93564 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective opacification of aortocoronary venous or arterial bypass graft(s) (eg, aortocoronary saphenous vein, free radial artery, or free ma

Name of the Procedure:

Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report for selective opacification of aortocoronary venous or arterial bypass graft(s) (e.g., aortocoronary saphenous vein, free radial artery, or free mammary artery).

Summary

This procedure involves the injection of a contrast dye into coronary artery bypass grafts during a cardiac catheterization to help visualize the blood flow and detect any blockages using imaging technology. The procedure is supervised by a specialist, who interprets the results and provides a detailed report.

Purpose

The purpose is to assess the patency and functionality of coronary artery bypass grafts.

• Diagnose issues like blockages or stenosis in the bypass grafts.
• Determine the success of previous coronary artery bypass graft surgery.
• Aid in planning further medical or surgical interventions if necessary.

Indications

• Symptoms suggestive of graft blockage, such as chest pain, shortness of breath, or abnormal stress test results.
• Post-Coronary Artery Bypass Grafting (CABG) patients experiencing recurrent symptoms.
• Monitoring known grafts over time to ensure they remain open and functional.

Preparation

• Patients may need to fast for several hours before the procedure.
• Blood tests, EKG, and imaging studies may be required pre-procedure.
• Medications may need to be adjusted under the guidance of a healthcare provider, particularly blood thinners.

Procedure Description

1. The patient is positioned on a procedure table in a catheterization lab.
2. Local anesthesia is administered at the catheter insertion site (usually the groin or wrist).
3. A catheter is inserted into an artery and guided to the coronary arteries.
4. A contrast dye is injected into the bypass grafts while imaging equipment captures real-time video.
5. The specialist interprets the images to detect any abnormalities.
6. The catheter is removed, and the insertion site is bandaged.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in a hospital catheterization lab, often as an outpatient procedure.

Personnel

• Interventional cardiologist
• Nurses
• Radiology technicians
• Anesthesiologist or sedation specialist (if sedation beyond local anesthesia is needed)

Risks and Complications

• Allergic reactions to contrast dye
• Bleeding or infection at the catheter site
• Arrhythmias or irregular heartbeats during the procedure
• Rarely, heart attack or stroke
• Damage to blood vessels

Benefits

• Accurate diagnosis of graft patency
• Clear visualization of blood flow and blockages
• Informs treatment plans and necessary interventions
• Immediate decision-making based on real-time results

Recovery

• Patients are typically monitored for a few hours post-procedure.
• Avoid heavy lifting or strenuous activities for a day or two.
• Keep the insertion site clean and dry.
• Follow-up appointments to discuss results and further treatment if needed.

Alternatives

• Non-invasive imaging tests like CT coronary angiography.
• Enhanced external counterpulsation (EECP) if non-surgical alternatives are necessary.
• Stress tests to evaluate heart function indirectly.

Patient Experience

• The patient may experience a mild burning sensation when the contrast dye is injected.
• Some pressure or discomfort at the catheter insertion site.
• Pain management includes local anesthesia, and in some cases, sedation for comfort.