Lower Extremity Invasive Diagnostic and Endovascular Procedures
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Management of Acute Limb Ischemia in the Emergency Department
edicine: O M p y e c n n A e c g c r e e s Diaconu, Emerg Med (Los Angel) 2015, 5:6 s m E Emergency Medicine: Open Access DOI: 10.4172/2165-7548.1000E139 ISSN: 2165-7548 Editorial Open Access Management of Acute Limb Ischemia in the Emergency Department Camelia C Diaconu* University of Medicine and Pharmacy “Carol Davila”, Clinical Emergency Hospital of Bucharest, Romania *Corresponding author:Camelia C Diaconu, MD, Ph.D, University of Medicine and Pharmacy “Carol Davila”, Clinical Emergency Hospital of Bucharest, Romania, E- mail: [email protected] Received date: October 19, 2015; Accepted date: October 23, 2015; Published date: October 30, 2015 Copyright: © 2015 Diaconu CC. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Editorial lab, under local anesthesia, in patients with Rutherford IIa ischemia. Patients with Rutherford IIb ischemia need immediate surgical Acute limb ischemia (ALI) is an emergency condition caused by the revascularization. The endovascular interventions have the best results sudden occlusion of an artery. The tissue perfusion is compromised in the femuro-popliteal segment and in the thrombosed vascular grafts and the viability of the limb is threatened. The etiology of acute limb or thrombosed stents (compared to thrombosed native arteries). ischemia may be acute thrombosis, an embolic event or trauma. Catheter-directed thrombolysis is a technique that uses thrombolytic Sometimes, it appears when thrombosis occurs on a pre-existing agents (plasminogen activators). -
Percutaneous Revascularization of the Lower Extremities in Adults Table of Contents Related Coverage Resources
Medical Coverage Policy Effective Date ............................................. 3/15/2021 Next Review Date ....................................... 3/15/2022 Coverage Policy Number .................................. 0537 Percutaneous Revascularization of the Lower Extremities in Adults Table of Contents Related Coverage Resources Overview.............................................................. 1 Venous Angioplasty and/or Stent Placement in Adults Coverage Policy .................................................. 1 General Background ........................................... 2 Medicare Coverage Determinations .................. 17 Coding/Billing Information ................................. 17 References ........................................................ 19 INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage -
Choosing the Correct Therapeutic Option for Acute Limb Ischemia
REVIEW Choosing the correct therapeutic option for acute limb ischemia Acute limb ischemia (ALI) occurs due to abrupt interruption of arterial flow to an extremity, which may lead to loss of limb or life. ALI is typically caused by either a thrombotic or embolic arterial occlusion. Management strategies, which may not be mutually exclusive, include anticoagulation and observation, catheter-directed thrombolysis and/or surgical thrombectomy. The therapeutic choice depends on the patient functional status, severity of ischemia and time required for treatment. A logical approach to the evaluation and management of patients with ALI is presented in this article. 1 KEYWORDS: acute limb ischemia n arterial embolus n arterial thrombosis Jeffrey A Goldstein & n catheter‑directed thrombolysis n limb salvage n peripheral arterial disease Gregory Mishkel†1 n thrombectomy n thrombolysis 1Prairie Cardiovascular Consultants, PO Box 19420, Springfield, IL 62794-9420, USA Present day cardiology has evolved from exclu- disease (PAD) may eventually develop ALI †Author for correspondence: sively directing the cardiologic health of patients, [3]. The majority of ALI cases (85%) are due Tel.: +1 217 788 0708 Fax: +1 217 788 8794 to additionally managing their vascular health. to in situ thrombosis, with the remaining 15% [email protected] Increasingly, both general and particularly inter- of cases due to embolic arterial occlusion. The ventional cardiologists are called upon to man- vast majority of emboli, upwards of 90%, are age the care of the patients in their practice when cardiac in etiology [6] and are usually due to they present with acute vascular emergencies. either atrial fibrillation or acute myocardial inf- Unfortunately, subsequent to their subspecialty arction. -
