jdmjine
Contributor
37229 and 75716 I'll be using these codes but is this all I have for this procedure? need some help, thanks
An antegrade micropuncture sheath was inserted directly into the common femoral artery and into the superficial femoral artery. 5-French 35 cm Cordis Brite tip sheath was advanced into the mid SFA. IV heparin was given for anticoagulation. Right Lower Extremity angiogram was performed. A v18 wire was taken over a 0.018 cm straigh tip CXI catheter. The V18 wire was able to be advanced into the anterior tibial artery. The wire was then changed out for a Treasure 12 wire, which was able to be advanced w/ careful manipulation, passed the entire mid SFA, mid anterior tibial artery occlusion and into the widely patent dorsalis pedis artery in the foot. Over this wire, the catheters could not be passed. The CXI catheter could not be advanced over this to change wire out. New CXI catheter was taken.An 0.018 2 X 20mm balloon was taken and was also unable to be advanced over the wire into the distal vessel. At this point, with CXI catheter buried into the tip of the plaque as far as it could go. The treasure 12 wire was removed and 0.014 PT2 moderate support wire was taken and was able to be advancedthrough the same channel w/0 difficulty into the dorsalis pedis artery. Subsequently, it was decided to perform laser atherectomy with 0.9mm Spectranetics laser catheter. The laser catheter was taken and was advanced into the distal popliteal artery aith contrast flushed out of the vessel and saline continuously flushed during laser atherectomy. The catheter was slowly advanced from the distal politeal artery all the way into the proximal anterior tibial artery and into the mid vessel. There was a point of resistance in the mid vessel, which was able to be traversed with an increased pulse rate to 40 and a fluency of 45. Subsequently in the distal anterior tibial artery above the ankle, the laser catheter could not be passed despite a fluency set at 50 and pulse rate set at 50. At this point the catheter was removed and a 2.0x220 cm Bard 0.018 wire balloon was taken over the PT2 moderate support wire w/o difficulty. Balloon angioplasty was performed from the ankle all the way up into the distal popliteal artery with 2 separate inflations at roughly 2 min. each at 12 atmospheres. The balloon expanded w/o waste.Follow-up angiogram showed uninterrupted in-line flow through the anterior tibial artery, however, there was still scattered areas of severe stenosis, which was then treated with a balloon angioplasty using a 3X300cm balloon for 2 min inflation at 12 atmospheres. Follow-up angiogram showed widely patent anterior tibial artery with scattered areas of moderate narrowing, but no high-grade stenosis. There was a brisk antegrade flow into the dorsalis pedis artery at the ankle and foot. There is no evidence of dissection. There was some residual minimal filling defect in the distal popliteal artery and extending into the peroneal artery, but brisk antegrade flow. The distal popliteal artery eccentric stenosis also appeared to be reduced to roughly 50%. At this point, the wire was removed. Attention was then turned to the left lower extremity. Limited angiogram was performed.
An antegrade micropuncture sheath was inserted directly into the common femoral artery and into the superficial femoral artery. 5-French 35 cm Cordis Brite tip sheath was advanced into the mid SFA. IV heparin was given for anticoagulation. Right Lower Extremity angiogram was performed. A v18 wire was taken over a 0.018 cm straigh tip CXI catheter. The V18 wire was able to be advanced into the anterior tibial artery. The wire was then changed out for a Treasure 12 wire, which was able to be advanced w/ careful manipulation, passed the entire mid SFA, mid anterior tibial artery occlusion and into the widely patent dorsalis pedis artery in the foot. Over this wire, the catheters could not be passed. The CXI catheter could not be advanced over this to change wire out. New CXI catheter was taken.An 0.018 2 X 20mm balloon was taken and was also unable to be advanced over the wire into the distal vessel. At this point, with CXI catheter buried into the tip of the plaque as far as it could go. The treasure 12 wire was removed and 0.014 PT2 moderate support wire was taken and was able to be advancedthrough the same channel w/0 difficulty into the dorsalis pedis artery. Subsequently, it was decided to perform laser atherectomy with 0.9mm Spectranetics laser catheter. The laser catheter was taken and was advanced into the distal popliteal artery aith contrast flushed out of the vessel and saline continuously flushed during laser atherectomy. The catheter was slowly advanced from the distal politeal artery all the way into the proximal anterior tibial artery and into the mid vessel. There was a point of resistance in the mid vessel, which was able to be traversed with an increased pulse rate to 40 and a fluency of 45. Subsequently in the distal anterior tibial artery above the ankle, the laser catheter could not be passed despite a fluency set at 50 and pulse rate set at 50. At this point the catheter was removed and a 2.0x220 cm Bard 0.018 wire balloon was taken over the PT2 moderate support wire w/o difficulty. Balloon angioplasty was performed from the ankle all the way up into the distal popliteal artery with 2 separate inflations at roughly 2 min. each at 12 atmospheres. The balloon expanded w/o waste.Follow-up angiogram showed uninterrupted in-line flow through the anterior tibial artery, however, there was still scattered areas of severe stenosis, which was then treated with a balloon angioplasty using a 3X300cm balloon for 2 min inflation at 12 atmospheres. Follow-up angiogram showed widely patent anterior tibial artery with scattered areas of moderate narrowing, but no high-grade stenosis. There was a brisk antegrade flow into the dorsalis pedis artery at the ankle and foot. There is no evidence of dissection. There was some residual minimal filling defect in the distal popliteal artery and extending into the peroneal artery, but brisk antegrade flow. The distal popliteal artery eccentric stenosis also appeared to be reduced to roughly 50%. At this point, the wire was removed. Attention was then turned to the left lower extremity. Limited angiogram was performed.