such78
Expert
The patient was brought to Radiology, placed on
the angio table in the prone position.The bilateral popliteal veins
were then accessed using ultrasound-guided micropuncture technique
and a Bentson wire was advanced.It should be noted that on the left
side, I did access first the small saphenous vein which had a very
tortuous course and would not easily drop into the femoral vein.I
abandoned that access and used popliteal vein secondarily.
Nine-French sheaths were placed through the bilateral popliteal
fossae.Sheath injections were then performed for ascending
venography.Straight flush catheters were then introduced to the
bilateral common femoral veins and pelvic runoff and inferior vena cava venogram was then performed.
Using the Bentson wires, intravascular ultrasound was then performed
from the inferior vena cava pullback to the common femoral veins
bilaterally.No significant stenosis was noted.I then opted to
terminate the case.Wires and catheter sheath were then withdrawn
and direct manual pressure was held with hemostatic patch for 5
minutes.Hemostasis was good.Dry sterile dressings were then
applied.
All counts were correct at the end the case.I was present throughout
the entirety of the case.The patient was then transported to
recovery room in stable condition.
COMPLICATIONS:
None.
FINDINGS:
1.Tortuous course of the left small saphenous vein for its junction
with the femoral vein.
2.At least a bifid left femoral vein system and also bifid right
femoral vein system.
3.No significant stenosis or occlusion throughout the bilateral
femoral veins.
4.No significant stenosis or impingement of the bilateral iliac
veins or inferior vena cava.
5.Intravascular ultrasound measurements are as follows:
a. Inferior vena cava 18.9 x 26.0 mm, 401 square mm.
b. Left common iliac vein 11.5 x 19.3 mm, 184.4 square mm.
c. Left external iliac vein 8.4 x 15.4 mm, 106.2 square mm.
d. Left common femoral vein 10.3 x 11.9 mm, 98.4 square mm.
e. Right common iliac vein 11.9 x 16.1 mm, 151.8 square mm.
f. Right external iliac vein 10.4 x 12.9 mm, 104.6 square mm.
g. Right common femoral vein 9.2 x 13.3 mm, 100.5 square mm.
6.On my ultrasound interrogation of the left lower extremity during
access I was able to follow a gastrocnemius vein which seemed to have
a noncompressible dilated segment to it before it dove deeply.This
was concerning to me for possible venous thrombosis; although, none
had ever been visualized on previous imaging.Because of this, will
obtain a vascular lab venous ultrasound of the left lower extremity
in the recovery room.
I have 36005 Lt, 36005 -Rt, 75822-pelvis venogram with runoff, 75825 - IVC venogram, and 37252.
The IR department charged for 36010 x2 times, but i dont see the catheter was advanced to IVC.
I am not confident with my codes. Please advice. Thank you.
the angio table in the prone position.The bilateral popliteal veins
were then accessed using ultrasound-guided micropuncture technique
and a Bentson wire was advanced.It should be noted that on the left
side, I did access first the small saphenous vein which had a very
tortuous course and would not easily drop into the femoral vein.I
abandoned that access and used popliteal vein secondarily.
Nine-French sheaths were placed through the bilateral popliteal
fossae.Sheath injections were then performed for ascending
venography.Straight flush catheters were then introduced to the
bilateral common femoral veins and pelvic runoff and inferior vena cava venogram was then performed.
Using the Bentson wires, intravascular ultrasound was then performed
from the inferior vena cava pullback to the common femoral veins
bilaterally.No significant stenosis was noted.I then opted to
terminate the case.Wires and catheter sheath were then withdrawn
and direct manual pressure was held with hemostatic patch for 5
minutes.Hemostasis was good.Dry sterile dressings were then
applied.
All counts were correct at the end the case.I was present throughout
the entirety of the case.The patient was then transported to
recovery room in stable condition.
COMPLICATIONS:
None.
FINDINGS:
1.Tortuous course of the left small saphenous vein for its junction
with the femoral vein.
2.At least a bifid left femoral vein system and also bifid right
femoral vein system.
3.No significant stenosis or occlusion throughout the bilateral
femoral veins.
4.No significant stenosis or impingement of the bilateral iliac
veins or inferior vena cava.
5.Intravascular ultrasound measurements are as follows:
a. Inferior vena cava 18.9 x 26.0 mm, 401 square mm.
b. Left common iliac vein 11.5 x 19.3 mm, 184.4 square mm.
c. Left external iliac vein 8.4 x 15.4 mm, 106.2 square mm.
d. Left common femoral vein 10.3 x 11.9 mm, 98.4 square mm.
e. Right common iliac vein 11.9 x 16.1 mm, 151.8 square mm.
f. Right external iliac vein 10.4 x 12.9 mm, 104.6 square mm.
g. Right common femoral vein 9.2 x 13.3 mm, 100.5 square mm.
6.On my ultrasound interrogation of the left lower extremity during
access I was able to follow a gastrocnemius vein which seemed to have
a noncompressible dilated segment to it before it dove deeply.This
was concerning to me for possible venous thrombosis; although, none
had ever been visualized on previous imaging.Because of this, will
obtain a vascular lab venous ultrasound of the left lower extremity
in the recovery room.
I have 36005 Lt, 36005 -Rt, 75822-pelvis venogram with runoff, 75825 - IVC venogram, and 37252.
The IR department charged for 36010 x2 times, but i dont see the catheter was advanced to IVC.
I am not confident with my codes. Please advice. Thank you.