36246 Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family

Name of the Procedure:

Selective Catheter Placement in the Arterial System; Initial Second Order Abdominal, Pelvic, or Lower Extremity Artery Branch, Within a Vascular Family

Summary

This procedure involves placing a catheter into the bloodstream and guiding it to a specific second-order artery branch in the abdomen, pelvis, or lower extremities. It’s a targeted approach used for diagnostic or therapeutic purposes.

Purpose

This procedure is performed to diagnose and treat conditions affecting the arteries in the abdomen, pelvis, or lower extremities. The goals include accurate assessment of vascular conditions, delivery of medication directly to the affected area, or interventions like angioplasty.

Indications

• Symptoms like severe leg pain, abdominal pain, or pelvic pain suggestive of vascular issues.
• Conditions such as peripheral artery disease, abdominal aortic aneurysm, or pelvic congestion syndrome.
• Need for precise imaging or targeted treatment in specific vascular branches.

Preparation

• Fasting before the procedure, usually from midnight the night before.
• Adjustments to medications, especially blood thinners.
• Pre-procedure assessments like blood tests, ECG, and imaging studies (e.g., ultrasound or CT angiography).

Procedure Description

1. The patient is positioned on an X-ray table.
2. Local anesthesia is administered at the insertion site (usually the groin).
3. A small incision is made, and a catheter is introduced into a major artery.
4. The catheter is guided to the targeted second-order artery branch using imaging technology.
5. Diagnostic imaging or therapeutic interventions are performed through the catheter.
6. The catheter is carefully removed, and the insertion site is closed and bandaged.

Tools: Catheters, guidewires, imaging equipment (fluoroscopy). Anesthesia: Local anesthesia is commonly used; sedation may be provided as needed.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Usually performed in a hospital's catheterization lab or an outpatient surgical center equipped with specialized imaging technology.

Personnel

• Interventional radiologist or vascular surgeon.
• Nurses and radiology technicians.
• Anesthesiologist or nurse anesthetist if sedation is used.

Risks and Complications

Common risks: Bruising and discomfort at the catheter insertion site. Rare risks: Infection, arterial damage, bleeding, allergic reaction to contrast dye, kidney issues from contrast dye.

Benefits

• Accurate diagnosis of vascular conditions.
• Direct and effective treatment of the affected artery.
• Minimally invasive with a comparatively quicker recovery time.

Recovery

• Monitoring in a recovery area for a few hours post-procedure.
• Instructions for keeping the insertion site clean and dry.
• Avoiding strenuous activities for a few days.
• Follow-up appointments to assess vascular health and procedure outcomes.

Alternatives

• Non-invasive imaging techniques like MRI or CT scans.
• Medications for underlying conditions.
• Surgical options like open bypass surgery. Pros: Alternatives are less invasive. Cons: May be less accurate or effective for certain conditions.

Patient Experience

During the procedure: Possible sensation of pressure or mild discomfort at the insertion site; some patients might feel a warm sensation from the contrast dye. After the procedure: Mild soreness at the insertion site; pain management includes over-the-counter pain relievers and comfort measures as advised by the healthcare team.