37223 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for prima

Name of the Procedure:

Revascularization, Endovascular, Open or Percutaneous, Iliac Artery, Each Additional Ipsilateral Iliac Vessel; with Transluminal Stent Placement(s), Includes Angioplasty Within the Same Vessel, When Performed

Summary

Revascularization of the iliac artery is a medical procedure designed to restore blood flow through narrow or blocked sections of the iliac arteries. This is done by placing a stent (a small mesh tube) inside the artery. The procedure usually involves the insertion of a balloon through a catheter to widen the artery, which is followed by the placement of a stent to keep the artery open.

Purpose

This procedure addresses arterial blockages or narrowing (stenosis) in the iliac arteries, which supply blood to the lower limbs. The goals are to improve blood flow, relieve symptoms such as pain or claudication (pain caused by too little blood flow during exercise), and prevent more severe complications like tissue damage or limb loss.

Indications

• Peripheral artery disease (PAD) affecting the iliac arteries.
• Symptoms like leg pain, cramping, or fatigue due to poor blood flow.
• Non-healing wounds or ulcers on the lower extremities.
• Risk of tissue damage or gangrene due to poor circulation.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustments to medications as advised by the healthcare provider (e.g., stopping blood thinners).
• Pre-procedure imaging tests like an ultrasound, CT scan, or MRI to locate blockages.

Procedure Description

1. The patient receives local anesthesia and possibly sedation.
2. A small incision is made in the groin area to access the femoral artery.
3. A catheter with a balloon tip is threaded through the artery to the blockage.
4. The balloon is inflated to widen the artery.
5. A stent is placed in the widened area to keep it open.
6. The catheter and instruments are removed, and the incision is closed.

Special tools and imaging technology (fluoroscopy) guide the procedure. It typically uses local anesthesia and mild sedation.

Duration

The procedure usually takes 1 to 2 hours.

Setting

Performed in a hospital's catheterization laboratory or an outpatient surgical center.

Personnel

• Interventional radiologist or vascular surgeon.
• Nurses and technicians.
• Anesthesiologist or nurse anesthetist for sedation or anesthesia management.

Risks and Complications

• Infection at the incision site.
• Bleeding or hematoma formation.
• Blood vessel damage or perforation.
• Blood clots or embolism.
• Allergic reaction to contrast dye.
• Restenosis (re-narrowing of the artery).

Benefits

• Improved blood flow to the lower extremities.
• Relief from pain and other symptoms.
• Enhanced mobility and quality of life.
• Reduced risk of severe complications like limb loss.

Recovery

• Monitoring in a recovery area for a few hours post-procedure.
• Instructions for wound care and activity restrictions.
• Avoiding strenuous activities and heavy lifting for several days.
• Follow-up appointments to monitor progress and check for complications.

Alternatives

• Medication management (anti-platelet drugs, statins).
• Surgical options like open bypass surgery.

• Lifestyle changes (diet, exercise, smoking cessation).

  Each alternative has its pros and cons, depending on the patient's overall health, the severity of the condition, and other factors.

Patient Experience

During the procedure, the patient may feel slight pressure but should not feel pain due to anesthesia. Post-procedure, patients might experience mild discomfort or bruising at the incision site. Pain management with prescribed medications is generally effective, and most patients can return to their normal activities within a week, with full recovery expected in a few weeks.