37244 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation

Name of the Procedure:

Vascular Embolization or Occlusion

Summary

Vascular embolization or occlusion is a minimally invasive procedure used to block blood flow to a particular area of the body. This is achieved by introducing substances through a catheter to stop bleeding or prevent blood flow to a problematic area. The procedure involves real-time imaging guidance to ensure accuracy.

Purpose

The primary purpose of vascular embolization or occlusion is to control arterial or venous hemorrhage or to address lymphatic extravasation. This procedure aims to stop internal bleeding, reduce blood flow to a tumor, or manage other vascular issues, ultimately stabilizing the patient’s condition.

Indications

• Acute or severe arterial or venous hemorrhage
• Trauma-induced internal bleeding
• Gastrointestinal bleeding
• Preoperative or postoperative bleeding control
• Lymphatic system leaks
• Certain tumors requiring reduced blood supply

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustment or discontinuation of certain medications, particularly blood thinners.
• Blood tests and imaging studies (e.g., CT scans, MRIs, or ultrasounds) may be required for planning.

Procedure Description

1. Imaging Setup: The patient is positioned, and initial imaging (X-ray, CT, or ultrasound) is performed to visualize the target area.
2. Catheter Insertion: A small incision is made, usually in the groin, and a catheter is inserted into the blood vessel.
3. Navigation: Using live imaging (fluoroscopy), the catheter is guided to the target site.
4. Embolizing Agent Delivery: Once in place, tiny coils, particles, or a liquid embolic agent is introduced to block the vessel.
5. Confirmation: Final imaging is done to confirm successful occlusion of the targeted vessel.
6. Catheter Removal: The catheter is carefully removed, and the insertion site is bandaged.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity and the specific situation.

Setting

Vascular embolization or occlusion is usually performed in a hospital's interventional radiology suite.

Personnel

• Interventional Radiologist
• Radiologic Technologist
• Nurses
• Anesthesiologist or sedation nurse (if sedation is used)

Risks and Complications

• Infection at the catheter insertion site
• Allergic reaction to contrast dye
• Vessel injury or rupture
• Migration of the embolizing material to unintended sites
• Post-embolization syndrome (fever, pain, nausea)
• Kidney damage (particularly in patients with pre-existing renal issues)

Benefits

• Rapid control of life-threatening bleeding
• Minimally invasive with less recovery time compared to surgery
• Targeted treatment, reducing impact on surrounding tissues
• Relief of symptoms soon after the procedure

Recovery

• Monitoring in a recovery area for several hours post-procedure
• Bed rest for a few hours, sometimes overnight
• Instructions on activity restrictions and signs of complications to watch for
• Follow-up imaging to assess the success of the embolization
• A follow-up appointment with the interventional radiologist or primary physician

Alternatives

• Surgical intervention
• Endoscopic procedures for certain types of bleeding
• Medication management for bleeding control
• Pros: Non-invasive alternatives may be less risky for some patients.
• Cons: Alternatives may not be as effective or rapid in controlling acute hemorrhage.

Patient Experience

• During the procedure, mild discomfort or a sensation of pressure in the area may be felt.
• Some patients may experience anxiety and will be given sedatives.
• Post-procedure pain is typically managed with medications.
• Patients may feel tired and might experience mild discomfort at the catheter insertion site.

Patients are encouraged to discuss any concerns or questions with their healthcare provider to ensure a clear understanding of the procedure and its implications.