I NEED HELP CODING A PTA AND STENT OF THORACIC AORTA. WE ALSO DID A THORACIC AORTOGRAM.
INDICATIONS FOR THE PROCEDURE: STENOTIC AND ANASTOMOTIC LESION OF THE COARCTATION OF THE AORTA THAT WAS SURGICALLY REPAIRED OVER 30 YEARS AGO.
FINDINGS: A 125 mm gradient from the ascending aorta to the femoral artery. Discrete lesion, narrow band-like at the distal anastomosis of Dacron graft that was placed in the descending aorta distal to the left subclavian. The lesion was located in the mid thoracic aorta. Again, a gradient of 135 mm was measured.
Description of the Procedure: Under local anesthetic utilizing 2%, the right femoral artery was cannulated and a 7-French sheath was introduced. A 6-French pigtail through a guidewire was able to cross the lesion and was positioned above the stenosis. Thoracic aortogram was performed injecting 50 ml of dye at rate of 25 per second to the PSI of 600 and a rise of 1 second. This was performed in a shallow left anterior oblique that moved the sternal wires out of the field and allowed better visualization of the stenosis. After thoracic aortogram, the lesion was identified and the wire eas left in place. The pigtail was exchanged for a 8 x 2 balloon Boston brand that was cineangiography, the balloon was inflated to 2 atmospheres in order to obtain enough lumen to allow position of the stent. The inflation was maintained for 40 seconds and was then removed. The patient prior to the procedure received 7500 units of heparin.
Once the balloon dialated the lesion, a 10 x 4 stent was advanced and positioned at the site of stenosis. This was correlated with angiography. The stent was then deployed properly, dilated to 10 atmospheres. That gave a good impression that covered the entire aorta. This was maintained inflated for approximately 1 minute. Thereafter, the balloon was deflated and it was noted immediately that the gradient was completely abolished with equalization of pressures between the thoracic aorta and the femoral artery. The patient complained of moderate to severe pain during the deployment of the stent. This, however, was relieved with intravenousfentanyl. The pigtail was then re-advanced and positioned above the lesion. Then, a repeat thoracic aortogram was performed again injecting 50 ml of dye at a rate of 25 per second with a PSI of 600. An excellent angiographic result was noted. The stent was properly deployed and there was no extravasation or dissection at the site of teh stent. Again, there was no gradient being completely abolished after the deployment of the stent. The patient tolerated the procedure well. His pain was ablated with the fentanyl, and the patient was sent to recovery room to have the sheaths removed once the ACT returned to a level below 130. He tolerated the procedure very well. There were no complications.
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