0236T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; abdominal aorta

Name of the Procedure:

Transluminal Peripheral Atherectomy, Open or Percutaneous, Including Radiological Supervision and Interpretation; Abdominal Aorta

Summary

Transluminal peripheral atherectomy involves removing plaque buildup from the abdominal aorta using either an open or percutaneous (through the skin) approach. Radiological guidance is used to visualize the arteries during the procedure.

Purpose

The procedure is used to treat atherosclerosis (plaque buildup in arteries), which can restrict blood flow in the abdominal aorta, potentially leading to significant health issues. The primary goal is to restore normal blood flow and prevent complications like aneurysms or blood clots.

Indications

• Symptoms of abdominal aortic atherosclerosis, such as abdominal pain or intermittent claudication (pain and cramping in the legs).
• Patients with significant artery narrowing or blockage confirmed by diagnostic imaging.
• Individuals not responding to lifestyle changes or medication management.

Preparation

• Patients may need to fast for several hours before the procedure.
• Pre-procedure blood tests, imaging studies (e.g., ultrasound, CT scan), and physical exam.
• Instructions on medication adjustments, including blood thinners.

Procedure Description

1. The patient is positioned in a sterile environment.
2. Local or general anesthesia is administered.
3. A catheter is inserted into the artery, usually through the groin.
4. Radiological imaging guides the catheter to the affected segment of the abdominal aorta.
5. A specialized atherectomy device at the catheter's tip removes the plaque.
6. The removed plaque is collected and extracted.
7. The area is checked for successful blood flow restoration and the catheter is removed.
8. The insertion site is closed and bandaged.

Duration

Typically, the procedure takes 1 to 2 hours.

Setting

The procedure is usually performed in a hospital's operating room or a surgical center with specialized radiological equipment.

Personnel

• Vascular surgeon or interventional radiologist
• Radiologic technologist
• Anesthesiologist or nurse anesthetist
• Surgical nurses

Risks and Complications

• Bleeding at the catheter insertion site
• Infection
• Blood vessel damage
• Blood clots
• Re-narrowing of the artery (restenosis)

Benefits

• Improved blood flow in the abdominal aorta
• Relief of symptoms associated with atherosclerosis
• Reduced risk of aneurysms and other complications

Recovery

• Monitoring in a recovery area for several hours post-procedure.
• Instructions on wound care and activity restrictions.
• Follow-up visits and imaging studies to ensure successful outcomes.
• Possible short-term limitations on strenuous activities.

Alternatives

• Medication management (e.g., statins, blood pressure medications).
• Lifestyle changes (diet and exercise).
• Other surgical options, such as angioplasty or stenting.
• Each alternative has its pros and cons, balanced against the patient's specific condition.

Patient Experience

During the procedure, patients may feel pressure but should not experience pain due to anesthesia. Post-procedure, they might experience mild discomfort at the catheter insertion site, managed with pain medication. Recovery is typically smooth with gradual return to normal activities.