Ask Dr. Z

My surgeon approaches this like an endovascular AAA repair; however, it is for severe atherosclerotic disease (not aneurysm), so I know we need to use lower extremity stent codes. My problem is deciding what is bundled due to inflow/outflow. HELP! "Bilateral fem exposures were made, and embolectomy was performed on one side just to get to aorta to take grams, which revealed patency of renal arteries and abdominal aorta to just inferior IMA, then occluded. Right external iliac is occluded. Large amount of thrombus both chronic and subacute from aorta and right iliac arteries retrieved. Flow was established and majority of clot burden removed. Good flow down the right iliac with multiple areas of stenosis and dissection. Neither internal iliacs filled, nor did the left common or left external iliacs. Angioplastied aorta, bilateral common iliacs, and bilateral external iliacs. Bilateral femoral embolectomy performed with severe residual stenosis. Bilateral stents from IMA into origin each common iliac. Two more bilateral common iliac stents. Two bilateral external iliac stents. On the right, common iliac residual disease beyond the stent at site of initial femoral incision required full endarterectomy with large core removed."