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Thoracic Abdominal Aneurysm--please help

  1. Default Thoracic Abdominal Aneurysm--please help
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    INDICATION: HISTORY: 83-year-old female with large descending thoracic aortic aneurysm for possible endograft repair.


    PELVIC ARTERIOGRAM, DESCENDING THORACIC AORTOGRAM, ENDOGRAFT REPAIR
    OF DESCENDING THORACIC AORTIC ANEURYSM, RIGHT COMMON ILIAC AND
    EXTERNAL ILIAC ARTERY STENT GRAFT PLACEMENT AND ANGIOPLASTY, RIGHT
    COMMON FEMORAL ARTERY STENT PLACEMENT AND ANGIOPLASTY, RIGHT EXTERNAL
    ILIAC TO COMMON FEMORAL ARTERY BYPASS GRAFT, OCCLUSION BALLOON
    ANGIOPLASTY AND THORACIC AORTA STENT GRAFT

    HISTORY: 83-year-old female with large descending thoracic aortic
    aneurysm for possible endograft repair.
    PROCEDURE: After consent was obtained, spinal anesthetic catheter,
    central line and arterial line were placed by the anesthesiologist in
    attendance. Patient placed supine on the angiography table and
    prepped and draped in the usual sterile manner from the nipples to
    the toes for open aneurysm repair. Transverse incision was made over
    the right lower quadrant and in sharp and blunt dissection carried
    down to the distal right external iliac artery. Loops were placed
    proximally and distally along for vascular control. Patient was
    heparinized. 18 gauge needle was used to puncture the right external
    iliac artery under direct visualization. Wire was advanced to the
    descending thoracic aorta. 5 French catheter was placed and stiff
    wire was manipulated to the aortic arch through the abdominal aortic
    as well as thoracic aneurysms. A Gore introducer sheath was prepped
    in the usual fashion and this was brought over the wire in the right
    external iliac artery and manipulated into the distal right external
    iliac artery. A 28 mm x 15 cm Gore thoracic endoprosthesis was
    prepped in the usual fashion and this was brought the right external
    iliac artery sheath and attempt was made to place it in the iliac
    vessels which failed. This was removed. 8 mm x 4 cm balloon was
    placed and 8 mm angioplasty performed throughout the right external
    iliac artery and right common femoral artery. Balloon was removed
    and again attempt was made to place the tag device which again
    failed. The device was removed.
    A 10 mm x 10 cm Viabon covered endoprosthesis was prepped in the
    usual fashion and brought through the right external iliac artery
    sheath. This was deployed from the right common iliac artery origin
    into the right external iliac artery. Delivery catheter was removed.
    8 mm x 4 cm balloon was placed and 8 mm angioplasty performed
    throughout the stented segment. Balloon was removed and followup
    angiogram was obtained. A 10 mm x 5 cm Gore Viabon endoprosthesis
    was prepped in the usual fashion and brought through the right
    external iliac artery sheath and after position angiography was
    deployed in the distal right external iliac artery. Delivery
    catheter was removed. 8 mm x 4 cm balloon was placed and 8 mm
    angioplasty performed throughout the right common and external iliac
    artery. Balloon was removed and followup angiogram was obtained.
    Attempt was again made to place the protective device which failed.
    18 gauge needle was used to puncture the left common femoral artery.
    Wire was advanced to the abdominal aorta. Long 6-French sheath was
    placed. Sos catheter was placed and manipulated into the right
    external iliac artery. Catheter was removed. 10 mm x 4 cm balloon
    was placed and 10 mm angioplasty performed throughout the right
    common iliac and external iliac artery at the stented segment.
    Followup angiogram was obtained showing active extravasation. A
    balloon was inflated for a tamponade at the area of rupture below the
    previously placed iliac stent graft. A 12 mm x 14 cm Gore excluder
    iliac limb was prepped in the usual fashion and this was brought over
    the wire in the right external iliac artery and balloon was deflated.
    Excluder endograft was deployed from the right common iliac limb to
    the distal most right external iliac artery. Delivery catheter was
    removed. 10 mm balloon was placed and 10 mm balloon angioplasty was
    performed throughout the upper portion of the excluder limb. 8 mm
    balloon was placed and 8 mm angioplasty performed throughout the
    lower porion of the excluder limb. Balloon was removed and followup
    angiogram was obtained. A second 28 mm x 15 cm Gore thoracic
    endoprosthesis was prepped in the usual fashion and this was brought
    through the sheath in the right external iliac artery and again
    attempt was made to place the endograft which failed. This was
    removed. Sheath was removed.
    10 mm Gore-Tex graft was sutured onto the Gore excluder iliac limb
    and brought out through the right groin incision. Gore introducer
    sheath was placed through this Gore limb and manipulated to the level
    of the external iliac artery. 10 mm balloon was placed and 10 mm
    angioplasty again performed throughout the right common and external
    iliac artery. Balloon was removed. 28 mm x 15 cm Gore-Tex device
    was again placed through the right groin sheath and manipulated to
    the level of the thoracic aorta. Marker pigtail catheter was placed
    through the left common femoral sheath. Biplane thoracic aortogram
    was obtained. Gore tag device was deployed from the celiac axis up
    to the upper portion of the thoracic aneurysm. Delivery catheter was
    removed. a second 28 mm x 15 cm Gore endoprosthesis was prepped in
    the usual fashion and brought through the right groin sheath and
    manipulated to the descending thoracic aorta. This was deployed from
    the descending thoracic aorta into the previously placed tag device.
    Delivery catheter was removed. Trilobed balloon catheter was placed
    and trilobed balloon angioplasty performed throughout the descending
    thoracic aortic stent graft. Balloon was removed. Pigtail catheter
    was placed and biplane aortogram was obtained. Selective pelvic
    arteriogram was obtained. Sos catheter was placed in the right iliac
    limb. Balloon was placed from the left common femoral artery sheath
    into the right iliac limb and inflated and for vascular control. The
    right common femoral artery was resected and bypass was performed
    from the right external iliac limb to the right common femoral
    artery. Occlusion balloon was removed. Soft tissues were closed in
    the usual fashion. The left external iliac artery sheath was removed
    and arteriotomy closed with Star Close closure device. Patient
    tolerated the procedure well with no apparent complications.

