36482 Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated

Name of the Procedure:

Endovenous Ablation Therapy of Incompetent Vein, Extremity, by Transcatheter Delivery of a Chemical Adhesive (e.g., cyanoacrylate) Remote from the Access Site, Inclusive of All Imaging Guidance and Monitoring, Percutaneous; First Vein Treated

Summary

Endovenous ablation therapy using a chemical adhesive like cyanoacrylate involves sealing off an incompetent vein in the leg by injecting a medical-grade glue. This minimally invasive procedure is performed remotely from the vein access site and includes all necessary imaging and monitoring to ensure accuracy and safety.

Purpose

This procedure treats varicose veins and chronic venous insufficiency. The main goal is to reduce symptoms like pain, swelling, and skin changes, and to improve the appearance of the affected leg.

Indications

• Painful or symptomatic varicose veins
• Chronic venous insufficiency
• Failed conservative management (e.g., compression stockings)
• Patient criteria: Typically recommended for patients with confirmed venous reflux through duplex ultrasound.

Preparation

• Patients may be required to fast for several hours prior.
• Adjustments to medications, particularly blood thinners, may be necessary.
• A duplex ultrasound of the affected leg is performed to map the veins.
• Patients should arrange for transportation home post-procedure.

Procedure Description

1. Preparation: The patient is positioned, and the area is cleaned and numbed with local anesthesia.
2. Access: A small catheter is inserted into the vein through a tiny skin incision.
3. Delivery: The chemical adhesive (cyanoacrylate) is delivered via the catheter.
4. Imaging: Real-time ultrasound imaging guides the placement and delivery of the adhesive.
5. Sealing: The adhesive seals the vein, causing it to close and divert blood flow to healthier veins.
6. Monitoring: Continuous monitoring is done to ensure the procedure's success.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Performed in an outpatient clinic, surgical center, or hospital.

Personnel

• Vascular Surgeon or Interventional Radiologist
• Nurses
• Ultrasound Technician

Risks and Complications

• Common: Bruising, discomfort at the catheter site, transient skin discoloration
• Rare: Deep vein thrombosis, infection, nerve injury
• Management: Follow-up care includes monitoring for complications and prompt intervention if they occur.

Benefits

• Relief from pain and other symptoms associated with varicose veins
• Improved leg appearance
• Minimal downtime and quick recovery

Recovery

• Patients can usually walk immediately after the procedure.
• Compression stockings may be recommended.
• Avoid strenuous activities and heavy lifting for about a week.
• Follow-up appointments to monitor progress.

Alternatives

• Conservative treatments like compression stockings and lifestyle changes.
• Other procedures: Sclerotherapy, radiofrequency ablation, laser ablation, and surgical vein stripping.
• Pros and cons: Alternatives may have varying efficacy, recovery times, and risk profiles.

Patient Experience

• During: Mild discomfort or pressure sensation.
• Post-procedure: Minimal pain, managed with over-the-counter pain relievers.
• Quick return to daily activities with some restrictions initially to ensure optimal healing.