36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family

Name of the Procedure:

Selective Catheter Placement, Arterial System - First Order; Each First Order Abdominal, Pelvic, or Lower Extremity Artery Branch

Summary

Selective catheter placement involves inserting a thin, flexible tube (catheter) into a specific artery in the abdomen, pelvis, or lower extremity. The catheter is guided to the precise location of interest within the vascular system to diagnose or treat vascular conditions.

Purpose

This procedure addresses conditions like arterial blockages, aneurysms, or arterial malformations. The goal is to diagnose these conditions accurately or to deliver treatments such as medications or stents directly to the affected area.

Indications

• Peripheral artery disease (PAD)
• Claudication (pain caused by too little blood flow)
• Unexplained lower extremity pain
• Vascular malformations
• Suspected arterial blockages or aneurysms
• Pre-surgical mapping of arteries

Preparation

• Fasting for 6-8 hours prior to the procedure.
• Adjusting or pausing certain medications (e.g., blood thinners).
• Pre-procedure diagnostic tests such as blood tests and imaging studies (e.g., ultrasound, MRI).

Procedure Description

1. The patient lies on an X-ray table, and a local anesthetic is applied to the insertion site.
2. A small incision is made to access the artery.
3. A sheath is inserted into the artery, and a catheter is threaded through the sheath to the target artery branch.
4. Contrast dye may be injected to visualize the vascular system via X-ray.
5. Once positioned, the catheter can be used for diagnostic purposes or treatments like stent placement or medication delivery.
6. The catheter and sheath are removed, and pressure is applied to stop any bleeding.

Duration

Typically, the procedure takes 1-2 hours.

Setting

This procedure is usually performed in a hospital's catheterization lab or interventional radiology suite.

Personnel

• Interventional radiologist or vascular surgeon
• Radiologic technologists
• Nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

• Bleeding at the insertion site
• Infection
• Allergic reaction to the contrast dye
• Arterial damage or dissection
• Blood clots
• Kidney damage (due to contrast dye)

Benefits

• Accurate diagnosis of vascular conditions
• Targeted delivery of treatments
• Minimally invasive with shorter recovery times compared to surgery
• Potentially immediate symptom relief

Recovery

• Monitoring in the recovery area for a few hours post-procedure.
• Keeping the insertion site clean and dry.
• Avoiding strenuous activities for a few days.
• Follow-up appointments to assess the vascular health and the effectiveness of the treatment.

Alternatives

• Non-invasive imaging tests (e.g., CT angiography, MR angiography)
• Medications to manage symptoms (e.g., blood thinners)
• Lifestyle changes (e.g., diet, exercise)
• Open surgical procedures (e.g., bypass surgery)

Patient Experience

During the procedure, the patient may feel some pressure but should not experience significant pain. Post-procedure, there might be some soreness at the catheter insertion site. Pain management involves over-the-counter pain relievers and rest. Most patients can return to normal activities within a few days, depending on the specific case and outcome.