nlbarnes
Expert
37226, 37228, 37224, 37232 (I coded 37224 & 37232 as popliteal & tibioperoneal are 2 different areas?)
PROCEDURES:
1. Open surgical exploration of the left superficial femoral artery.
2. Left lower extremity angiogram.
3. Percutaneous transluminal angioplasty and stenting of left SFA
and popliteal artery with a 10 mm x 15 cm Viabahn followed by
another 10 mm x 15 cm Viabahn post-dilated with a 9 mm x 60 mm
angioplasty balloon.
4. Percutaneous transluminal angioplasty of left peroneal artery
with a 3 mm x 100 mm balloon.
5. Percutaneous transluminal angioplasty of left below-knee
popliteal artery and tibioperoneal trunk with a 4 mm x 60 mm
balloon.
6. Completion angiography.
7. Supervision and interpretation of the above.
DESCRIPTION OF PROCEDURE:
After local anesthetic infiltration, a 15
blade was used to create a 2 cm incision overlying the medial aspect
of the sartorius muscle in the upper thigh. Electrocautery with blunt
and sharp dissection was used to carry this down through the
subcutaneous tissue to the level of the sartorius muscle itself, which
was reflected laterally exposing the superficial femoral artery. The
SFA was encircled with a large vessel loop. The patient was
systemically heparinized with a total of 8000 units of intravenous
heparin. The SFA was then accessed with arterial needle after which a
guidewire and sheath were placed in the vessel without difficulty.
Left lower extremity angiogram was performed, which revealed large SFA
and popliteal artery aneurysm as well as significant occlusive disease
involving the left peroneal artery. The anterior tibial artery was
occluded distal to its origin and the posterior tibial artery was also
occluded. At this time, a stiff-angled Glidewire was used to traverse
the aneurysm and remained the below-knee popliteal artery after which
a 12-French sheath was tracked into the vessel without difficulty.
Two 10 mm x 15 cm Viabahn stents were deployed from the mid popliteal
artery to the proximal SFA. These were post-dilated with a 9 mm x 60
mm angioplasty balloon with good angiographic results. At this time,
then a V-18 wire was then placed distally through the stenosis in the
peroneal artery without difficulty. The peroneal artery was
angioplastied with a 3 mm x 100 mm balloon followed by the below-knee
popliteal artery with a 4 mm x 60 mm balloon. Completion angiography
revealed good angiographic result with complete exclusion of the
605612438_03_16
PROCEDURES:
1. Open surgical exploration of the left superficial femoral artery.
2. Left lower extremity angiogram.
3. Percutaneous transluminal angioplasty and stenting of left SFA
and popliteal artery with a 10 mm x 15 cm Viabahn followed by
another 10 mm x 15 cm Viabahn post-dilated with a 9 mm x 60 mm
angioplasty balloon.
4. Percutaneous transluminal angioplasty of left peroneal artery
with a 3 mm x 100 mm balloon.
5. Percutaneous transluminal angioplasty of left below-knee
popliteal artery and tibioperoneal trunk with a 4 mm x 60 mm
balloon.
6. Completion angiography.
7. Supervision and interpretation of the above.
DESCRIPTION OF PROCEDURE:
After local anesthetic infiltration, a 15
blade was used to create a 2 cm incision overlying the medial aspect
of the sartorius muscle in the upper thigh. Electrocautery with blunt
and sharp dissection was used to carry this down through the
subcutaneous tissue to the level of the sartorius muscle itself, which
was reflected laterally exposing the superficial femoral artery. The
SFA was encircled with a large vessel loop. The patient was
systemically heparinized with a total of 8000 units of intravenous
heparin. The SFA was then accessed with arterial needle after which a
guidewire and sheath were placed in the vessel without difficulty.
Left lower extremity angiogram was performed, which revealed large SFA
and popliteal artery aneurysm as well as significant occlusive disease
involving the left peroneal artery. The anterior tibial artery was
occluded distal to its origin and the posterior tibial artery was also
occluded. At this time, a stiff-angled Glidewire was used to traverse
the aneurysm and remained the below-knee popliteal artery after which
a 12-French sheath was tracked into the vessel without difficulty.
Two 10 mm x 15 cm Viabahn stents were deployed from the mid popliteal
artery to the proximal SFA. These were post-dilated with a 9 mm x 60
mm angioplasty balloon with good angiographic results. At this time,
then a V-18 wire was then placed distally through the stenosis in the
peroneal artery without difficulty. The peroneal artery was
angioplastied with a 3 mm x 100 mm balloon followed by the below-knee
popliteal artery with a 4 mm x 60 mm balloon. Completion angiography
revealed good angiographic result with complete exclusion of the
605612438_03_16