Peripheral Angio + PTA

amym

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Is it appropriate to bill this as 37228, 36200, 75716-26-59, 75625-26

Procedure Performed:
1. Peripheral arteriogram with bilateral lower extremity runoff.
2. Percutaneous transluminal angioplasty of the left peroneal
artery.

Protocol: After the patient was brought to the endovascular
laboratory and prepped and draped in usual fashion, Xylocaine was
infiltrated in the right groin and using a 5-French sheath, a 5-
French Omni Flush catheter was advanced and imaging of the aorta was
done and subsequently catheter was pulled back above the bifurcation
and lower extremity runoff was performed using 6 mL of contrast with
a bolus chase method. No complications occurred.

Findings:
1. The visualized portion of the aorta and bilateral renal arteries
is normal.
2. Common iliac, external iliac, common femoral artery, and
bilateral SFA show only mild disease.
3. The right circulation below the knee revealed aggressive disease
with patency of the right anterior tibial artery which reaches
all the way to the foot with only minimal disease. The peroneal
artery is also patent- however, it occludes in the mid segment
which is filling via collateral flow and faint visualization of
the posterior tibial artery is also noted by faint collaterals.
On the left side, the trifurcation area begins to show disease
popliteal arteries without any disease. However, the anterior
tibial artery is proximally shows 95% stenosis and then in the
ostial area and then proximal part is occluded with only faint
filling. There is only single-vessel runoff at peroneal artery
visualized and shows a proximal 90% to 95% stenosis which is
serving as the only vessel to the foot. The anterior tibial and
posterior tibial artery on the left side are totally occluded
beyond the proximal third.

Impression:

High-grade stenosis with a high-risk lesion in the single-vessel
runoff to the left foot with a nonhealing ulcer in a patient with
critical limb ischemia.

Plan: Based on these findings, recommend percutaneous transluminal
angioplasty of the peroneal artery.

PTA protocol: After the lesion is identified, a 6-French
Destination sheath was then advanced and positioned in the
contralateral superficial femoral artery and then subsequently using
0.014 Kinetics guidewire fed over an Invitek inferion 2.0 x 40
length balloon was advanced to the lesion and dilated at 12
atmospheres. Excellent results were noted with marked improvement
with no evidence of dissection. Brisk flow was noted to the distal
foot and improvement in flow noted into the posterior and to the
anterior tibial artery, which may serve as a potential target at a
later date.

Final Impression: Successful percutaneous transluminal angioplasty
of the proximal part of the left peroneal artery using 2.0 x 40
balloon with stenosis reduction from 90% to 30% residual with brisk
flow to the foot and no complications.
 
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