Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dia
CPT4 code
Name of the Procedure:
Transcatheter Placement of Intravascular Stent(s) in the Central Dialysis Segment
Summary
Transcatheter placement of intravascular stent(s) in the central dialysis segment is a minimally invasive procedure to open up blocked or narrowed vessels in a dialysis circuit. A stent—a tiny wire mesh tube—is placed within the blood vessels to keep them open, ensuring adequate blood flow for dialysis.
Purpose
This procedure addresses blockages or narrowing (stenosis) in the central veins of patients undergoing dialysis. The goal is to restore adequate blood flow through the dialysis circuit, ensuring effective dialysis treatment and preventing complications such as access loss or inadequate dialysis.
Indications
- Symptoms of poor dialysis access, such as swelling of the arm or face, prolonged dialysis sessions, and poor cleaning of the blood.
- Diagnostic imaging showing significant narrowing or blockage in the central veins used for dialysis.
Preparation
- Fasting for a specific period before the procedure.
- Review of current medications; some medications may need to be adjusted.
- Routine blood tests and imaging studies to assess the area needing treatment.
Procedure Description
- Access: A catheter is inserted into a vein, usually in the groin or neck.
- Imaging: Imaging tests (e.g., X-rays, ultrasound) guide the catheter to the precise location of the blockage or narrowing.
- Angioplasty: A balloon attached to the catheter is inflated to expand the narrowed area.
- Stenting: A stent is placed to keep the vessel open. The stent is expanded with the balloon and left in place.
- Imaging and Verification: Further imaging confirms the stent placement and adequate blood flow.
Advanced imaging technology and radiological supervision are utilized throughout the procedure to ensure precision.
Duration
Typically, the procedure takes 1-2 hours.
Setting
The procedure is performed in a hospital, usually in a specialized interventional radiology suite or cardiac catheterization lab.
Personnel
- Interventional Radiologist or Vascular Surgeon
- Radiology Technologist
- Nurses
- Anesthesiologist (if sedation or general anesthesia is used)
Risks and Complications
- Bleeding or hematoma at the puncture site.
- Infection at the access site.
- Allergic reaction to contrast dye.
- Blood clots or embolism.
- Stent migration or misplacement.
- Re-narrowing of the vessel (restenosis) over time.
Benefits
- Improved blood flow through the dialysis circuit.
- Enhanced efficiency and effectiveness of dialysis treatment.
- Reduced symptoms of poor dialysis access.
- Short recovery time due to the minimally invasive nature of the procedure.
Recovery
- Monitoring in a recovery area for a few hours post-procedure.
- Instructions for care of the puncture site.
- Avoid heavy lifting and strenuous activities for a few days.
- Follow-up imaging to ensure the stent remains open, typically within a few weeks.
Alternatives
- Surgical creation of a new dialysis access.
- Balloon angioplasty without stenting.
- Medication management to improve blood flow.
- Each alternative has varying levels of invasiveness, risk, and long-term success rates.
Patient Experience
- Local anesthesia or sedation may be used to ensure comfort.
- Mild discomfort or pressure during catheter insertion and balloon inflation.
- Post-procedure, some minor soreness or bruising at the access site.
- Pain management and comfort measures provided during and after the procedure.
Overall, patients can expect a relatively quick return to normal activities with proper care and follow-up.