Ask Dr. Z

This patient was brought in for repair of iliac aneurysm and AAA. A bifurcated graft was placed and in addition, a stent was placed inside of the iliac limb of the graft due to vessel tortuosity. CPT book indicates that 37221 iliac stent is for occlusive disease. We have 34803, 75952, 36200 x2. Main body stent graft 32 x 96 was advanced from a right approach into the abdominal aorta. The contralateral limb was oriented anterolaterally. Proximal 2 stents were deployed and position adjusted to just below the level of the renal arteries. Contralateral limb was deployed. The suprarenal stent was deployed and catheter was pulled back to the distal abdominal aorta. Catheter was exchanged to a Kumpe catheter and later a Vanshee catheter. Contralateral gate was cannulated using the Vanshee catheter. Intraluminal position was confirmed by injecting a small amount of contrast within the graft. Lunderquist wire was advanced to the upper descending thoracic aorta. The catheter was removed. Left iliac arteriogram was performed to evaluate the common iliac bifurcation. A left limb 14 x 90 was advanced from a left approach to about 1-1/2 stent overlap. The stent was deployed proximal to the common iliac bifurcation. Due to tortuosity of the common iliac artery, it was decided to place a self expanding stent to increase radial force. A 14 mm x 60 mm SMART stent was deployed within the left iliac limb. The remaining 2 stents from the main body were deployed and nose cone was retrieved. Right iliac arteriogram was performed. Right limb 12 x 107 was advanced from a right approach to the right iliac limb. 2 stents overlap proximally and distally. The stent was deployed in the proximal right external iliac artery covering the origin of the right hypogastric. The infrarenal neck areas overlap and distal limbs were dilated using compliant balloons. The stent on the left was dilated using a 12 mm angioplasty balloon. Completion arteriogram was performed through a pigtail catheter from a left approach.