Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous; initial vessel
CPT4 code
Name of the Procedure:
Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous; initial vessel
Common name: Peripheral Stent Placement
Technical term: Transcatheter Stent Placement
Summary
Peripheral stent placement involves the insertion of a small, expandable tube (stent) into a blood vessel to help keep it open. This procedure is performed using a catheter that is threaded through the blood vessels to the affected area.
Purpose
Medical Condition: Peripheral Artery Disease (PAD), renal artery stenosis, or other conditions causing narrowing or blockage of peripheral blood vessels.
Goals: To restore adequate blood flow, relieve symptoms such as pain or swelling, and prevent complications such as tissue damage.
Indications
- Chronic limb ischemia
- Renal artery stenosis
- Mesenteric artery stenosis
- Aneurysms (in some cases)
- Recurrent or resistant to other treatments blockages
Patient Criteria:
- Patients with significant symptoms (e.g., claudication, rest pain)
- Evidence of significant arterial stenosis via imaging studies
Preparation
Pre-procedure Instructions:
- Fasting for 6-8 hours before the procedure
- Adjustment of medications, especially blood thinners, as advised by a doctor
- Hydration, if not contraindicated
Diagnostic Tests:
- Blood tests (e.g., clotting profile)
- Imaging studies such as Doppler ultrasound, CT angiography, or MR angiography
- Baseline kidney function tests
Procedure Description
- Anesthesia: Local anesthesia with possible sedation.
- Insertion: A small incision is made, typically in the groin, to access the blood vessel.
- Catheterization: A catheter is threaded through the vascular system to the site of the blockage.
- Stent Placement: The stent is guided through the catheter and expanded at the site of the blockage, using a balloon or self-expanding mechanism.
- Completion: The catheter and tools are removed, and the incision site is closed and bandaged.
Tools/Equipment:
- Catheter
- Guidewire
- Intravascular stent
- Imaging technology (fluoroscopy)
Duration
Typically, the procedure takes about 1-2 hours, depending on the complexity.
Setting
Performed in a hospital's catheterization lab or interventional radiology suite.
Personnel
- Interventional radiologist or vascular surgeon
- Nurses
- Anesthesiologist or nurse anesthetist (if sedation is used)
- Radiologic technologist
Risks and Complications
Common Risks:
- Bleeding at the insertion site
- Infection
- Allergic reaction to contrast dye
Rare Complications:
- Blood vessel damage
- Blood clots
- Kidney damage from contrast dye
- Need for emergency surgery
Benefits
- Immediate improvement in blood flow
- Relief from symptoms associated with arterial blockage
- Prevention of complications such as tissue damage
Recovery
Post-procedure Care:
- Monitoring in recovery area for several hours
- Pain management with medication if needed
- Keeping the insertion site clean and dry
Recovery Time: Typically, 1-2 days with restrictions on heavy lifting and strenuous activity for up to a week.
Follow-Up: Follow-up appointments to monitor stent function and vascular health.
Alternatives
- Medication management (antiplatelet drugs, statins)
- Lifestyle modifications (exercise, diet)
- Surgical bypass
- Balloon angioplasty without stenting
Pros and Cons: Pros of stenting over surgery include less invasiveness, shorter recovery time. Cons may include risk of re-narrowing and dependence on long-term medication.
Patient Experience
During the procedure: Minimal pain due to local anesthesia; some pressure or discomfort might be felt.
After the procedure: Rest and limited mobility for a short period, mild pain at incision site, management with pain relievers as needed.