Peripheral Angioplasty – Revascularization: Femoral/Popliteal Artery(S)
Surgical Services: Peripheral Angioplasty – Revascularization: Femoral/Popliteal Artery(s) POLICY INITIATED: 06/30/2019 MOST RECENT REVIEW: 06/30/2019 POLICY # HH-5675 Overview Statement The purpose of these clinical guidelines is to assist healthcare professionals in selecting the medical service that may be appropriate and supported by evidence to improve patient outcomes. These clinical guidelines neither preempt clinical judgment of trained professionals nor advise anyone on how to practice medicine. The healthcare professionals are responsible for all clinical decisions based on their assessment. These clinical guidelines do not provide authorization, certification, explanation of benefits, or guarantee of payment, nor do they substitute for, or constitute, medical advice. Federal and State law, as well as member benefit contract language, including definitions and specific contract provisions/exclusions, take precedence over clinical guidelines and must be considered first when determining eligibility for coverage. All final determinations on coverage and payment are the responsibility of the health plan. Nothing contained within this document can be interpreted to mean otherwise. Medical information is constantly evolving, and HealthHelp reserves the right to review and update these clinical guidelines periodically. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from HealthHelp. All trademarks, -
Clinical Value of Pelvic and Penile Magnetic Resonance Angiography in Preoperative Evaluation of Penile Revascularization
International Journal of Impotence Research (1999) 11, 83±86 ß 1999 Stockton Press All rights reserved 0955-9930/99 $12.00 http://www.stockton-press.co.uk/ijir Clinical value of pelvic and penile magnetic resonance angiography in preoperative evaluation of penile revascularization H John*1, GM Kacl2, K Lehmann1, JF Debatin2 and D Hauri1 1Department of Urology, University Hospital Zurich, Switzerland and 2Department of Radiology, University Hospital Zurich, Switzerland Penile angiography is invasive, costly and requires postinterventional surveillance. The aim of this pilot study was to determine whether three dimensional magnetic resonance (3D-MR)- angiography may replace conventional penile angiography in preoperative planning of penile revascularization. Twelve patients with a mean age of 39 (21 ± 59) y were evaluated. All patients underwent evaluation with intracavernous pharmacotesting, color Doppler sonography (CDS), digital subtraction angiography (DSA) and pelvic MR-angiography with gadolinium diethylene- triaminepentaacetic acid (Gd-Dota) 0.2 ± 0.3 mmol=kg body weight. MR-angiography demonstrated the anatomy of the internal iliac arteries in 9 out of 12 patients. Intrapenile vessels were visible in 7 out of 12 patients. In comparison DSA provided complete visualization of all pelvic and penile vessels. Relevant arterial obstruction was found in 10 out of 12 patients. CDS revealed a mean maximal arterial ¯ow of 27 (22 ± 40) cm=s and showed in accordance to angiography arterial insuf®ency in 10 out of 12 cases. Indication for revascularization could have been based on MR- angiography alone in only one patient. Therefore, selective penile angiography remains the `gold standard' for preoperative planning of revascularization procedures. -
Management of Patients Undergoing Coronary Artery Revascularization
ACCF/AHA Pocket Guideline Management of Patients Undergoing Coronary Artery Revascularization November 2011 Adapted from the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons) © 2011 by the American College of Cardiology Foundation and the American Heart Association, Inc. The following material was adapted from the 2011 ACCF/AHA/ SCAI guideline for percutaneous coronary intervention. J Am Coll Cardiol 2011; doi: 10.1016/j.jacc.2011.08.007; and the 2011 ACCF/ AHA guideline for coronary artery bypass graft surgery. J Am Coll Cardiol 2011; doi: 10.1016/j.jacc.2011.08.009. This pocket guideline is available on the World Wide Web sites of the American College of Cardiology (www.cardiosource.org) and the American Heart Association (my.americanheart.org). For copies of this document, please contact Elsevier Inc. Reprint Department, e-mail: [email protected]; phone: 212-633-3813; fax: 212-633-3820. Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American College of Cardiology Foundation. Please contact Elsevier’s permission department at [email protected]. Contents 1. Introduction ............................................................................................. -
