Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Revascularization, Endovascular, Open or Percutaneous, Tibial/Peroneal Artery, Unilateral, Each Additional Vessel; with Atherectomy, Includes Angioplasty within the Same Vessel, When Performed
Summary
This procedure involves restoring blood flow in the tibial or peroneal arteries of the leg by using a minimally invasive technique called atherectomy to remove plaque buildup. Angioplasty, a method of widening the artery, is included if performed within the same vessel.
Purpose
Medical Condition/Problem Addressed
- Peripheral artery disease (PAD) affecting the tibial or peroneal arteries.
- Severe arterial blockages causing inadequate blood flow to the lower extremities.
Goals/Expected Outcomes
- Improved blood flow to the lower leg and foot.
- Relief from symptoms like pain, cramping, and difficulty walking.
- Prevention of tissue damage and ulcers due to poor circulation.
Indications
Specific Symptoms/Conditions
- Chronic pain in the legs or feet, especially when walking.
- Non-healing wounds or ulcers on the lower extremities.
- Diagnosis of significant arterial blockages in the tibial or peroneal arteries.
Patient Criteria
- Patients with confirmed PAD.
- Patients who have not adequately responded to conservative treatments like medication or lifestyle changes.
- Those at risk of losing limb function due to poor circulation.
Preparation
Pre-procedure Instructions
- Fasting for several hours prior to the procedure.
- Adjustments to medications, especially blood thinners.
- Arrangements for someone to drive the patient home post-procedure.
Diagnostic Tests
- Doppler ultrasound or angiography to assess the extent of arterial blockage.
- Blood tests and cardiovascular evaluations as required.
Procedure Description
Step-by-Step Explanation
- Anesthesia/Sedation: The patient may receive local anesthesia and sedation or general anesthesia, depending on the case's complexity.
- Access: A small incision is made, typically near the groin, to access the artery.
- Guide Wire/Catheter Insertion: A catheter is guided to the blockage using imaging technology.
- Atherectomy: A special device is used to shave or cut away the plaque within the artery.
- Angioplasty: A balloon-tipped catheter may be inflated to widen the artery (if necessary, included within the same vessel).
- Completion: The catheter is withdrawn, and the incision is closed.
Tools/Equipment
- Catheters, guide wires, atherectomy devices, balloon catheters, and imaging equipment.
Anesthesia/Sedation:
- Local anesthesia, conscious sedation, or general anesthesia based on the specific case and patient health.
Duration
- The procedure typically takes 1 to 3 hours.
Setting
- Usually performed in a hospital’s catheterization lab or an outpatient surgical center.
Personnel
- Interventional radiologist or vascular surgeon
- Surgical nurses
- Anesthesiologist or nurse anesthetist
- Radiologic technologist
Risks and Complications
Common Risks
- Bruising or bleeding at the incision site.
- Blood vessel damage.
Rare Risks
- Blood clots or embolism.
- Infection.
- Allergic reactions to contrast dye or medications.
- Kidney damage (from contrast dye).
Complication Management
- Immediate medical intervention to address any complications.
- Monitoring for adverse reactions during and after the procedure.
Benefits
- Relief from PAD symptoms.
- Improved ability to walk and perform daily activities.
- Prevention of severe outcomes like limb amputation.
Recovery
Post-procedure Care
- Monitoring in a recovery area for a few hours.
- Instructions on activity levels, typically advising limited movement for a day or two.
- Medication adjustments as needed.
Recovery Time
- Most patients can resume normal activities within a few days.
- Follow-up appointments to monitor artery health and recovery.
Alternatives
Other Treatment Options
- Medications to manage PAD.
- Lifestyle modifications, including exercise and diet changes.
- Open surgical bypass.
Pros and Cons
- Medications and Lifestyle Changes: Non-invasive but may not be sufficient for severe blockages.
- Open Surgical Bypass: More invasive, longer recovery but may be necessary for complex cases.
Patient Experience
During the Procedure
- Minimal discomfort due to anesthesia.
- Possible sensation of pressure during catheter insertion.
After the Procedure
- Mild soreness at the incision site.
- Fatigue or discomfort that subsides within a few days.
- Pain management with prescribed medication if needed.
- Follow-up care and recovery instructions provided by the medical team.