36227 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

Name of the Procedure:

Selective Catheter Placement, External Carotid Artery with Angiography

Summary

This procedure involves the insertion of a catheter (a thin, flexible tube) into the external carotid artery on one side of the neck to perform angiography, which is an imaging test that uses X-rays to take pictures of the blood vessels.

Purpose

This procedure is intended to diagnose and evaluate conditions affecting blood flow in the external carotid artery, such as blockages or aneurysms. The goal is to get detailed images of the artery to guide further treatment.

Indications

• Symptoms such as dizziness, headaches, or vision problems which may suggest a blood flow issue.
• Known or suspected arterial blockages or abnormalities.
• A stroke or transient ischemic attack (TIA).
• Need for precise vascular mapping before surgery.

Preparation

• Patients may be asked to fast for several hours before the procedure.
• Medication adjustments might be necessary, especially for blood thinners.
• Blood tests and other imaging studies may be required to ensure safe and effective results.

Procedure Description

1. Anesthesia: Local anesthesia is administered to numb the insertion area. Sedation may also be used to help the patient relax.
2. Catheter Insertion: The catheter is inserted through a small incision, usually in the groin or arm, and carefully guided to the external carotid artery using fluoroscopy (a type of X-ray).
3. Contrast Dye Injection: A contrast dye is injected through the catheter to make the blood vessels visible on the X-ray images.
4. Image Capture: Angiographic images are taken to visualize the blood flow and identify any abnormalities.
5. Removal: The catheter is then removed, and pressure is applied to the incision site to prevent bleeding.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital's special radiology department or an outpatient surgical center.

Personnel

• Interventional radiologist or vascular surgeon.
• Radiologic technologists.
• Nurses.
• Anesthesiologist or sedation nurse.

Risks and Complications

• Bleeding or bruising at the catheter insertion site.
• Allergic reaction to the contrast dye.
• Infection.
• Blood vessel damage.
• Rarely, stroke or other serious complications.

Benefits

• Accurate diagnosis of vascular conditions.
• Helps in planning appropriate treatments like surgery or angioplasty.
• Minimally invasive with a relatively quick recovery time.

Recovery

• Patients may need to lie flat for several hours post-procedure to prevent bleeding.
• The insertion site will be monitored for any signs of complications.
• Most patients can return to normal activities within a day or two.
• Follow-up appointments may be necessary to discuss results and further treatment.

Alternatives

• Non-invasive imaging tests like CT angiography or MRI.
• Watchful waiting in less severe cases.
• Direct surgical intervention if the patient's condition warrants immediate treatment.

Patient Experience

During the procedure, patients may feel some pressure but should not experience significant pain due to local anesthesia. Afterward, there could be mild soreness at the insertion site. Pain management and comfort measures will be provided to ensure a smooth recovery.