Procedure Dx: CTO of RCIA, PVD and Claudication
Procedure in detail: Pt brought to cath lab, doppler needle used to access RCFA as well as flourscopy. Difficult due to lack of pulses on R. leg. Then doppler needle was used to gain access to LCFA. Then angiomax bolus and infusion was begun. Then pigtail cath was advanced into LIA and positioned in AA. Then AA and bilateral iliac arteriogram was performed using digital subtraction angiography. Following this balloon was advanced over stork wire into RCIA. Attempts were made to dot thru the distal cap of totally occluded RCI. Balloon was able to advance, but went suboptimal and then advanced into distal aorta. Then spartacore wire was advanced into distal aorta subintimal space. Following this Pioneer cath was advanced over wire and tip of cath was positioned into distal aorta. Ultrasound imagaing was performed of iliac artery and distal aorta for reentry and sizing purposes. Following intravascular ultrasound imaging of distal aorta, needle was deployed and access was reachieved into distal aorta lumen. Following this, second spartacore wire was davanced into true lumen port out the needle and into aorta. Once wire was advanced into true lumen of aorta, pioneer cath and support guidewire was withdrawn and removed from body. Then predilatation balloon was selected. This was advanced to reenter site in aorta. Initial dilatation was performed to nomial pressures for 30 seconds. Then stents were positioned at bifurcation. A combo cath was advanced over true lumen wire and wire was exchanged for stork wire. The combo cath was withdrawn from the body. A pigtail cath was positioned via LIA was removed and stork wire positioned on L side as well. Once had two wires, L side and R side positioned stents were selected 8x60 medtronic assurant stent was positioned on R side, covering entire segment of previous total occlusion and extending int distal aorta, then 8x40 medtronic stent was positioned in LIA, covering diseased area and projectiong into distal aorta covering ostium of LCIA, so that the 2 stents chris crossed in the distal aorta. After appropriate postioning of both stents, they were deployed to optimal pressures. During process, pt experienced discomfort and developed bagal reaction w/hypotension and bradycardia that resolved after 1 mg of atropine and bolus of normal saline and at that time she was taken away from cath table. Her BP and Heart rate were normalized and symptoms resolved. Following deployment of both stents, the cath was readvanced into L leg up into distal AA, AA was performed w/digital subtraction angiography. Final angiographic result w/full expansion of both stents, no evidence of dissection or obstructive disease, lesions were noted. At this point, cas was ended. Final assessment 2 stents, one in RCIA, one in LCIA crisscrossing in distal aortal resolving CTO of RCIA w/excellent results, no complications
Codes: 37221, 37222 & 75630-26-59?
Procedure in detail: Pt brought to cath lab, doppler needle used to access RCFA as well as flourscopy. Difficult due to lack of pulses on R. leg. Then doppler needle was used to gain access to LCFA. Then angiomax bolus and infusion was begun. Then pigtail cath was advanced into LIA and positioned in AA. Then AA and bilateral iliac arteriogram was performed using digital subtraction angiography. Following this balloon was advanced over stork wire into RCIA. Attempts were made to dot thru the distal cap of totally occluded RCI. Balloon was able to advance, but went suboptimal and then advanced into distal aorta. Then spartacore wire was advanced into distal aorta subintimal space. Following this Pioneer cath was advanced over wire and tip of cath was positioned into distal aorta. Ultrasound imagaing was performed of iliac artery and distal aorta for reentry and sizing purposes. Following intravascular ultrasound imaging of distal aorta, needle was deployed and access was reachieved into distal aorta lumen. Following this, second spartacore wire was davanced into true lumen port out the needle and into aorta. Once wire was advanced into true lumen of aorta, pioneer cath and support guidewire was withdrawn and removed from body. Then predilatation balloon was selected. This was advanced to reenter site in aorta. Initial dilatation was performed to nomial pressures for 30 seconds. Then stents were positioned at bifurcation. A combo cath was advanced over true lumen wire and wire was exchanged for stork wire. The combo cath was withdrawn from the body. A pigtail cath was positioned via LIA was removed and stork wire positioned on L side as well. Once had two wires, L side and R side positioned stents were selected 8x60 medtronic assurant stent was positioned on R side, covering entire segment of previous total occlusion and extending int distal aorta, then 8x40 medtronic stent was positioned in LIA, covering diseased area and projectiong into distal aorta covering ostium of LCIA, so that the 2 stents chris crossed in the distal aorta. After appropriate postioning of both stents, they were deployed to optimal pressures. During process, pt experienced discomfort and developed bagal reaction w/hypotension and bradycardia that resolved after 1 mg of atropine and bolus of normal saline and at that time she was taken away from cath table. Her BP and Heart rate were normalized and symptoms resolved. Following deployment of both stents, the cath was readvanced into L leg up into distal AA, AA was performed w/digital subtraction angiography. Final angiographic result w/full expansion of both stents, no evidence of dissection or obstructive disease, lesions were noted. At this point, cas was ended. Final assessment 2 stents, one in RCIA, one in LCIA crisscrossing in distal aortal resolving CTO of RCIA w/excellent results, no complications
Codes: 37221, 37222 & 75630-26-59?
