Smb77
New
Procedures performed:
1. Selective pulmonary artery angiogram with runoff and selective right and left main and segmental pulmonary artery angiogram with runoff
2. Right heart catheterization with oximetry
3. IVC venogram
4. Mechanical thrombectomy (Inari Flow retriever) of the right and left main and segmental pulmonary arteries
5. IVUS of main and right left segmental and sub-segmental pulmonary arteries
6. Ultrasound guidance right common femoral vein access
I personally supervised administration moderate sedation for 60 minutes.
Estimated blood loss: 60cc
Indication:
Submassive pulmonary embolism with high risk findings
Procedure in detail:
Right common femoral vein was successfully accessed using ultrasound guidance and modified Seldinger technique and using initially micro-puncture 4 French sheath and thereafter upsized to a 6 French sheath. Next, a pigtail catheter was placed to the level of the IVC confluence via the right common femoral vein. Selective ascending venogram was performed using digital subtraction angiography to ensure is no evidence of thrombus prior to placing large bore sheath. Next, a pigtail catheter was placed in the right atrium right ventricle pulmonary arteries allow for hemodynamic measurements and oximetry of the right atrium and pulmonary artery. Thereafter the pigtail catheter was placed at the level of the main pulmonary artery with selective angiography followed by pigtail catheter placement into the right and left pulmonary arteries and its segmental branches to further visualize thrombus severity and distal runoff. Due to the significant thrombus burden, the pigtail catheter was exchanged over a .035 super core wire and the 6 French sheath was upsized to a 22 French sheath with the use of serial venous dilators. Heparin was then given via the peripheral IV line and the guide delivery sheath was inserted into the main pulmonary artery followed by careful manipulation into the right and left pulmonary arteries and its segmental branches. A selective angiogram was also performed via the guide delivery sheath to ensure appropriate positioning adjacent to thrombus burden. Mechanical aspiration was then performed with multiple passes and successful thrombus extraction. Thereafter intravascular ultrasound, IVUS was used to further evaluate segmental and subsegmental pulmonary arteries involving left pulmonary system and also evaluated right main and segmental and subsegmental pulmonary arteries. Thereafter equipment is removed patient tolerated procedure well.
I'm second guessing myself....I came up with 37184-RT, 37184-LT, 93451-26, 36010-RT, 37252, 37253, 75825-26, 76937-26, 99152. I would appreciate any feedback on this!!
1. Selective pulmonary artery angiogram with runoff and selective right and left main and segmental pulmonary artery angiogram with runoff
2. Right heart catheterization with oximetry
3. IVC venogram
4. Mechanical thrombectomy (Inari Flow retriever) of the right and left main and segmental pulmonary arteries
5. IVUS of main and right left segmental and sub-segmental pulmonary arteries
6. Ultrasound guidance right common femoral vein access
I personally supervised administration moderate sedation for 60 minutes.
Estimated blood loss: 60cc
Indication:
Submassive pulmonary embolism with high risk findings
Procedure in detail:
Right common femoral vein was successfully accessed using ultrasound guidance and modified Seldinger technique and using initially micro-puncture 4 French sheath and thereafter upsized to a 6 French sheath. Next, a pigtail catheter was placed to the level of the IVC confluence via the right common femoral vein. Selective ascending venogram was performed using digital subtraction angiography to ensure is no evidence of thrombus prior to placing large bore sheath. Next, a pigtail catheter was placed in the right atrium right ventricle pulmonary arteries allow for hemodynamic measurements and oximetry of the right atrium and pulmonary artery. Thereafter the pigtail catheter was placed at the level of the main pulmonary artery with selective angiography followed by pigtail catheter placement into the right and left pulmonary arteries and its segmental branches to further visualize thrombus severity and distal runoff. Due to the significant thrombus burden, the pigtail catheter was exchanged over a .035 super core wire and the 6 French sheath was upsized to a 22 French sheath with the use of serial venous dilators. Heparin was then given via the peripheral IV line and the guide delivery sheath was inserted into the main pulmonary artery followed by careful manipulation into the right and left pulmonary arteries and its segmental branches. A selective angiogram was also performed via the guide delivery sheath to ensure appropriate positioning adjacent to thrombus burden. Mechanical aspiration was then performed with multiple passes and successful thrombus extraction. Thereafter intravascular ultrasound, IVUS was used to further evaluate segmental and subsegmental pulmonary arteries involving left pulmonary system and also evaluated right main and segmental and subsegmental pulmonary arteries. Thereafter equipment is removed patient tolerated procedure well.
I'm second guessing myself....I came up with 37184-RT, 37184-LT, 93451-26, 36010-RT, 37252, 37253, 75825-26, 76937-26, 99152. I would appreciate any feedback on this!!