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Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image post
CPT4 code
Name of the Procedure:
Superselective catheter placement (one or more second order or higher renal artery branches), renal artery and any accessory renal artery(s) for renal angiography
Summary
This procedure involves placing a catheter into specific branches of the renal arteries to obtain detailed images of the blood vessels in the kidneys. This is done to diagnose and evaluate conditions affecting the renal arteries.
Purpose
- Medical Condition: Addresses issues such as renal artery stenosis, aneurysms, or other vascular abnormalities.
- Goals: Obtain high-resolution images of the renal arteries to assist in diagnosis and treatment planning.
Indications
- Hypertension suspected to be due to renal artery stenosis
- Suspected aneurysms in renal arteries
- Unexplained kidney dysfunction
- Preoperative mapping of renal vascular anatomy
Preparation
- Pre-procedure Instructions: Fasting for at least 6 hours before the procedure; adjustments in medications may be necessary.
- Diagnostic Tests: Blood tests to check kidney function and clotting parameters; possibly a pre-procedural imaging study (e.g., CT angiography).
Procedure Description
- Arterial Puncture: A needle is used to puncture an artery, usually in the groin area.
- Catheterization: A thin tube (catheter) is threaded into the specific branches of the renal arteries.
- Fluoroscopy: Real-time X-ray guiding is used to place the catheter precisely.
- Contrast Injection: A contrast dye is injected through the catheter.
- Imaging: High-resolution images are captured using X-ray technology.
- Tools Used: Needle, catheter, fluoroscopy machine, contrast dye.
- Anesthesia: Usually local anesthesia at the puncture site; sedation may be used for patient comfort.
Duration
Approximately 1-2 hours.
Setting
Performed in a hospital’s interventional radiology suite or a specialized outpatient imaging center.
Personnel
- Interventional radiologist or vascular surgeon
- Radiology technologists
- Nursing staff
- Anesthesiologist (if sedation or general anesthesia is used)
Risks and Complications
- Common Risks: Bruising or bleeding at the puncture site, allergic reaction to contrast dye.
- Rare Complications: Kidney damage, blood clot formation, arterial dissection, infection.
Benefits
- Provides detailed images aiding in accurate diagnosis.
- Can inform treatment plans and interventions.
- Potentially life-saving by identifying critical vascular issues.
Recovery
- Post-procedure Care: Monitoring in a recovery area for a few hours; hydration to flush out contrast dye.
- Recovery Time: Typically, patients can go home the same day but should avoid strenuous activity for 24-48 hours.
- Follow-Up: Scheduled appointments to discuss imaging results and further treatment if necessary.
Alternatives
- Other Options: CT or MR angiography, Doppler ultrasound.
- Pros and Cons: These alternatives may be less invasive but could provide less detailed images compared to superselective catheter placement.
Patient Experience
- During: May feel slight pressure or discomfort at catheter insertion site; infrequent mild discomfort when dye is injected.
- After: Mild soreness at the puncture site, generally well-managed with over-the-counter pain relievers.