36225 Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when per

Name of the Procedure:

Selective Catheter Placement, Subclavian or Innominate Artery, Unilateral, with Angiography of the Ipsilateral Vertebral Circulation and All Associated Radiological Supervision and Interpretation. Includes Angiography of the Cervicocerebral Arch, When Performed.

Summary

This procedure involves the precise placement of a catheter in either the subclavian artery or the innominate artery on one side of the body. It includes detailed imaging of the nearby vertebral circulation and the cervicocerebral arch to evaluate blood flow and identify any abnormalities.

Purpose

The procedure is performed to diagnose and sometimes treat conditions related to the blood vessels supplying the brain and spinal cord. The goal is to obtain high-resolution images that can help identify blockages, aneurysms, or other vascular issues that could impact neurological function.

Indications

• Symptoms such as dizziness, headaches, or signs of a stroke.
• Suspected arterial blockages, aneurysms, or dissections in the cervicocerebral region.
• Follow-up evaluation after previous vascular interventions or surgeries.

Preparation

• Patients may need to fast for a specific period before the procedure.
• Certain medications might need to be adjusted or paused as advised by the doctor.
• Pre-procedure tests could include blood work and imaging studies like ultrasound or MRI.

Procedure Description

1. The patient is positioned on an X-ray table, and local anesthesia is administered at the catheter insertion site.
2. A thin, flexible tube, or catheter, is inserted into an artery in the groin or arm.
3. Using imaging guidance, the catheter is navigated to the subclavian or innominate artery.
4. Contrast dye is injected to highlight the arteries, and X-ray images are taken to visualize blood flow and vascular structures.
5. The catheter is then carefully removed, and pressure is applied to the insertion site to prevent bleeding.

Tools involved include X-ray equipment, catheters, and contrast dye. Local anesthesia is used to numb the insertion area, and sedation may be provided to keep the patient comfortable.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a hospital's radiology or interventional radiology suite.

Personnel

• Interventional radiologist or vascular surgeon
• Radiology technician
• Nurses
• Anesthesiologist (if sedation is required)

Risks and Complications

• Common: Bruising or bleeding at the catheter insertion site, allergic reactions to contrast dye.
• Rare: Infection, blood vessel damage, stroke, or kidney problems due to contrast dye.

Benefits

The procedure provides detailed and accurate visualization of the blood vessels supplying the brain. It can help diagnose and guide treatment of vascular conditions, potentially preventing serious complications like stroke. Benefits are typically realized immediately upon diagnosis.

Recovery

• Patients usually rest in a recovery area for several hours post-procedure.
• Instructions may include avoiding strenuous activities for a few days, keeping the insertion site clean, and watching for signs of infection.
• Follow-up appointments may be scheduled to monitor recovery and discuss results.

Alternatives

• Non-invasive imaging tests like MRI or CT angiography.
• Pros: Less risk and no need for catheter insertion.
• Cons: May not provide images as detailed as direct angiography, and might not be suitable for all patients depending on their medical conditions.

Patient Experience

During the procedure, the patient might feel slight pressure at the insertion site and a warm sensation when the contrast dye is injected. Post-procedure, there may be some soreness at the catheter site, which can be managed with mild pain relievers. Comfort measures include local anesthesia and possible sedation to ensure the patient remains relaxed and pain-free.