM OF ACCESS, EXTREMITY, AND CENTRAL VEINS:
Utilizing the working sheath, dilute radiocontrast and sequential flouroscopic images were obtained from the SVC to the working sheath. A retrograde arteriogram was then performed with balloon outflow occlusion allowing visualization of the arterial anastomosis.
All visualized vessels were normal except those mentioned
Open band ligation of venous tributary details:
Tributary vein as found on angiographic imaging to be carry over 50% of fistula flow. An appropriate skin incision was made overlying the proximal aspect of the vein as it branched from the fistula. Careful blunt dissection was carried out to identify the vessel using a right-angled clamp. The vein was then encircled with a 7-0 GoreTex suture and ligated. Skin incision was then closed with deep dermal 3-0 Monocryl and covered with Dermabond.
