Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
CPT4 code
Name of the Procedure:
Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed Common names: Tibial/Peroneal Artery Revascularization with Atherectomy and Angioplasty
Summary
This medical procedure involves restoring blood flow in the tibial or peroneal artery of one leg using a minimally invasive technique. It includes both atherectomy (removal of plaque) and angioplasty (widening of the artery with a balloon and possibly a stent).
Purpose
- Condition: Peripheral Arterial Disease (PAD), particularly in the lower extremities.
- Goals: To reduce symptoms like pain and cramping during walking, heal foot ulcers or prevent gangrene, and improve overall limb functionality.
Indications
- Significant narrowing or blockage of the tibial or peroneal artery due to atherosclerosis.
- Symptoms such as claudication (leg pain while walking), rest pain, non-healing wounds, or ulcers on the lower legs or feet.
- Patients for whom non-invasive treatments (e.g., lifestyle changes, medications) have been ineffective.
Preparation
- Pre-procedure Instructions:
- Fast for at least 6 hours before the procedure.
- Adjust or cease certain medications as advised, particularly anticoagulants.
- Diagnostic Tests:
- Peripheral arterial ultrasound, angiogram, blood tests, and possibly an MRI or CT scan.
Procedure Description
- Accessing the Artery:
- A small incision is made, typically in the groin, to access the blood vessel.
- Atherectomy:
- A specialized catheter with a cutting device is inserted to remove plaque from the artery.
Angioplasty:
A balloon catheter is then advanced to the site of blockage and inflated to widen the artery. A stent may be placed to keep the artery open.
- Tools Used: Atherectomy device, balloon catheter, possibly a stent, imaging equipment.
- Anesthesia: Local anesthesia with sedation, sometimes general anesthesia for open procedures.
Duration
Typically, 1 to 2 hours depending on the complexity.
Setting
Conducted in a hospital or specialized outpatient surgical center, usually in a catheterization lab.
Personnel
- Vascular surgeon or interventional cardiologist.
- Radiologist.
- Anesthesiologist or nurse anesthetist.
- Surgical nurses and technicians.
Risks and Complications
- Common Risks: Infection, bleeding, bruising at the incision site.
- Rare Risks: Artery damage, allergic reactions to contrast dye, blood clots, restenosis (re-narrowing of the artery), and kidney problems.
Benefits
- Improved blood flow and relief of symptoms like pain and cramping.
- Healing of ulcers and prevention of tissue death (gangrene).
- Enhanced mobility and quality of life, usually noticeable soon after recovery.
Recovery
- Post-procedure Care: Monitoring in a recovery area, bed rest for a few hours, instructions on wound care.
- Recovery Time: Typically, a few days to a week for initial recovery, with gradual resumption of normal activities.
- Restrictions: Avoid heavy lifting and strenuous activity until fully recovered.
- Follow-up: Regular check-ups to monitor artery health and adjust medications if necessary.
Alternatives
- Non-Surgical Treatments: Medication management, lifestyle changes, and supervised exercise programs.
- Other Procedures: Bypass surgery, different types of endovascular interventions.
- Pros and Cons: Non-surgical options are less invasive but might be less effective. Bypass surgery is more invasive with longer recovery but might be needed for extensive blockages.
Patient Experience
- During Procedure: Minimal discomfort; sedation helps with relaxation. Possible mild pressure or discomfort at the insertion site.
- After Procedure: Mild soreness at the incision site, possible fatigue for a few days. Pain management includes prescribed medications for any discomfort. Regular follow-up ensures optimal recovery and monitoring.