Here is what I came up with:
75630-26
37224-RT
37228-RT
99152
I73.9
Thank you in advance!
PROCEDURES:
1. Distal aortogram.
2. Distal runoff bilaterally.
3. CSI, right SFA and posterior tibial artery.
4. PTCA, popliteal and posterior tibial artery.
5. Drug-coated balloon angioplasty, distal SFA/popliteal artery.
INDICATIONS:
Claudication.
DESCRIPTION OF PROCEDURE:
The risks and benefits of lower extremity angiography and PCI were discussed
with the patient. He is agreeable to procedure. Consent was obtained.
Time-out was performed. The patient, physician, and procedure to be
performed were identified.
The patient was given Versed 1 mg and fentanyl 50 mcg intermittently
during the procedure for conscious sedation.
The patient was prepped and draped in the normal fashion. A 1% lidocaine
was generously infiltrated into the left groin region. The common femoral
artery was accessed with ultrasound guidance. A 6-French sheath was
introduced without difficulty. Distal aortogram was performed using
a Contra catheter. Distal aortogram showed ectatic abdominal aorta.
The renal arteries are patent bilaterally.
The right and left common iliac, internal and external iliac arteries
were without significant disease.
The right and left common femoral artery are also without significant disease.
On the right side, the superficial femoral artery has mild plaquing in
the mid and distal segment. The popliteal artery had diffuse 70% to
80% stenosis. The anterior tibial artery was totally occluded in the
proximal segment. The posterior tibial artery was also occluded in
the proximal segment. The peroneal artery had 90% proximal stenosis.
On the left side, there was mild popliteal disease, 40% to 50%. The
distal posterior tibial trunk had 90% stenosis. The peroneal artery
is totally occluded. The posterior tibial artery had ostial 90% stenosis.
The anterior tibial artery was totally occluded at the ostial/proximal
segment.
Our attention was directed to the right popliteal and peroneal artery.
A 6-French Terumo 45 cm catheter was used to go up and over from the
left to the right external iliac artery. The FiberWire was advanced
to the popliteal artery. We were able to cross the stenosis with backup
with a Quick-Cross support. The wire was exchanged for a ViperWire.
We did multiple runs with a CSI 1.5 bur. This was followed by PTCA
with a NanoCross 3.0/115 mm balloon. The distal SFA/proximal popliteal
artery was post dilated with a TrailBlazer drug-coated balloon 3.5/120
mm.
Final angiography showed the previous 80% to 90% stenosis to have 0% stenosis.
At the end of procedure, the sheath was removed and a 6-French Angio-Seal
collagen sponge was successfully deployed. Good hemostasis was obtained.
The patient tolerated the procedure well and was transferred back to
the floor in stable condition. While in the cath lab here, he received
Plavix 300 mg and aspirin 325 mg x1.
DEVICE USED: CCL Dev Vasc Clos Angioseal BCE