Ask Dr. Z

Does the dissection below justify 37221 ? I have 34802,34812-50, 75952-26, 36200-50 with no true extension? Could you please advise? Bilateral groin incisions were created and we dissected down to the common femoral artery. We gained proximal and distal control and heparinized the patient with the appropriate amount of heparin. We cannulated each artery with large bore needles and inserted wires into the suprarenal aorta. Wires were switched out appropriately with a guide caths and placement of a stiff wire. We planned for deployment of the Medtronic Endurant stent graft, main body through the right limb and contralateral limb being managed by Dr. Kunstmann. We performed angiography and identified renal artery orifices. We planned for deployment of the stent graft in an infrarenal artery location and using spot fluoroscopy, we deployed the stent graft in an AP cross limb fashion. The contralateral gate was cannulated from the left lower extremity. Left lower extremity was measured to length with pigtail and fluoroscopy and when we had appropriate length, the left lower extremity or contralateral limb extension was placed by Dr. Kunstmann and brought down to the internal, external iliac junction. We deployed the remainder of the main body and limb into the right common iliac artery. ** There was a small area of dissection with aneurysmal dilatation that we felt needed to be covered and, therefore, we brought an atrium stent into the case and placed it into the sheath and further into the common iliac artery and deployed the atrium stent which was 8 x 38 stent, but ballooned up to a 12 balloon proximally.** Once this was complete, we used a Reliant balloon and ballooned as usual the proximal and distal extensions and gait junctions. Then we performed completion angiography. Completion angiography was satisfactory and; therefore, we removed the wires, catheters and sheaths, repaired the common femoral arteries with 6-0 Prolene suture in a running fashion.