37186 Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolyt

Name of the Procedure:

Secondary Percutaneous Transluminal Thrombectomy (e.g., non-primary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolysis.

Summary

This procedure involves the removal of blood clots from arteries or arterial bypass grafts using specialized mechanical tools or suction techniques. It is performed using fluoroscopic guidance to visualize the affected area. During the procedure, medications may be administered to help dissolve the clots.

Purpose

This procedure addresses the presence of blood clots in arteries or arterial bypass grafts, which can block blood flow and cause serious health issues. The primary goal is to restore normal blood circulation and reduce the risk of complications such as tissue damage or stroke.

Indications

• Presence of blood clots in arteries or arterial bypass grafts.
• Symptoms like severe pain, swelling, or discoloration of limbs.
• Conditions like peripheral artery disease or deep vein thrombosis.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to current medications, particularly blood thinners, as directed by the physician.
• Pre-procedure diagnostic tests such as blood tests, ultrasound, or angiography to assess the location and extent of the clot.

Procedure Description

1. The patient is positioned on a fluoroscopy table.
2. Local anesthesia is administered at the insertion site, typically in the groin.
3. A catheter is introduced into the affected artery using a small needle puncture.
4. Fluoroscopic imaging guides the catheter to the location of the clot.
5. Mechanical devices, snare baskets, or suction tools are used to remove or break up the clot.
6. Pharmacological thrombolytics may be infused directly at the clot site to help dissolve any remaining fragments.
7. The catheter is removed, and the insertion site is sealed.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and location of the clot.

Setting

Performed in a hospital's interventional radiology or surgical suite.

Personnel

• Interventional radiologist or vascular surgeon.
• Radiology technologist.
• Registered nurse.
• Anesthesiologist (if general anesthesia is used).

Risks and Complications

• Infection at the insertion site.
• Bleeding or hematoma.
• Vessel damage.
• Reaction to contrast dye.
• Rarely, embolism or post-procedural clot formation.

Benefits

• Restoration of normal blood flow.
• Relief from symptoms caused by the clot.
• Prevention of further complications such as tissue damage or stroke.
• Improvement may be noticed immediately or within a few hours.

Recovery

• Monitor at the hospital for a few hours post-procedure.
• Instructions on caring for the insertion site.
• Limiting strenuous activities for a few days.
• Follow-up appointments to monitor progress and ensure no new clots have formed.

Alternatives

• Medical management with anticoagulants or thrombolytics.
• Surgical thrombectomy.
• Endovascular stenting or angioplasty.
• Pros and cons vary; some alternatives may have longer recovery times or be more invasive.

Patient Experience

• Localized discomfort or pressure during the catheter insertion.
• Conscious sedation may keep the patient awake but relaxed.
• Post-procedure soreness at the insertion site.
• Pain management with prescribed medications.

Overall, Secondary Percutaneous Transluminal Thrombectomy is a minimally invasive option aimed at quickly addressing blood clots and restoring normal vascular function.