Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day
CPT4 code
Name of the Procedure:
Transcatheter Therapy, Venous Infusion for Thrombolysis, Any Method (Including Radiological Supervision and Interpretation), Initial Treatment Day.
Summary
Transcatheter therapy for venous infusion thrombolysis involves delivering medication directly into the veins to dissolve blood clots. The procedure is guided by imaging techniques to ensure accuracy and effectiveness.
Purpose
This procedure addresses blood clots in veins, often occurring in conditions like deep vein thrombosis (DVT) or pulmonary embolism (PE). The goal is to dissolve clots, restore normal blood flow, and prevent complications associated with blockages such as pain, swelling, and tissue damage.
Indications
- Presence of significant blood clots in major veins
- Symptoms of DVT such as swelling, pain, or redness in the affected area
- Pulmonary embolism symptoms like shortness of breath or chest pain
- Risk of clot-related complications
- Patients who have not responded to or are unsuitable for oral anticoagulant therapy
Preparation
- Fasting for several hours before the procedure
- Adjustments to current medications, particularly blood thinners
- Blood tests to assess clotting function and overall health
- Imaging studies like ultrasound or CT scan to locate the clot
Procedure Description
- The patient is positioned on an X-ray table.
- Local anesthesia is applied to the entry site, usually in the groin or neck.
- A catheter is inserted into the vein and guided to the clot location using fluoroscopy or ultrasound imaging.
- Thrombolytic medication is infused directly through the catheter to dissolve the clot.
- Continuous imaging guides and monitors the medication delivery and clot dissolution.
- The catheter may be left in place to allow for prolonged medication infusion if needed.
Duration
The procedure typically takes 1-3 hours, depending on the clot size and location.
Setting
The procedure is performed in a hospital's interventional radiology suite or cardiovascular operating room.
Personnel
- Interventional radiologist or vascular surgeon
- Radiology technologists
- Nurses specialized in interventional procedures
- Anesthesiologist or sedation nurse, if deeper sedation is needed
Risks and Complications
- Bleeding at the insertion site
- Allergic reactions to contrast dye or medication
- Damage to the blood vessel
- Infection
- Rarely, embolization of the clot to other parts of the body
Benefits
- Rapid relief from symptoms caused by blood clots
- Prevention of clot-related complications
- Restoration of normal blood flow
- Typically, the benefits are realized within hours to days
Recovery
- Monitoring in a recovery room for several hours post-procedure
- Instructions on wound care at the catheter insertion site
- Possible continuation of anticoagulant medications
- Avoiding strenuous activities for a few days
- Follow-up appointments and imaging to assess the effectiveness
Alternatives
- Oral or injectable anticoagulants
- Surgical thrombectomy to remove the clot
- Watchful waiting with lifestyle adjustments
- Pros: Less invasive options like medications can be easier; surgical methods are direct but more invasive.
- Cons: Medications may take longer to show effects; surgery involves higher risks and longer recovery.
Patient Experience
During the procedure, patients might feel pressure or mild discomfort at the catheter site. Post-procedure, they can expect soreness at the insertion site, fatigue, and potentially mild bruising. Pain management includes over-the-counter medications, and comfort measures include rest and application of ice to the affected area if needed.