pre-sirt mapping angiography-- more detailed this time

AgnieszkaMarek

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Saratoga Springs, NY
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Doctor is going everywhere within Celiac arterial family. I feel lost how may 36248 codes i should use..
please help
PRE-SIRT, mapping procedure

PROCEDURE:
* Selective angiography of the celiac arteries.
* Superselective angiography of the common hepatic artery.
* Injection of Tc-99m-MAA into the distal segment 8 and a distal
segment 7 hepatic artery.
* US and fluoroscopy guided left radial artery access.
* Left radial artery arteriotomy closure with radial band compression
device
TECHNIQUE:
The risks, benefits and alternatives of the procedure were discussed
with the patient, and informed written consent was obtained. The
patient was brought to the angiography suite, and the left wrist was
prepped and draped in sterile fashion. All elements of maximal sterile
barrier technique were followed including cap and mask, sterile gown,
sterile gloves, large sterile sheet, hand hygiene and 2% chlorhexidine
for cutaneous antisepsis.

Barbeau test was performed, and left radial artery size was measured
on ultrasound to document that there is no contraindication for left
radial access.

Next, left radial artery was accessed under ultrasound and fluoroscopy
guidance. 6 French radial sheath was placed. Radial arterial access
cocktail, mixture of 200 mcg nitroglycerin and 2.5 mg verapamil, was
given through the sheath. Next, 5000 unit IV heparin was given.

Next, the aortic arch was crossed with a combination of 120 cm 5
French Tiger catheter and 035 glidewire under fluoroscopy guidance.
The catheter was advanced to the abdominal aorta.

The celiac artery was selected followed by angiography. Celiac artery
dividing to splenic, left gastric, and common hepatic artery.

Next, the common, and proper hepatic artery was selected with a
microcatheter microwire in coaxial fashion for by angiography. Common
hepatic artery branch into proper hepatic artery and GDA. Proper
hepatic arteries dividing to left and right hepatic artery.

Next, segment 5/8, segment 8 hepatic artery was subselected, followed
by angiography. There is large tumor blush coming off subsegmental
segment 8 hepatic artery.

Having isolated the arterial flow to the subsegmental segment 8,
approximately 3.9 millicuries of Tc-99m macroaggregated albumin was
injected via the lantern microcatheter.

Next, in similar fashion segment 6/7, segment 7 hepatic artery was
subselected followed by angiography. Additional tumor blush,
subsegmental segment 7 hepatic artery. Then, approximately 3.9
millicuries of Tc-99m macroaggregated albumin was injected via the
lantern microcatheter.
Wires, catheters and sheaths were removed. The left radial artery
hemostasis was achieved with radial band.

The patient tolerated the procedure well and there were no
complications.

The patient tolerated the procedure well without immediate
complication and was transported to Nuclear Medicine for further
imaging.


FINDINGS/IMPRESSION:
* Selective angiography of the celiac arteries. Celiac artery branch
into left gastric, splenic, and common hepatic artery.
* Superselective angiography of the common hepatic, proper hepatic,
right hepatic, segment 5/8, segment 6/7, subsegmental segment 8,
subsegmental segment 7 artery. Common hepatic artery dividing to
proper hepatic artery and GDA. Proper hepatic artery dividing to left
and right hepatic artery. Tumor blush noted in the subsegmental
segment 8, and subsegmental segment 7 hepatic arteries.
* Injection of Tc-99m-MAA into the distal segment 8 and a distal
segment 7 hepatic artery.
 
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