Acute Limb Ischemia
Acute Limb Ischemia R. J. Guzman M. J. Osgood 10/7/11 Outline • Etiologies • Classification • Presentation • Workup/diagnosis • Management • Outcomes Etiologies • Embolic • Thrombotic • Bypass Graft Occlusion • Trauma • Iatrogenic • Other – Popliteal entrapment syndrome – Popliteal aneurysm Embolic Sources • Cardiac – Atrial – Ventricular - mural thrombus – Paradoxical – Endocarditis – Cardiac tumor (atrial myxoma) • Noncardiac – Atheroembolism – Aortic mural thrombus Embolism • Emboli usually lodge at arterial bifurcations • Most common locations: – Common femoral artery – Popliteal artery • Embolic ischemia is usually poorly tolerated because it often occurs in non-diseased peripheral arteries without established collaterals Acute popliteal embolism in patient without established collaterals Embolism • Embolic ischemia is progressive because thrombus propagates proximal and distal to the embolus Embolism • Embolic ischemia is progressive because thrombus propagates proximal and distal to the embolus Thrombotic Sources • Atherosclerotic obstruction • Hypercoagulable states • Aortic or arterial dissection Atherosclerotic obstruction • Acute thrombosis of a narrowed, atherosclerotic peripheral artery • Usually better tolerated because involved vessel has well-developed collaterals • May be asymptomatic or present as acute claudication or rest pain • May result from plaque disruption or from global reduction in cardiac output in patients with atherosclerotic burden Hypercoagulability • Inherited and acquired thrombophilias • Low arterial -
Vela Proximal Endograft System Phoenix Atherectomy System
A PREVIEW OF today’s NEW PRODUCTS ONS I Vela Proximal Endograft System Endologix (Irvine, CA) has Endologix announced the United States (949) 595-7200 launch of the FDA-approved INNOVAT www.endologix.com/Vela Vela proximal endograft sys- KEY FEATURES tem, which is designed for • Circumferential graft line marker the treatment of proximal for enhanced visibility aortic neck anatomies during • New delivery system endovascular aneurysm repair. • ActiveSeal technology The Vela system, which was developed with feedback from leading physicians, features a new delivery system and a circumferen- tial graft line marker for enhanced visibility during the implantation procedure. One of the first Vela procedures in the United States was performed by Julio Rodriguez, MD, FACS, a vascular surgeon at the Arizona Heart Institute in Phoenix, Arizona. In the company’s press release, Dr. Rodriguez commented, “The Vela delivery system is very intuitive, and the endograft has excellent visibility.” Phoenix Atherectomy System AtheroMed, Inc. (Menlo Park, CA) AtheroMed, Inc. has received CE Mark approval and FDA (650) 473-6846 510(k) clearance to market the Phoenix www.atheromedinc.com Atherectomy System, a pushable, over-the- KEY FEATURES wire system that uses a rotating, front-cut- • Cut, capture, and clear mechanism ting element located at the distal tip of the of action catheter to shave diseased material directly • Able to treat soft plaque or calcium • Profile down to 5 F into the catheter. The debulked material is • No capital equipment required then continuously captured and removed • Front-cutting, single insertion by an internal Archimedes screw that runs the length of the catheter. -
Diagnosing and Treating Vascular Disease
THE CENTER FOR VASCULAR CARE AT WASHINGTON HOSPITAL CENTER Diagnosing and Treating Vascular Disease If you have symptoms of vascular disease or Peripheral Artery Disease (PAD), the best thing to do is see your physician for examination and possible testing. And, if you have the following risk factors, see your doctor to determine if you should be tested. The Center for Vascular Care at Washington Hospital Center can provide painless, risk free tests and the most complete array of treatment options for vascular disease in the region. RISK FACTORS TESTING FOR VASCULAR DISEASE FOR VASCULAR DISEASE Ankle-brachial Index: Patients with leg I Cigarette smoking artery