37231 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, 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) and atherectomy, includes angioplasty within the same vessel, when performed

Summary

This procedure involves opening a narrowed or blocked tibial or peroneal artery in one leg using minimally invasive techniques. It includes the placement of a stent, removal of plaque (atherectomy), and balloon angioplasty in the same vessel.

Purpose

The procedure addresses peripheral artery disease (PAD), which causes reduced blood flow to the legs. The goal is to restore proper blood flow to relieve symptoms such as pain and improve mobility and overall function of the affected leg.

Indications

Patients experiencing symptoms of PAD such as:

• Leg pain during walking (claudication)
• Numbness or weakness in the legs
• Sores on toes, feet, or legs that won't heal
• Coldness in the lower leg or foot
• Poor hair growth on legs

Preparation

• Fasting for 6-8 hours before the procedure
• Adjustments to medications, especially anticoagulants
• Pre-procedure imaging studies such as Doppler ultrasound, CT angiography, or MR angiography

Procedure Description

1. The patient is given local anesthesia with sedation, or general anesthesia if required.
2. A catheter is inserted through a small incision, usually in the groin.
3. The catheter is guided to the affected tibial or peroneal artery using X-ray imaging.
4. Angioplasty is performed with a balloon to open up the artery.
5. An atherectomy device is used to remove plaque from the artery walls.
6. The stent is placed to keep the artery open and ensure good blood flow.
7. The catheter is removed, and the incision site is sealed.

Duration

The procedure typically takes 1-2 hours.

Setting

This procedure is performed in a hospital's catheterization lab or a specialized outpatient clinic.

Personnel

• Interventional radiologist or vascular surgeon
• Nursing staff
• Anesthesiologist or sedation nurse

Risks and Complications

• Bruising or bleeding at the incision site
• Infection
• Allergic reaction to contrast dye
• Blood clots
• Artery re-narrowing (restenosis)
• Vessel injury or rupture

Benefits

• Improved blood flow to the affected leg
• Relief from pain and other symptoms of PAD
• Enhanced ability to perform daily activities and exercise
• Quicker recovery compared to open surgery

Recovery

• Hospital stay: generally a few hours to overnight
• Light activity for the first few days, avoiding strenuous activities
• Follow-up appointments to monitor the stent and overall health
• Medications may include antiplatelet drugs to prevent clots

Alternatives

• Medication management (e.g., antiplatelets, statins)
• Supervised exercise programs
• Open surgical bypass
• Conservative management with lifestyle changes

Pros and cons may vary; stenting and atherectomy offer less invasive options with quicker recovery but may have limitations for severe cases compared to open surgery.

Patient Experience

During the procedure:

• Mild discomfort from the catheter insertion
• Sedation helps minimize pain and anxiety

After the procedure:

• Mild soreness at the incision site
• Slight bruising or swelling
• Instructions on activity levels and medications to manage discomfort easily

Pain is generally minimal and manageable with prescribed medications. Regular follow-up is essential to ensure proper healing and monitor the stent function.