37184 Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel

Name of the Procedure:

Primary Percutaneous Transluminal Mechanical Thrombectomy, Noncoronary, Non-Intracranial, Arterial or Arterial Bypass Graft, Including Fluoroscopic Guidance and Intraprocedural Pharmacological Thrombolytic Injection(s); Initial Vessel

Summary

This procedure is a minimally invasive treatment to remove a blood clot from an artery or an arterial bypass graft. It uses a special device inserted through a small incision and navigated to the clot site with the help of X-ray imaging. Medication may also be injected to help dissolve the clot.

Purpose

This procedure is used to treat blocked arteries outside the heart and brain due to blood clots. The goal is to restore normal blood flow, relieve symptoms, and prevent tissue damage or organ failure caused by the blocked artery.

Indications

• Acute limb ischemia (sudden loss of blood flow to a limb)
• Critical limb ischemia with non-healing wounds or severe pain
• Acute mesenteric ischemia (sudden loss of blood flow to the intestines)
• Other noncoronary and non-intracranial acute arterial thrombotic events

Preparation

• Patients may need to fast for several hours before the procedure.
• Blood tests and imaging studies such as ultrasound, CT angiography, or MRI may be required.
• Medications may be adjusted, particularly blood thinners or anticoagulants.

Procedure Description

1. The patient is positioned on the procedure table, and the area of access is sterilized.
2. Local anesthesia is administered at the incision site, and sedation may be provided.
3. A small incision is made to insert a catheter into the artery.
4. Using fluoroscopic guidance (continuous X-ray), the catheter is navigated to the site of the blood clot.
5. Mechanical devices within the catheter are used to break up and remove the clot.
6. Thrombolytic medication may be injected to help dissolve any remaining clot.
7. The catheter is removed, and the incision is closed and bandaged.

Duration

The procedure typically takes 1-3 hours, depending on the complexity and size of the clot.

Setting

This procedure is usually performed in a hospital setting, specifically in an interventional radiology or catheterization lab.

Personnel

• Interventional radiologist or vascular surgeon
• Interventional radiology technologists
• Nurses
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Bleeding at the incision site
• Infection
• Allergic reaction to contrast dye or medications
• Damage to the artery
• Recurrent clot formation
• Kidney problems due to contrast dye
• Embolization (clot traveling to another part of the body)

Benefits

• Rapid restoration of blood flow
• Relief from symptoms such as pain, numbness, or organ dysfunction
• Lower risk of tissue damage and organ failure compared to untreated blockages
• Minimally invasive with shorter recovery time compared to open surgery

Recovery

• Patients typically stay in the hospital for observation for several hours to a day.
• Monitoring of the puncture site and vital signs.
• Instructions on wound care and activity restrictions.
• Follow-up appointments to assess the success of the procedure and plan further treatment if needed.

Alternatives

• Pharmacological thrombolysis alone
• Open surgical thrombectomy
• Endovascular stenting
• Conservative management with anticoagulation therapy

Patient Experience

During the procedure, the patient may feel pressure or discomfort at the incision site but should not feel significant pain due to anesthesia. Post-procedure, patients might experience mild pain or bruising at the incision site, which can be managed with over-the-counter pain relievers. It's important to follow all post-procedure care instructions to ensure proper healing and monitor for any signs of complications.