75658 Angiography, brachial, retrograde, radiological supervision and interpretation

Name of the Procedure:

Angiography, Brachial, Retrograde, Radiological Supervision, and Interpretation

Summary

Angiography of the brachial artery is a diagnostic test where a special dye is injected into the brachial artery (located in the upper arm) to visualize blood flow and detect any abnormalities. The term "retrograde" means the dye is injected against the normal direction of blood flow. Radiological supervision and interpretation entail a radiologist using imaging technology to guide and evaluate the procedure.

Purpose

Angiography of the brachial artery helps identify blockages, narrowing, or other vascular conditions affecting blood flow. The goal is to diagnose conditions that may be causing symptoms like arm pain, numbness, or other circulatory issues, ultimately aiding in proper treatment planning.

Indications

• Persistent arm or hand pain.
• Numbness or weakness in the arm.
• Suspected blockages or narrowing of the brachial artery.
• Vascular malformations or aneurysms.
• Trauma to the upper arm with suspected arterial injury.

Preparation

• Patients may be instructed to fast for 4-6 hours before the procedure.
• Certain medications, such as blood thinners, may need to be adjusted.
• Pre-procedure diagnostics may include blood tests and imaging studies like ultrasound or MRI.

Procedure Description

1. The patient lies on an exam table, and the upper arm is cleansed and sterilized.
2. Local anesthesia is administered to numb the insertion site.
3. A small incision is made, and a catheter is inserted into the brachial artery.
4. Contrast dye is injected through the catheter, moving retrograde (against normal blood flow direction).
5. X-ray or fluoroscopy imaging captures real-time images of the brachial artery.
6. The radiologist interprets the images to identify any abnormalities.
7. The catheter is removed, and pressure is applied to the insertion site to prevent bleeding.

Duration

The procedure typically takes about 1-2 hours.

Setting

The procedure is performed in a hospital radiology department or an outpatient radiology clinic.

Personnel

• Interventional radiologist (who performs the procedure)
• Radiology technologist (assists with imaging)
• Nurse (prepares and monitors the patient)
• Anesthesiologist (if sedation is required)

Risks and Complications

• Bleeding or hematoma at the insertion site.
• Allergic reaction to the contrast dye.
• Infection at the catheter insertion site.
• Damage to the artery or surrounding tissues.
• Rarely, a stroke or heart attack.

Benefits

• Accurate diagnosis of vascular conditions in the arm.
• Helps in planning appropriate treatment.
• Minimally invasive with relatively quick recovery.

Recovery

• Apply pressure to the insertion site post-procedure to minimize bleeding.
• Keep the arm still and avoid strenuous activities for 24-48 hours.
• Follow-up appointments may be required to assess the insertion site and discuss findings.

Alternatives

• Non-invasive imaging tests like Doppler ultrasound or MR angiography.
• Direct surgical exploration, which is more invasive.

Pros of Alternatives:

• Non-invasive options have fewer risks and no need for incision.

Cons of Alternatives:

• May not provide as detailed information as direct angiography.

Patient Experience

During the procedure, the patient might feel slight discomfort or pressure at the insertion site. Post-procedure, there may be temporary soreness or bruising in the upper arm. Pain can be managed with over-the-counter pain medications as recommended by the healthcare provider.