blockage are at increased risk of I Older than age 50* heart attack and stroke. This test (ABI) is I Obesity a simple, safe, painless test for blockages. A blood pressure cuff is placed above I Diabetes the ankles and pressures are measured I Heart disease compared to arm pressures to determine I High Cholesterol the risk of cardiovascular events. It takes I High-stress lifestyle 5–10 minutes. I High blood pressure Carotid Duplex Scan: Blockage in a major I Family history of aneurysms artery increases the likelihood of a stroke. *Over age 65 if no other risk factors exist Thickening of the walls of the carotid arteries can lead to heart attack. An arterial SYMPTOMS OF VASCULAR DISEASE duplex scan is a safe, painless, highly I Leg pain that goes away with rest accu rate method of determining blockage. A sound wave device, placed lightly on the I Numbness of the legs or feet at rest skin, can tell if there is a problem. -
Literature Summary: Clinical Use of Eptfe Pediatric Shunts
Literature Summary: Clinical Use of ePTFE Pediatric Shunts P E R F O R M A N C E through experience Pediatric shunts are small diameter (3 – 6 mm) vascular connections (native vessels or synthetic vascular grafts) between systemic and pulmonary circulations. The shunts provide additional blood flow to the lungs as a palliative procedure in patients with cyanotic congenital heart disease (CCHD). Expanded polytetrafluoroethylene (ePTFE) vascular grafts are routinely used as pediatric shunts due to their superior performance and ease of use compared to native vessels. As surgical technique and post-operative care has improved, pediatric cardiac surgeons are palliating and repairing increasingly complex lesions which, not long ago, were considered uniformly fatal conditions. The alternatives for these infants are limited. Complications associated with the surgical procedures and the use of prosthetic shunts in these complex defects are multivariate and have not been completely eliminated. These complications, including shunt thrombosis, are experienced by all pediatric cardiac surgeons at all hospitals throughout the world. Although the use of ePTFE shunts is not without complications, to date it is reported in the literature as the best surgical strategy available. PALLIATIVE PEDIATRIC SHUNT PROCEDURES 1980s to 2000, the performance of CBTS (native vessels) and MBTS (ePTFE grafts) were evaluated. In a comparative study of Systemic-to-pulmonary artery shunts are palliative procedures 12 CBTS and 27 MBTS, combined early and late shunt failure performed in the neonatal period for patients with severe CCHD was 33% for CBTS and 41% for MBTS 24. One shunt related death associated with diminished or absent pulmonary blood flow. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
Final Addenda Fy 1999 Icd-9-Cm Volume 3, Procedures
FINAL ADDENDA FY 1999 ICD-9-CM VOLUME 3, PROCEDURES Tabular List 36 Operations of vessels of heart Add code also Code also any injection or infusion of platelet inhibitor (99.20) 36.04 Intracoronary artery thrombolytic infusion Revise exclusion term Excludes: infusion of platelet inhibitor (99.20) infusion of thrombolytic agent (99.10) New category 36.3 Other heart revascularization Delete inclusion term Abrasion of epicardium Delete inclusion term Cardio-omentopexy Delete inclusion term Intrapericardial poudrage Delete inclusion term Myocardial graft: Delete inclusion term mediastinal fat Delete inclusion term omentum Delete inclusion term pectoral muscles New code 36.31 Open chest transmyocardial revascularization New code 36.32 Other transmyocardial revascularization Percutaneous transmyocardial revascularization Thoracoscopic transmyocardial revascularization New code 36.39 Other heart revascularization Abrasion of epicardium Cardio-omentopexy Intrapericardial poudrage Myocardial graft: mediastinal fat omentum pectoral muscles 37 Other operations on heart and pericardium Add code also Code also any injection or infusion of platelet inhibitor (99.20) 37.32 Excision of aneurysm of heart Add inclusion term Repair of aneurysm of heart New code 37.67 Implantation of cardiomyostimulation system Note: Two-step open procedure consisting of transfer of one end of the latissimus dorsi muscle; wrapping it around the heart; rib resection; implantation of epicardial cardiac pacing leads into the right ventricle; tunneling and pocket creation for