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Thread: Embolization - Patient is a 38-year-old gentleman

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    Default Embolization - Patient is a 38-year-old gentleman

    AAPC: Back to School
    Can anyone help me out with this procedure????

    Clinical history: Patient is a 38-year-old gentleman with history
    of TB in the past now with significant hemoptysis. Patient status
    post bronchoscopy demonstrating bleeding from the right mid an
    lower lobe. Request for bronchial artery embolization.

    Embolization particles: 500 to 700-mu. Embospheres, one vial

    Fluoroscopy time: 20 minutes
    Contrast: 150 cc of Isovue-300

    The patient was placed on
    the angiography table in the supine position. The right groin was
    prepped and draped in the usual sterile fashion. Local anesthesia
    was obtained with 1% lidocaine. There was continuous physiologic
    monitoring of the patient throughout the procedure. Utilizing
    single wall puncture technique the right common femoral artery was
    entered. Utilizing exchange technique a 5-French last was sheath
    was placed. Over a Bentson wire an omni-flush catheter was
    advanced into the ascending thoracic aorta. Digital subtraction
    angiography of the thoracic aorta was performed. The Omni flush
    catheter was then exchanged initially for a 5 french MicKesson
    catheter which was unsuccessful at cannulating the orifice of the
    bronchial artery. This was then exchanged for a 5 french Cobra 3
    catheter with successful catheterization of multiple intercostal
    arteries on the right and left. These demonstrated only very
    small bronchial branches without any significant abnormality or
    evidence of extravasation. Selective catheterization was obtained
    of a prominent enlarged right bronchial artery with tortuosity and
    extensive branch formation. No direct extravasation of contrast
    material was identified. Given abnormality of this branch vessel
    embolization was performed. This was performed utilizing 500 to
    700-mu embosphere particles. This was performed until adequate
    stasis was obtained without evidence of significant reflux.
    Post-embolization selective angiogram of this vessel demonstrated
    adequate embolization. Selective catheterization of a left
    bronchial artery demonstrated normal vascular appearance. The
    catheter was removed over wire. The sheath was removed and
    compression applied until hemostasis was obtained. The patient
    tolerated these procedures well.

    Evaluation of thoracic aortogram demonstrates normal great
    vessels. The thoracic aorta was of normal caliber. Filling of
    multiple intercostal branches were demonstrated.

    Selective catheterization was performed of 5 separate intercostal
    branches on the left which failed to demonstrate abnormalities or
    filling of abnormal bronchial artery vessels. Selective
    catheterization of a left bronchial artery failed to demonstrate
    abnormal caliber or lesional vasculature. Selective
    catheterization of 3 separate right intercostal vessels fail to
    demonstrate abnormalities or abnormal bronchial arteries.
    Selective catheterization of the right bronchial artery
    demonstrated significant enlargement of the bronchial artery with
    lesional vessels. Successful embolization was performed of this
    vessel utilizing Embosphere's with post embolization angiogram
    demonstrating successful embolization.

    Impression: Successful embolization of abnormal right bronchial
    Last edited by ank3t; 10-06-2016 at 04:53 AM.
    Prabha CPC

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    Join Date
    Apr 2007


    Check out code 37204

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