36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family

Name of the Procedure:

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

Summary

This procedure involves inserting a catheter into the arterial system, specifically targeting a third-order or more selective branch in the abdominal, pelvic, or lower extremity arteries. It is performed to deliver medications, contrast agents for imaging, or other therapeutic substances directly to a specific artery.

Purpose

The procedure addresses various medical conditions including blockages, aneurysms, or tumors in the abdominal, pelvic, or lower extremity arteries. The goals are to improve blood flow, deliver targeted treatment, or diagnose specific vascular issues through imaging.

Indications

• Symptoms of vascular disease such as pain, claudication, or ulcers in the lower extremities.
• Aneurysms or arterial blockages in the abdominal or pelvic regions.
• Diagnosing or treating arterial diseases using imaging contrast agents.

Preparation

• Fasting may be required for 6-8 hours before the procedure.
• Patients might need to adjust or stop certain medications, especially blood thinners, as instructed by their healthcare provider.
• Diagnostic tests like blood work, EKG, or previous imaging studies to assess overall health and vascular condition.

Procedure Description

1. The patient is positioned on an imaging table.
2. Local anesthesia is administered to numb the insertion site.
3. A small incision is made to access the artery, usually in the groin.
4. Using imaging guidance, a catheter is threaded through the arterial system to the targeted third-order artery.
5. Contrast dye may be injected to visualize the artery, followed by medication or other therapeutic agents.
6. Once completed, the catheter is removed, and pressure is applied to the insertion site to prevent bleeding.

Tools/Equipment: Catheter, imaging equipment (X-ray, fluoroscopy), contrast dye.

Anesthesia: Local anesthesia; conscious sedation might be used in some cases.

Duration

The procedure typically takes 1-2 hours, depending on complexity and specific treatment delivered.

Setting

Performed in a hospital or an outpatient clinic equipped with specialized imaging facilities.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Radiology Technologists
• Nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

• Common: Bruising or bleeding at the catheter insertion site, mild pain.
• Rare: Infection, arterial damage, allergic reaction to contrast dye, blood clots, loss of kidney function due to dye.

Benefits

• Improved blood flow in targeted arteries.
• Accurate diagnosis and targeted treatment of vascular conditions.
• Reduced symptoms and potentially improved limb function or saving limb from severe vascular conditions.

Recovery

• Patients may need to lie flat for several hours post-procedure to ensure arterial closure.
• Monitoring in a recovery area for a few hours.
• Avoid strenuous activities for 24-48 hours.
• Follow-up appointments to assess the success of the procedure and monitor for any complications.

Alternatives

• Non-selective catheter placement with broader targeting.
• Medication-based management.
• Surgical interventions like bypass or endarterectomy.
• Pros and cons depend on the specific condition; more invasive alternatives might pose higher risks but could be necessary for severe cases.

Patient Experience

• Mild discomfort during catheter insertion and dye injection may be experienced.
• Post-procedure soreness or bruising at the insertion site.
• Pain management includes local anesthetics and possibly prescribed pain relievers.
• Comfort measures include close monitoring and assistance from healthcare staff for any immediate post-procedure needs.