Welcome to the STS-ACC TVT Registry February 2022 case scenario. This month, we will review sequence number 9002, intra-post-procedure events occurred. Fascular complication minor. In this scenario, the patient is an 86-year-old male with a diagnosis of severe aortic stenosis who presents for TAVR. Both the right and left groins were punctured for the procedure. However, the right groin was the access through which the valve was delivered. After the procedure, the patient complained of left groin pain. There was no active bleeding, and it was not associated with, number one, a hemoglobin drop of greater than or equal to three grams per deciliter, or, number two, a transfusion of whole blood or packed red blood cells. An ultrasound revealed a pseudoaneurysm, which was treated with a thrombin injection. The question is, is the pseudoaneurysm in the left groin a vascular complication minor, number one, no, or number two, yes? Please take a few moments to review the documentation and the question prior to making your final selection. And the answer is number two, yes. Sequence 9002 intrapost procedure events occurred would be coded as yes for vascular complication minor. Per the data definition, there is an indication of an access-related vascular injury, and in this scenario, specifically, a pseudoaneurysm that did not lead to death, life-threatening, or major bleeding, visceral ischemia, or neurological impairment. Additionally, within the data dictionary, sequence number 9002 cites the updated standardized endpoint definitions for transcatheter aortic valve implantation, published in 2012 in Table 7, which is where these definitions are directly pulled. Finally, it is important to mention that also within this document, it clearly states that VARC 2 recommends that all vascular complications be recorded as either access or, as in this case, non-access, site-related, also known as access-related. In addition to vascular complication minor, what other events would be coded in sequence number 9002? We'll provide a hint. It's two others. The answer is, number one, bleeding other, as the patient experienced bleeding from a site not otherwise specified, a non-access site pseudoaneurysm that required a procedural intervention or surgery at the bleeding site to reverse stop or correct the bleeding, which is criteria number three. And the second event, vascular surgery or intervention unplanned, would be captured for the thrombin injection. We hear quite often, as you might imagine, it was one event. Why is it captured three times? Essentially, any single event may be captured in three different places. So while it seems as though it is triple coding, it is capturing different things. First, it captures the actual event, in this case, the pseudoaneurysm as a bleed. Then it captures how it was fixed, whether it was unplanned cardiac or vascular procedure surgery. And lastly, it captures its significance when coding it as major or minor. Thank you for viewing the February 2022 STS ACC TVT Registry Case Scenario. We'll see you next month.

TAVR procedure

aortic stenosis

groin pain

pseudoaneurysm

bleeding