This 53-year-old female has a known left common iliac artery occlusion status post failed attempt with an antegrade approach from the left femoral was brought in today for attempt from the left brachial. Procedure, risks, benefits, alternative options were explained. Risks including bleeding, infection, cerebrovascular accident, myocardial infarction, death, and arrhythmia were all explained patient was agreeable. He was brought into the cardiac cath lab where conscious sedation (moderate sedation) was performed by myself using Versed and fentanyl. Conscious sedation was started 8:26 AM and monitoring period Ended 10:16 AM. I was present throughout this whole entire period With the patient. Both groins were prepped and draped in the usual fashion. 2% lidocaine was used to anesthesize the skin. Using modified Seldinger technique, a 6 French sheath was inserted in the right femoral artery and the left brachial artery. A long destination sheath was inserted from the left brachial artery into the distal aorta at the bifurcation. The 6 French sheath from the right femoral artery was also a long sheath that was advanced to the distal aorta. .
Finding:
1: Repeat angiogram did show the occlusion in the left common iliac artery. There is barely any knob.
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Intervention:
With a support of an angled 4 French glide catheter, allowing zip wire was able to cross the occlusion all the way to the common femoral artery. The glide catheter was advanced over it. The wire was removed and angiogram so the catheter showed that we were all intraluminal. A V 18 wire was then used and advanced into the left superficial femoral artery. The catheter was then removed. The occlusion was dilated with a 5 x 80 mm balloon. As the occlusion was proximal, I decided to perform kissing stenting as I could not ensure that the stent placement in the origin of the common iliac artery would not impinge on the origin of the right common iliac artery. Since the occlusion is long I covered the distal occlusion with a 8 x 60 mm epic self-expanding stent. Following that simultaneous 8 x 27 mm express of the balloon-expandable stents were placed in the origin of bilateral common iliac artery in a kissing fashion with excellent result and no residual stenosis
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Impression:
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100% occlusion of the origin of the left common iliac artery. I placed a 8 x 80 mm epic self-expanding stent in the common iliac artery. The origin of bilateral common iliac arteries were covered with an 8 x 27 mm express LD balloon expandable stents in a kissing fashion
Plan: Continue medical treatment with dual antiplatelet therapy and aggressive risk factor control

thanks in advance
am I only coding 37221-50 or should I add 37223-lft also?