36252 Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of

Name of the Procedure:

Selective Catheter Placement (First-Order), Main Renal Artery, and Accessory Renal Arteries for Renal Angiography

Summary

Renal angiography with selective catheter placement involves inserting a catheter into the main and any accessory renal arteries to take detailed images of the renal blood vessels. This procedure helps to identify any abnormalities or blockages in the renal arteries.

Purpose

• Medical Condition: Kidney diseases, hypertension, renal artery stenosis.
• Goals: To diagnose conditions affecting the renal arteries, guide treatment plans, and evaluate the effectiveness of previous interventions.

Indications

• Unexplained high blood pressure.
• Suspected renal artery stenosis.
• Post-operative evaluation of renal artery stenting.
• Monitoring renal blood flow in kidney transplant patients.

Preparation

• Pre-procedure Instructions: Fast for 6-8 hours before the procedure, adjust medications as advised by the physician, particularly blood thinners.
• Pre-assessments: Blood tests (e.g., kidney function test), hydration assessment, allergy check for contrast dye.

Procedure Description

1. Arterial Puncture: A small needle puncture is made, usually in the groin.
2. Catheter Placement: A thin catheter is inserted through the puncture site and navigated to the main and accessory renal arteries under fluoroscopic guidance.
3. Fluoroscopy and Contrast Injection: Real-time X-ray images guide the catheter; contrast dye is injected to visualize the arteries.
4. Image Postprocessing and Recording: Captured images are processed and stored for further examination.

Tools and Equipment:

• Catheter, contrast dye, fluoroscopy machine.

Anesthesia/Sedation:

• Local anesthesia at the puncture site, with or without mild sedation.

Duration

Typically 1-2 hours.

Setting

Hospital radiology department or a specialized outpatient surgical center.

Personnel

• Interventional Radiologist
• Radiologic Technologist
• Nurse
• Possibly an Anesthesiologist

Risks and Complications

• Common Risks: Bruising or bleeding at puncture site.
• Rare Complications: Allergic reaction to contrast dye, kidney damage, arterial injury, or clot formation.
• Management: Allergy medication for reactions, prompt treatment for bleeding or clot formation.

Benefits

• Accurate Diagnosis: Detailed images can confirm the presence of issues like blockages or deformities.
• Treatment Planning: Helps in planning surgeries or other interventions.
• Monitoring: Assesses the success of renal interventions.

Recovery

• Post-Procedure Care: Observation for a few hours, hydration to flush out the contrast dye.
• Recovery Time: Generally, patients can return to normal activities within 24 hours.
• Restrictions: Avoid heavy lifting or strenuous activities for at least 24 hours.
• Follow-Up: Instructions for follow-up appointments and symptom monitoring.

Alternatives

• Non-Invasive Options: Doppler ultrasound, MR angiography, or CT angiography.
• Pros and Cons: Non-invasive methods are safer but may be less accurate than direct catheter-based angiography.

Patient Experience

• During Procedure: Minimal discomfort due to local anesthesia; may feel pressure or slight pain at the puncture site.
• Post-Procedure: Mild soreness at the puncture site, usually manageable with over-the-counter pain relievers.