Question Venogram

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Venogram - Pelvic Venous Stenosis
EXAM: Left Lower Extremity and Pelvic Venogram with Iliac Venous Angioplasty and Stenting
PROCEDURES PERFORMED:
1. Ultrasound guided access of the left popliteal vein.
2. Left lower extremity and pelvic venogram.
3. Selective catheterization of the left internal iliac vein.
4. Left internal iliac venogram.
5. Selective catheterization of the inferior venocava.
6. Inferior venocavogram.
7. Evaluation of the left femoral, common femoral, external iliac, and common ilac veins as well as the infrarenal inferior venacava with intravascular ultrasound.
8. Angioplasty and stenting of the left common and external iliac veins.

PROCEDURE: The patient was placed prone on the angiographic table. Sterile preparation of the left posterior knee was performed and sterile drapes placed to expose the access site. Ultrasound guided access was made of the left popliteal vein using an 21-gauge micropuncture set . A 0.35 Glidewire was advanced to the level of the IVC and access was secured with a 5 French sheath. The patient was heparinized.
A C2 catheter was advanced to the level of the left common femoral vein and a left lower extremity venogram was performed demonstrating decreased visualization of the left common and external iliac veins with evidence of pelvic and paraspinal collaterals suggestive of iliac venous compression/stenosis. The combination of an angled glidewire and C2 catheter were used to selectively catheterize the left internal iliac vein and a left internal iliac venogram was performed confirming multiple pelvic venous collaterals.
The catheter and wire combination were then used to cross the stenotic segment of the left common and external iliac veins and advanced into the inferior venocava. Inferior venocavagram was unremarkable.
An IVUS catheter was advanced into the left iliac venous system. Intravascular ultrasound confirmed luminal narrowing with intimal scarring in the left common and external iliac veins. The IVUS catheter was removed and an 16mm x 90cm Wallstent was advanced over the wire to the level of the iliac stenosis. The stent was deployed and postdilated to 18mm distally and 16mm proximally. Post angioplasty venogram confirmed excellent stent placement as well as improved luminal diameter with rapid through flow and decreased filing of the previously noted pelvic and paraspinal collaterals.
The catheter and wire combination were then used to selectively catheterize the right femoral and right internal iliac veins with subsequent right femoral and iliac venograms demonstrating no significant stenosis. These findings were confirmed with IVUS.
Completion left lower extremity and inferior venocavagram confirmed excellent stent placement with markedly improved luminal diameter, rapid through flow, and no residual filling of the previously noted pelvic and paraspinal venous collaterals.
All wires and catheters were then removed and hemostasis was obtained with manual pressure. The patient tolerated the procedure well. There were no immediate complications. The patient was discharged from our care in stable condition.
IMPRESSION:
1. High grade left common and external iliac venous stenosis. Findings confirmed with intravascular ultrasound.
2. Successful angioplasty and stenting of left common and external iliac venous stenosis with excellent results.


CAN I PLEASE GET HELP WITH THE CORRECT CODES FOR THIS PROCEDURE? THANK YOU SO MUCH!!
THESE ARE THE CODES I COME UP WITH.

CPT:
36010
37238
37239
37252
37253
76937

ICD 10
I87.1
R06.00
I87.329
I87.2
 
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