36217 Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family

Name of the Procedure:

Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family.
Common name(s): Third-Order Arterial Catheterization

Summary

This is a specialized medical procedure where a thin, flexible tube (catheter) is navigated through the arterial system to precisely target a specific artery in the thoracic (chest) or brachiocephalic (arm, head, and neck) region. It involves accessing third-order or more selective branches of these arteries.

Purpose

The procedure is used to diagnose or treat conditions affecting the arteries in the chest, arm, head, or neck. The primary goals are to obtain detailed images (angiography), deliver medications, or perform interventions such as opening narrowed arteries.

Indications

• Suspected arterial blockage or narrowing (stenosis)
• Aneurysms or abnormal artery formation
• Tumor blood supply evaluation
• Pre-surgical planning for thoracic or brachiocephalic surgeries
• Specific symptoms such as severe chest pain, arm pain, stroke symptoms, or transient ischemic attacks (TIAs)

Preparation

• Fasting for 6-8 hours before the procedure
• Adjustment of blood-thinning medications as directed by a healthcare provider
• Pre-procedure blood tests and imaging studies (e.g., ultrasound, CT scans)

Procedure Description

1. The patient lies on an X-ray table.
2. Local anesthesia is applied at the insertion site, usually the groin or arm.
3. An introducer sheath is placed into the artery.
4. A guidewire is threaded through the sheath into the arterial system.
5. The catheter is advanced over the guidewire to the targeted third-order or more selective arterial branch.
6. Contrast dye is injected through the catheter, and X-ray images are taken to visualize the artery.
7. If necessary, treatments like balloon angioplasty, stent placement, or medication delivery are performed.
8. The catheter and sheath are removed, and pressure is applied to the insertion site to prevent bleeding.

Duration

Typically takes about 1-2 hours, depending on the complexity.

Setting

The procedure is performed in a hospital setting, specifically in a catheterization laboratory (cath lab) equipped with X-ray imaging technology.

Personnel

• Interventional radiologist or vascular surgeon
• Radiology technologist
• Nurse
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Bleeding or bruising at the insertion site
• Infection
• Allergic reaction to contrast dye
• Artery damage or dissection
• Blood clots or embolism
• Kidney damage (rare, due to contrast dye)
• Stroke or heart attack (very rare)

Benefits

• Precise diagnosis and treatment of arterial conditions
• Minimally invasive compared to open surgery
• Immediate visualization and treatment within the same procedure
• Reduced recovery time compared to surgical alternatives

Recovery

• Post-procedure monitoring for a few hours in a hospital recovery area
• Instructions to rest and avoid strenuous activities for 24-48 hours
• Keeping the insertion site clean and dry
• Follow-up appointment to monitor the insertion site and overall recovery

Alternatives

• Non-invasive imaging (e.g., MRI, CT angiography)
• Medical management with medications
• Open surgical procedures for more extensive arterial diseases
• Each alternative has its own benefits and limitations, which should be discussed with a healthcare provider.

Patient Experience

• During the procedure, patients may feel slight pressure but generally no pain due to local anesthesia.
• After the procedure, some discomfort or bruising at the insertion site is common.
• Pain management will include over-the-counter pain relievers and keeping the site immobile.
• Patients should communicate any unusual symptoms, like severe pain or swelling, to their healthcare provider immediately.