Wiki Superior venal cavalgram & PTCA


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I've never coded this before. Per the doctor he did: superior venal cavalgram, PTCA of SVC x 2, placement of wall stent in SVC.

Procedure as dictated:

Indication(s) for procedure:
The patient has known malignancy with superior vena caval symptoms, including flushing in her head, headache, and hypertension as well. She had a CT which showed a superior vena caval obstruction. She comes in today for assessment and relief of her severe superior vena caval obstruction due to cancer. She is also getting radiation at that site.

Description of procedure:
The patient was brought to the laboratory and put under the direction of anesthesia. Right jugular access was gained. A wire was placed. Angiography was performed and that confirmed the superior vena caval obstruction. Measurements were made and then we predilated the obstruction. First, with a Boston Scientific XXL vascular balloon, 14mm x 4cm, then repeated angiography, and then did another balloon dilation with an XXL 18mm x 4cm. This appeared to show significant improvement. I then placed a wall stent and a prosthesis, 22 x 35. I tried to pass the balloon to post dilate, but there was angulation and difficulty with the pass. I then did angiography and it showed the successful placement of the wall stent and really pretty good relief of the obstruction. We thought to be angiographically stable. The catheter was then pulled out of the jugular and direct pressure applied. The patient tolerated the procedure well.

Your thoughts are comments would be extremely helpful because I am lost!