    FINDINGS: Initial pelvic arteriogram demonstrates diffusely small
    calcified vessels throughout with significant right external iliac
    artery stenosis. 8 mm angioplasty throughout the right common and
    external iliac artery with followup angiogram demonstrates improved
    luminal diameter however inability to place the thoracic graft. A
    stent graft was placed from the common iliac to the distal external
    iliac artery as described above with 8 mm and 10 mm angioplasty.
    Followup angiogram demonstrates area of hemorrhage within the
    external iliac artery below the level of the grafted segment.
    Placement of Gore excluder endograft as described above from the
    right common femoral to the distal most right external iliac artery
    with 8 and 10 mm angioplasty as described above. Followup angiogram
    demonstrates widely patent limb. Dual limb anastomosis to the right
    external iliac artery as described above to allow for access with the
    tag device. Placement of two 28 mm x 15 cm Gore thoracic
    endoprosthesis as described above with occlusion angioplasty
    throughout the stented segment. Followup angiogram demonstrates
    complete exclusion of the very large descending thoracic aortic
    aneurysm. Patent celiac axis and superior mesenteric arteries.
    Followup angiogram demonstrates small infrarenal abdominal aortic
    aneurysm with widely patent right common and external iliac limb.
    Widely patent right common femoral artery bypass graft.

    IMPRESSION:
    1. Large descending thoracic aortic aneurysm.
    2. Diffusely small calcified common and external iliac artery.
    3. Stent graft placement right common and external iliac artery with
    angioplasty as described above.
    4. Placement of Gore thoracic endoprosthesis through the right iliac
    endograft with complete exclusion of the large descending thoracic
    aortic aneurysm.
    5. Right external iliac and common femoral artery bypass graft
    widely patent.
    6. Good distal flow with intact pedal pulses bilaterally after
    intervention.

  2. Default Star close closure
    Noticed star close closure in note can anyone tell me
    who manufactures this and if there is a procedure code
    for this closure?

    Thanks for any info on this item brenda

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