Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, a
CPT4 code
Name of the Procedure:
Endovascular Venous Arterialization Technical Terms: Tibial or Peroneal Vein Endovascular Arterialization, Transcatheter Stent Graft Placement
Summary
Endovascular venous arterialization is a minimally invasive procedure aimed at redirecting blood flow from the arteries to the veins in the lower leg. This method involves placing stent grafts and creating a new route for blood flow, typically accessed via a catheter inserted through a vein in the leg.
Purpose
This procedure is primarily used to address severe chronic limb-threatening ischemia (CLI), a condition where there is significant restriction of blood flow to the legs and feet. The goal is to improve blood circulation, thereby reducing pain, promoting healing of ulcers, and avoiding the need for limb amputation.
Indications
- Severe chronic limb-threatening ischemia (CLI)
- Non-healing ulcers or wounds due to poor blood flow
- Rest pain in the legs indicating critical lack of blood supply
- Patients who have not responded to conventional treatments or are not candidates for open surgical revascularization
Preparation
- Patients may be instructed to fast for 6-8 hours before the procedure.
- Certain medications, especially blood thinners, may need to be adjusted or stopped.
- Pre-procedure assessments often include blood tests, imaging like ultrasound or angiography to map the blood vessels, and a thorough review of the patient’s medical history.
Procedure Description
- Vascular Access: The procedure typically starts with gaining access to a vein in the leg, often with the aid of ultrasound guidance.
- Catheter Insertion: A catheter is then inserted and guided to the target veins and arteries.
- Stent Graft Placement: Using fluoroscopic guidance, stent grafts are placed to create a new channel between the arterial and venous systems.
Closure: Access sites are closed either percutaneously (through the skin) or with a small open incision.
Anesthesia used can be local or general depending on the patient's condition and the complexity of the procedure.
Duration
The procedure generally takes between 2 to 4 hours, depending on the complexity and the specific techniques used.
Setting
This procedure is typically performed in a hospital setting, often in a specialized vascular or interventional radiology suite.
Personnel
- Interventional Radiologist or Vascular Surgeon
- Anesthesiologist
- Vascular Technologists
- Nursing Staff trained in vascular interventions
Risks and Complications
- Infection at the access site
- Bleeding or hematoma
- Blood vessel damage or dissection
- Stent graft displacement or failure
- Allergic reaction to contrast dye used in imaging
- Deep vein thrombosis (DVT) or embolism
Benefits
- Improved blood flow to severely ischemic limbs
- Reduction in pain and faster healing of ulcers
- Lower risk of limb amputation
- Enhanced quality of life
Recovery
- Patients typically stay in the hospital for observation for 1-2 days post-procedure.
- There may be some pain or swelling at the incision site; pain management includes medications and rest.
- Follow-up appointments are necessary to monitor the success of the procedure and check for any complications.
- Activities might be limited for a few weeks, especially heavy lifting and extensive walking.
Alternatives
- Open surgical revascularization
- Angioplasty without stent placement
- Medication management (antibiotics, vasodilators)
- Conservative wound care and hyperbaric oxygen therapy
- Amputation in severe cases
Each alternative has its pros and cons. Open surgery might provide more long-term results but comes with higher risks and longer recovery. Medications and conservative care might be less invasive but may not be effective in severe cases.
Patient Experience
During the procedure, patients may be under sedation or general anesthesia, thus experiencing minimal discomfort. Post-procedure, some soreness or bruising at the access site is common. Pain management will be provided, and most patients report significant improvement in the symptoms related to limb ischemia within a few weeks to months. Regular follow-up visits ensure long-term success and address any late complications.