36904 Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s),

Name of the Procedure:

Percutaneous Transluminal Mechanical Thrombectomy and/or Infusion for Thrombolysis in a Dialysis Circuit

• Common Name: Mechanical Thrombectomy for Dialysis
• Medical Term: Percutaneous Transluminal Mechanical Thrombectomy and Thrombolysis

Summary

This minimally invasive procedure is used to remove or dissolve blood clots from a dialysis circuit. It involves threading a catheter through a blood vessel to the site of the clot and using mechanical means or medication to clear the obstruction, ensuring the dialysis circuit remains open and functional.

Purpose

• Addresses the problem of blood clots (thrombosis) in dialysis circuits.
• Aims to restore proper blood flow through the dialysis circuit to allow effective dialysis treatment.

Indications

• Symptoms such as swelling, pain, or reduced blood flow in the area of the dialysis access site.
• Decreased efficiency of dialysis sessions due to clot formation.
• Patients with frequent or recurring clots in their dialysis circuit.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustment of medications, especially blood thinners, as directed by the healthcare provider.
• Pre-procedure diagnostics such as blood tests or imaging studies to assess clot size and location.

Procedure Description

1. The patient is positioned and prepped, and the access site is sterilized.
2. Local anesthesia is applied to the insertion site, with sedation if needed.
3. A catheter is inserted into the blood vessel and guided to the location of the clot using fluoroscopic guidance.
4. Mechanical devices or aspiration techniques may be used to physically remove the clot, or thrombolytic medication may be infused to chemically dissolve it.
5. Diagnostic angiography may be performed to assess the success of the procedure.
6. Once the clot is cleared, the catheter is removed, and a bandage is applied to the insertion site.

Duration

Typically takes 1 to 2 hours.

Setting

Performed in a hospital radiology suite or an outpatient interventional radiology center.

Personnel

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

Risks and Complications

• Common risks: bleeding, infection at the insertion site, allergic reactions to contrast dye.
• Rare risks: damage to blood vessels, renal complications from contrast dye, recurrent clots.
• Management of complications involves immediate medical intervention and supportive care.

Benefits

• Immediate improvement in blood flow through the dialysis circuit.
• Quick restoration of effective dialysis treatment.
• Reduced need for more invasive surgical procedures.

Recovery

• Post-procedure monitoring for a few hours in a recovery area.
• Instructions to avoid heavy lifting or strenuous activities for a few days.
• Regular follow-up appointments to monitor the dialysis circuit function and check for reoccurrence of clots.

Alternatives

• Surgical thrombectomy: more invasive and requires a longer recovery time.
• Pharmacological thrombolysis alone: less effective for large clots.

• Long-term anticoagulation therapy to prevent clot formation.

  Patient Experience

• During the procedure: little to no pain due to local anesthesia and potential sedation.
• After the procedure: mild discomfort or bruising at the insertion site, manageable with over-the-counter pain medication.
• Patients can expect to resume normal activities within a few days, with specific follow-up instructions provided.