Help- CV Surgery is very new to me. Can someone help me with this?? I have the 37221 for the iliac stenting..


OPERATIVE PROCEDURE: Abdominal aortogram, pelvic arteriogram,

bilateral lower extremity arteriogram and runoff from the femoral

artery level, right common iliac artery stent angioplasty.
Pelvic arteriogram: The pelvic vessels were patent with internal and

external iliac arteries patent with calcified walls but no high-grade

disease other than the high-grade calcific plaque at the inflow the

right common iliac artery. Left lower extremity arteriogram and

runoff, left common femoral artery, superficial femoral artery,

profunda femorus were patent with calcifications in the walls and

luminal irregularities. Left popliteal artery was patent. There was

luminal irregularities in the tibial vessels; however, she had

2-vessel runoff to the left foot.

DESCRIPTION OF OPERATION:

Right lower extremity arteriogram and runoff: Right common femoral

artery, profunda femorus and superficial femoral arteries were patent.

However, there was calcification and luminal irregularities. The

right superficial femoral artery had multiple areas of calcification

and 40-50 in some areas of 60% diffuse stenotic areas in the mid to

distal right superficial femoral artery. Popliteal artery was patent.

Tibial vessels have calcified plaque but were patent to the foot.

DESCRIPTION OF OPERATION: The patient was taken to the operating room

and placed in a supine position. General endotracheal anesthesia was

administered. Lower abdomen, groins and legs were prepped and draped

in the usual sterile manner. Using the CT angiogram for guidance, we

accessed the left common femoral artery and a Glidewire was advanced

into the thoracic aorta. All wire manipulation was done under

continuous fluoroscopic guidance. A 4-French sheath was placed. An

oblique angiogram done of the puncture site documenting common femoral

artery puncture site. The pelvic angiogram was performed and left

lower extremity arteriogram was performed. We accessed the right

common femoral artery and noted approximately 40 mmHg difference

between the radial artery pressure in the right common femoral artery.

We advanced the Glidewire through the lesion and into the thoracic

aorta. We heparinized the patient with a total of 10,000 units of

intravenous Heparin and activated clotting time was approximately 300

seconds. I placed a 6-French x 30 cm Raabe sheath on the right wire

through the lesion with the tip in the lower abdominal aorta. The

image intensifier and the bed were locked and flush aortography was

performed and the lesion was visualized and measured. We placed a 7

mm x 30 mm stent through the Raabe sheath and then withdrew the Raabe

sheath positioning it in the common iliac artery extending into the

aorta approximately 1 cm. We inflated this to 8-1/2 atmospheres and

had good profiling. This stent material, because of the small

diameter of the aorta and its protruding into the aorta, was in the

blood flow track to the left common iliac artery. I had the up on the

left side and decided to not place a stent in the left common iliac

artery as this would have required an 8 mm stent because of the

relative larger diameter and no stenosis on the left side. My concern

with been to then in that deployment to crush the right-sided stent

against the lateral aortic wall plaque which would then more an

obstruction to flow than a widely open stent from the right side

alone. We measured pressures and found approximately a 4 mmHg

difference between the two legs and angiogram showed no evidence of

extravasation or dissection. I used a StarClose device for hemostasis

on the right side since a 4-French sheath was placed on the left we

used digital pressure for hemostasis. Lower extremity perfusion was

judged at the completion and found to have excellent flow with the

right side, commensurate with the superficial femoral artery stenotic

disease noted. Sterile dressings were applied and the patient was

awakened and transported to the intensive care unit having tolerated

the procedure well. All needles and wires, sharps and sponge count

were correct x2.