36216 Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family

Name of the Procedure:

Selective Catheter Placement, Arterial System; Initial Second Order Thoracic or Brachiocephalic Branch, Within a Vascular Family

Summary

Selective catheter placement in the arterial system is a medical procedure where a catheter (a thin, flexible tube) is inserted into an artery and navigated to a specific branch within the thoracic or brachiocephalic region. This technique is used for diagnostic or therapeutic purposes, such as delivering contrast dye for imaging or administering medication directly to a targeted area.

Purpose

This procedure is typically performed to diagnose or treat vascular issues in the thoracic (chest) or brachiocephalic (arm and head) regions. It allows for precise delivery of medications, removal of blockages, or detailed imaging to assess blood flow and vascular health. The expected outcomes include better diagnosis of vascular conditions and effective treatment of localized arterial disorders.

Indications

• Symptoms like chest pain, arm/shoulder pain, or dizziness that may indicate vascular issues.
• Conditions such as arterial blockages, aneurysms, or vascular malformations in the thoracic or brachiocephalic regions.
• Patients with risk factors for vascular disease, such as hypertension, diabetes, or hyperlipidemia, showing relevant symptoms.

Preparation

• Fasting for 6-8 hours before the procedure.
• Medications: Adjusting or temporarily discontinuing certain medications, particularly blood thinners, as instructed by the doctor.
• Pre-procedure tests: Blood tests, electrocardiogram (EKG), and imaging studies like CT or MRI scans may be required.
• Arrive with a responsible adult for post-procedure transportation and support.

Procedure Description

1. Anesthesia: Local anesthesia is typically administered at the insertion site; conscious sedation may also be used.
2. Insertion: A small incision is made to access the artery, usually in the groin or wrist.
3. Navigation: A guidewire and catheter are carefully threaded through the arterial system to reach the targeted thoracic or brachiocephalic branch.
4. Imaging/Intervention: Contrast dye may be injected for imaging purposes, or therapeutic steps such as medication delivery or plaque removal might be performed.
5. Completion: Once the necessary actions are completed, the catheter is removed, and pressure is applied to the incision site to prevent bleeding.

Tools used include catheters, guidewires, and imaging technologies like fluoroscopy for real-time visualization.

Duration

The procedure generally takes 1-2 hours, depending on its complexity and the patient's condition.

Setting

Selective catheter placement is predominantly performed in a hospital's catheterization lab or an outpatient surgical center equipped with advanced imaging technology.

Personnel

• Interventional radiologist or cardiologist
• Radiologic technologist
• Registered nurse
• Anesthesiologist or nurse anesthetist, if sedation is used

Risks and Complications

• Common Risks: Bruising or bleeding at the insertion site, allergic reactions to contrast dye.
• Rare Complications: Infection, blood vessel damage, blood clots, or arterial spasm.
• Management includes monitoring for signs of complications and prompt medical intervention if needed.

Benefits

Expected benefits include accurate diagnosis, effective treatment of vascular conditions, improved blood flow, and symptom relief. Benefits can often be realized shortly after the procedure, especially if a blockage is cleared or medication is delivered directly to the site.

Recovery

• Immediate post-procedure: Patients need to lie flat for several hours to prevent bleeding.
• Activity: Avoid strenuous activities for a few days; follow specific advice from the healthcare team.
• Monitoring: Wearable monitoring or follow-up imaging might be required to assess the outcomes.
• Follow-ups: Scheduled appointments for checking recovery and effectiveness of the procedure.

Alternatives

• Non-invasive imaging techniques (e.g., MRA, CTA).
• Conservative management with medication.
• Surgical interventions like open bypass surgery. Pros and cons of alternatives vary, with non-invasive methods posing lower immediate risk but might not be as conclusive or targeted.

Patient Experience

During the procedure, patients may feel pressure or a mild burning sensation at the insertion site. Conscious sedation ensures they are relaxed but awake. Post-procedure, some discomfort at the incision site is common, and pain management options are available. Most patients can return to normal activities within a week, adhering to specific medical advice for optimal recovery.