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Thrombectomy and revision bypass graft

Date: Oct 29, 2010

Question:

9/20/10--I need assistance coding this vascular procedure--(1) Thrombectomy & Revision LT fem-tib bypass (2)Thrombectomy LT aortofem graft Limb--I think we should code this 35883 & 35876 but not sure. Procedure:Inc.over femoral anterior tibial bypass & bypass was exposed just above the knee. Transverse graftomtomy was made & fresh thrombus came out of the graft in both directions. A catheter passed proximally & distally & some organzied thrombus was returned. A french fogarty catheter could be passed all the way to the ankle. Some arterial backbleeding did occur distally, but was controlled with the Foagrt. Multiple attempts were made over the next hour to thrombectomize the proximal portion of the bypass. The graft itself thrombectomized although there did appear to be a stenosis of the proximal anastomosis. However, I was unable to get the aortofemoral graft limb thrombectomized from here, mostly because of the presenc of a large amount of chronic mural thrombus within the aortofemoral limb itself. After about 1 hour of trying & breaking multiple catheter (in excess of 10) the decision was made to open the groin incision. The ongitudinal incision was made & anastomosis was identified. A graftomomy was made in the hood of the femorotibial graft & then extended onto the aortofemoral graft limb. Large amount of very old organized thrombus in the anastomosis & this was removed with pickups. A fogarty catheter was advanced proximally & inflow was finally able to be established. The fogarty was used for inflow control. There was some backbleeding from the profunda, but not a large amount. The anastomosis was repaired with a Dacron patch angioplasty.After this was completed & catheter removed, there waqs good flow down to the fraftomtomy in the distal thigh. A fogarty cath was passed once more, no thrombus returned & this graftotomy was closed. Upon release of clamps, there was a strong pulse throughout the left femoral to anterior tibial artery bypass & a reasonable dorsalis pedis doppler signal in the proximal foot. Decision was made to close the groin incision & the counter incision in the distal thigh. Dry gauze dressing placed on both incisions.

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