Also, a different physician (who is not in our practice) did the angioplasty during the same surgical session. Co-surgeons mod? Is what my doc did even billable? Doesn’t cath placement bundle with intervention?
DESCRIPTION OF PROCEDURE: Risks and benefit of the procedure were explained to the patient and the patient was placed in the supine position on the Cath Lab table. He was draped in a sterile fashion and access of the right femoral artery was achieved under ultrasound guidance using a micropuncture kit. A 6-French sheath was inserted into the right femoral artery under ultrasound guidance. This was followed by insertion of a crossover catheter. A Glidewire was advanced into the crossover catheter to cross into the left common iliac. The Glidewire was selecting the internal iliac. The crossover catheter was advanced gently. This was followed by insertion of the J-tip wire into the superficial femoral artery and advancing the crossover catheter over it until the wire was far enough into the superficial femoral artery. This was followed by removal of the crossover catheter and advancing of a long sheath. The 45 cm Terumo sheath was advanced into the external iliac artery. On the left side, After the sheath was advanced into the left external iliac artery a selective angiography of the left lower extremity was performed. Multiple views were obtained to delineate the severity of stenosis in the left superficial femoral artery. A runoff was performed to the level of the foot on the left side. This was followed by attempts to cross the superficial femoral artery using a BMW wire. Multiple attempts were done; however, the BMW wire was not possible to cross into the lesion. An angiography revealed that the BMW wire is stuck in the lesion. Multiple attempts to remove the BMW wire was not successful. After more attempts, the distal end of the wire, which was attached to the stiff end of the wire broke off and the wire was lodged into the lesion. A Quick-Cross 0.035 sheath was or microcatheter was advanced over a Pilot 200 wire. The Pilot 200 wire was advanced beyond the lesion and the microcatheter was advanced over the BMW portion of the wire. A surgical backup was called regarding the fact that the superficial femoral artery flow was impaired. The Pilot 200 wire was beyond the lesion; however, it was not free enough to confirm that it is intraluminal therefore the Quick-Cross catheter was removed along with the Pilot 200 wire by Dr. Burke. This was followed by confirming that the BMW portion of the wire was removed with a Quick-Cross catheter. A confirmation was obtained and a Quick-Cross catheter removal was successfully done along with a portion of the BMW wire. A NanoCross catheter was advanced along with an angled Glidewire. This was successfully able to cross the lesion in the SFA. This was followed by advancing a 4 x 40 balloon, which was inflated 2 times in the lesion. This was followed by advancing a 6 x 100 _____ drug-coated balloon. The balloon was inflated once for 3 minutes with slow deflation. Angiography after removal of the balloon and wire showed no dissection that is flow limiting and no perforation.
The sheath was withdrawn into the external iliac artery on the right and this was followed by advancing a short 6-French sheath. A selective angiography of the right lower extremity was performed through the 6-French sheath down to the foot level.
FINDINGS OF THE STUDY: There was evidence of a 30% lesion in the external iliac artery on the left. The superficial femoral artery on the left had evidence of 80-90% mid SFA stenosis. The _____ artery was normal. There was evidence of 3-vessel runoffs was evidence of 40% proximal anterior tibial artery stenosis, 50% proximal peroneal stenosis.
On the right side, there was evidence of 30% external iliac stenosis.
Superficial femoral artery had evidence of 50-70% stenosis in the midportion with significant calcification. There was evidence of 40% stenosis in the popliteal artery. There was evidence of 3-vessel runoff down to the level of the foot.
CONCLUSION:
1. Severe disease in the SFA on the left. Moderate to severe disease in the SFA in the right.
2. Successful angioplasty of the left superficial femoral artery performed by
COMPLICATIONS: BMW wire fractured with a successful recovery of the fractured portion.