Injection procedures (eg, thrombin) for percutaneous treatment of extremity pseudoaneurysm
CPT4 code
Injection Procedures (eg, Thrombin) for Percutaneous Treatment of Extremity Pseudoaneurysm
Summary
This procedure involves using a needle to inject medication directly into a pseudoaneurysm to help seal it. Pseudoaneurysms are abnormal blood-filled sacs that can occur as a result of an injured or weakened blood vessel wall.
Purpose
The main purpose of this procedure is to treat and close off an extremity pseudoaneurysm, thereby preventing further bleeding and alleviating associated symptoms such as pain or swelling.
Indications
- Presence of a confirmed extremity pseudoaneurysm.
- Symptoms such as pain, swelling, or pulsating mass near an affected extremity.
- Failure of less invasive treatments or if surgery poses too high a risk for the patient.
Preparation
- Follow fasting instructions, usually nothing by mouth for several hours before the procedure.
- Adjust any blood-thinning medications as directed by the healthcare provider.
- Complete required diagnostic imaging (e.g., ultrasound) to confirm the location and size of the pseudoaneurysm.
Procedure Description
- Localization: Using imaging guidance, such as ultrasound, the healthcare provider identifies the pseudoaneurysm.
- Sterilization and Anesthesia: The skin over the pseudoaneurysm is cleaned and a local anesthetic is applied to numb the area.
- Injection: A needle is inserted into the pseudoaneurysm, and thrombin (a clotting agent) is carefully injected to promote clotting and closure of the pseudoaneurysm.
- Observation: Continuous imaging is used to monitor the immediate effects and ensure the success of the procedure.
Duration
The procedure typically takes about 30 minutes to 1 hour.
Setting
The procedure is generally done on an outpatient basis, often in a hospital or specialized clinic.
Personnel
- Interventional radiologist or vascular surgeon
- Nursing staff
- Ultrasound technician (if imaging guidance is used)
Risks and Complications
- Infection at the injection site
- Allergic reaction to thrombin
- Incomplete closure of the pseudoaneurysm leading to recurrence
- Thrombosis or clotting in nearby blood vessels
Benefits
- Minimally invasive compared to surgical options
- Quick recovery time
- Effective in resolving pseudoaneurysm and alleviating symptoms
Recovery
- Monitor the injection site for signs of infection or complications.
- Follow specific activity restrictions as advised by the healthcare provider.
- Attend any scheduled follow-up appointments to ensure the pseudoaneurysm has resolved completely.
Alternatives
- Surgical repair or ligation of the pseudoaneurysm.
- Ultrasound-guided compression therapy, which may be less effective and more uncomfortable.
- Conservative management, which might not be sufficient for large or symptomatic pseudoaneurysms.
Patient Experience
During the procedure, patients may feel the initial sting of the local anesthetic injection, but should remain comfortable afterward. Post-procedure, slight soreness at the needle site can occur, and pain can be managed with over-the-counter pain relievers as recommended. Most patients can resume normal activities within a few days.