Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s),
CPT4 code
Name of the Procedure:
Percutaneous Transluminal Mechanical Thrombectomy and/or Infusion for Thrombolysis, Dialysis Circuit
Common Names: Mechanical Thrombectomy, Dialysis Circuit Thrombectomy, Thrombolysis Infusion
Summary
Percutaneous transluminal mechanical thrombectomy is a minimally invasive procedure to remove blood clots from a dialysis circuit. This may involve infusing medication to dissolve clots, guided by real-time imaging technologies.
Purpose
This procedure addresses clots within the dialysis circuit, which can cause reduced efficiency or complete blockage of the dialysis process. The goal is to restore proper blood flow, ensuring the dialysis system functions effectively.
Indications
- Swollen or painful arm due to clot in dialysis access.
- Decreased dialysis effectiveness.
- Clot found through imaging or physical examination.
- Symptoms of poor circulation in the arm or hand.
Preparation
- Fasting for several hours before the procedure.
- Adjusting or stopping certain medications (e.g., blood thinners).
- Pre-procedural blood tests and imaging studies to locate the clot and assess overall health.
Procedure Description
- Imaging: Fluoroscopic guidance is used to visualize the blood vessels and locate the clot.
- Catheter Insertion: A small puncture is made to access the blood vessel, and a catheter is carefully fed through the blood vessel to the site of the clot.
- Thrombectomy: Mechanical devices, including rotating blades or suction, are used to break up and remove the clot.
- Thrombolysis (if needed): Medication may be infused through the catheter to dissolve any remaining clot.
- Completion: The site is assessed to ensure the blood flow has been restored, and all equipment is removed.
Duration
The procedure typically takes 1 to 2 hours.
Setting
Usually performed in a hospital's interventional radiology suite or a specialized outpatient clinic.
Personnel
- Interventional Radiologist or Vascular Surgeon
- Radiologic Technologist
- Nurses
- Anesthesiologist or Sedation Specialist, if necessary
Risks and Complications
- Bleeding or bruising at the catheter insertion site.
- Infection.
- Allergic reaction to contrast dye or thrombolytic medication.
- Damage to blood vessels.
- Rarely, clot fragments can travel and cause blockages elsewhere.
Benefits
- Restored blood flow in the dialysis circuit.
- Improved efficiency and effectiveness of dialysis.
- Minimally invasive approach with a relatively quick recovery.
Recovery
- Patients are monitored for several hours post-procedure.
- Instructions may include limited use of the arm, keeping the insertion site clean and dry.
- Follow-up appointments to assess the access site and dialysis function.
- Resuming normal activities usually within a day or two.
Alternatives
- Surgical thrombectomy: a more invasive option that involves open surgery to remove the clot.
- Pharmacological thrombolysis: medication alone to dissolve the clot, which might take longer to be effective.
- Conservative management: increased monitoring or adjustments in dialysis technique.
Patient Experience
- Mild discomfort or pressure during the insertion of the catheter.
- Sedation may cause sleepiness or grogginess post-procedure.
- Pain at the insertion site managed with over-the-counter pain relievers.
- Rapid recovery with minimal downtime.