36907 Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary proc

Name of the Procedure:

Transluminal Balloon Angioplasty, Central Dialysis Segment (also known as Percutaneous Transluminal Angioplasty or PTA)

Summary

Transluminal Balloon Angioplasty is a minimally invasive procedure to open up a narrowed or blocked blood vessel in the central dialysis segment, improving blood flow. It involves the insertion and inflation of a balloon within the vessel through a dialysis circuit.

Purpose

This procedure addresses central vein stenosis or blockages often associated with hemodialysis. The primary goal is to restore adequate blood flow, ensuring effective dialysis treatment and reducing associated symptoms like swelling and discomfort.

Indications

• Swelling in the arm, neck, or face
• Reduced dialysis efficiency
• Difficult or failed dialysis sessions
• Evidence of venous stenosis on imaging studies

Preparation

• Fasting for at least 6 hours prior to the procedure
• Adjusting medications as advised by the healthcare provider
• Pre-procedure imaging studies such as ultrasound or venogram
• Blood tests to check kidney function and clotting status

Procedure Description

1. The patient is positioned on an imaging table and given local anesthesia at the insertion site.
2. A small incision is made to access the dialysis circuit.
3. A catheter with a deflated balloon at its tip is inserted into the blood vessel.
4. Using fluoroscopic imaging, the catheter is guided to the narrowed segment.
5. The balloon is inflated to widen the vessel, compressing any blockages against the vessel wall.
6. After the desired dilation, the balloon is deflated and withdrawn.
7. Final imaging is done to ensure successful dilation and blood flow restoration.

Duration

Approximately 1 to 2 hours.

Setting

Usually performed in a hospital's radiology department or outpatient surgical center.

Personnel

• Interventional radiologist or vascular surgeon
• Radiology technician
• Nursing staff
• Anesthesiologist (if sedation is used)

Risks and Complications

• Infection at the insertion site
• Bleeding or hematoma
• Vascular damage or perforation
• Allergy to contrast dye
• Restenosis (re-narrowing of the vessel)
• Thrombosis (formation of a blood clot)

Benefits

• Immediate improvement in blood flow
• Enhanced efficiency of dialysis treatments
• Relief from associated symptoms like swelling
• Minimally invasive with a relatively quick recovery time

Recovery

• Observation for several hours post-procedure for any immediate complications
• Keeping the insertion site clean and dry
• Avoiding strenuous activities for a few days
• Follow-up imaging to assess the blood flow
• Monitoring for signs of infection or complications

Alternatives

• Surgical vein bypass
• Endovascular stent placement
• Conservative measures (e.g., medication)
• Pros: Surgical options may provide longer-lasting results.
• Cons: Surgery is more invasive and requires a longer recovery period compared to PTA.

Patient Experience

• Mild discomfort during the procedure due to local anesthesia.
• Possible pressure or balloon inflation sensation.
• Post-procedure soreness at the insertion site.
• Pain management with over-the-counter pain relievers if needed.
• Most patients can resume normal activities within a few days under medical advice.