37230 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed

Name of the Procedure:

Revascularization, Endovascular, Open or Percutaneous, Tibial, Peroneal Artery, Unilateral, Initial Vessel with Transluminal Stent Placement(s) (includes Angioplasty within the same vessel, when performed)

Summary

This procedure involves treating blockages in the tibial or peroneal arteries in one leg by using a stent. The stent helps to open up the artery, and this process often includes an angioplasty, which uses a small balloon to widen the artery.

Purpose

Medical Condition or Problem It Addresses:

• Peripheral artery disease (PAD)

  Goals or Expected Outcomes:

• Restore blood flow to the affected leg
• Relieve symptoms such as pain and cramping
• Improve mobility and quality of life
• Prevent tissue damage and potential limb loss

Indications

Specific Symptoms or Conditions Warranting the Procedure:

• Chronic limb ischemia
• Severe pain in the leg (claudication)
• Non-healing wounds or ulcers on the foot or lower leg
• Rest pain (pain in the feet or legs at rest)

Patient Criteria or Factors:

• Diagnosis of significant arterial blockage in the tibial or peroneal artery
• Failure to respond to conservative treatments like medications and lifestyle changes

Preparation

Pre-procedure Instructions:

• Fasting for several hours prior to the procedure
• Stopping certain medications (e.g., blood thinners) as instructed by the doctor

Diagnostic Tests or Assessments:

• Physical examination and medical history
• Imaging studies such as Doppler ultrasound, CT angiography, or MR angiography

Procedure Description

1. Access: A small incision is made to insert a catheter into a blood vessel, often in the groin area.
2. Navigation: Using imaging guidance, the catheter is guided to the blocked area in the tibial or peroneal artery.
3. Angioplasty: A balloon catheter is inflated to widen the artery.
4. Stent Placement: A stent is inserted to keep the artery open.
5. Final Checks: Imaging is done to ensure the artery is open and blood flow is restored.

Tools, Equipment, or Technology:

• Catheters
• Balloons for angioplasty
• Stents
• Imaging equipment (e.g., fluoroscopy)

Anesthesia or Sedation:

• Local anesthesia at the insertion site
• Sometimes mild sedation

Duration

• Typically takes 1 to 3 hours

Setting

• Hospital or specialized surgical center

Personnel

• Vascular surgeon or interventional radiologist
• Nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

Common Risks:

• Bleeding at the insertion site
• Infection
• Blood vessel damage

Rare Risks:

• Blood clots
• Allergic reaction to contrast dye
• Kidney damage (from contrast)

Complications Management:

• Monitoring and addressing complications promptly with medications or additional interventions

Benefits

• Improved blood flow to the leg
• Relief from pain and other symptoms
• Enhanced mobility and quality of life
• Reduced risk of limb loss

Recovery

Post-procedure Care:

• Monitoring in recovery area
• Instructions for wound care at the insertion site
• Medications for pain and to prevent blood clots

Recovery Time:

• Most patients can go home the same day or the next day
• Avoid heavy lifting and strenuous activities for a few days
• Follow-up appointments as scheduled by the doctor

Alternatives

Other Treatment Options:

• Lifestyle changes and medications
• Bypass surgery
• Thrombolytic therapy

Pros and Cons of Alternatives:

• Lifestyle Changes & Medications: Non-invasive but may not be effective for severe blockages
• Bypass Surgery: More invasive with longer recovery but can be more effective in some cases
• Thrombolytic Therapy: Less invasive but may not work for all blockages

Patient Experience

During the Procedure:

• Mild discomfort or pressure at the insertion site
• Awareness of steps if mild sedation is used

After the Procedure:

• Soreness at the incision site
• Instructions on pain management
• Gradual return to normal activities
• Monitoring wound site for signs of infection or complications

Pain management and comfort measures are a priority to ensure a smooth recovery and optimal outcomes.