Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vesse
CPT4 code
Name of the Procedure:
Percutaneous Transluminal Revascularization of or through Coronary Artery Bypass Graft (CABG) - Including Intracoronary Stent, Atherectomy, and Angioplasty (Single Vessel)
Summary
Percutaneous transluminal revascularization is a minimally invasive procedure to restore blood flow through a previously placed coronary artery bypass graft. This procedure can involve techniques like stent placement, atherectomy (removal of plaque), and angioplasty (widening of the artery), and may include distal protection to prevent debris from blocking smaller blood vessels.
Purpose
This procedure addresses the narrowing or blockage of a coronary artery bypass graft. The primary goal is to improve blood flow to the heart muscle, relieving symptoms like chest pain (angina) and reducing the risk of heart attacks.
Indications
- Symptoms of angina or chest pain due to reduced blood flow.
- Evidence of graft blockage on imaging studies.
- Previous coronary artery bypass graft (CABG) surgery.
- Patients who are not candidates for a repeat open-heart surgery.
Preparation
- Patients are typically required to fast for several hours before the procedure.
- Medication adjustments may be necessary, particularly with blood thinners.
- Diagnostic tests such as an electrocardiogram (ECG), blood tests, and imaging studies will be performed to assess the heart and graft condition.
Procedure Description
- Local anesthesia is administered to numb the groin or wrist area.
- A thin catheter is inserted through an artery in the groin or wrist and guided to the coronary artery bypass graft.
- Depending on the specifics, a stent may be placed to keep the artery open, plaque may be removed using atherectomy tools, and/or the artery may be widened using a balloon angioplasty.
- Distal protection devices may be employed to capture and remove debris that breaks loose during the procedure to prevent complications.
- Continuous imaging (fluoroscopy) helps guide the catheter and instruments through the vessels.
Duration
The procedure typically takes between 1 to 3 hours.
Setting
The procedure is performed in a hospital's cardiac catheterization laboratory (cath lab).
Personnel
- Interventional cardiologist
- Cardiovascular technologists
- Nurses
- Anesthesiologist (if deeper sedation is required)
Risks and Complications
- Bleeding or bruising at the catheter insertion site
- Damage to the artery or graft
- Infection
- Blood clots
- Heart attack or stroke
- Arrhythmias (irregular heartbeats)
- Contrast dye allergies or kidney damage
Benefits
- Relief from chest pain and other symptoms of reduced blood flow.
- Increased blood supply to the heart muscle.
- Reduced risk of heart attacks.
- Minimally invasive, often with quicker recovery compared to open-heart surgery.
Recovery
- Patients are usually monitored in the hospital for several hours or overnight.
- Instructions on wound care at the catheter insertion site.
- Gradual return to normal activities typically within a week.
- Medications may be prescribed to prevent clots and manage symptoms.
- Follow-up appointments to monitor heart health and graft function.
Alternatives
- Medical management with medications (e.g., nitrates, beta-blockers, antiplatelets, statins)
- Repeat coronary artery bypass graft surgery (CABG)
- Lifestyle modifications (diet, exercise)
- Each alternative has its pros and cons, such as varying levels of invasiveness, recovery time, and suitability depending on patient's overall health.
Patient Experience
During the procedure, the patient may feel pressure or mild discomfort at the catheter insertion site. Post-procedure, mild pain or bruising at the site is common. Pain management strategies and comfort measures (oral pain relievers, ice packs) will be provided. Patients typically feel an improvement in symptoms within days to weeks after the procedure.