Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s)
CPT4 code
Name of the Procedure:
Primary Percutaneous Transluminal Mechanical Thrombectomy (Noncoronary, Non-intracranial, Arterial or Arterial Bypass Graft) with Fluoroscopic Guidance and Intraprocedural Pharmacological Thrombolytic Injection(s); Second and All Subsequent Vessel(s).
Summary
This procedure involves removing blood clots from non-heart and non-brain arteries or arterial bypass grafts using a mechanical device and fluoroscopic (X-ray) guidance. Additional medications are injected to dissolve remaining clots, targeting second and subsequent vessels if multiple are affected.
Purpose
This procedure aims to restore blood flow in arteries obstructed by clots that are not located in the heart or brain. The primary goal is to prevent tissue damage, minimize symptoms, and improve overall blood circulation to the affected areas.
Indications
- Symptoms of acute limb ischemia, such as pain, numbness, or coldness in limbs.
- Evidence of arterial blockage shown by imaging tests.
- Patients with conditions that increase the risk of arterial clots, such as atherosclerosis.
- Previously unsuccessful or contraindicated treatments for clot removal.
Preparation
- Patients may need to fast for several hours before the procedure.
- Certain medications, particularly blood thinners, may need adjustment.
- Pre-procedure tests like blood work and imaging studies (e.g., ultrasound, CT scan) will be conducted to assess the clot's location and extent.
Procedure Description
- Sedation/Anesthesia: The patient receives local anesthesia or moderate sedation.
- Access: A small incision is made, usually in the groin, to access the artery.
- Catheter Insertion: A catheter is inserted into the artery and guided to the clot under fluoroscopic (X-ray) guidance.
- Mechanical Thrombectomy: A mechanical device is used to physically break up and remove the clot.
- Pharmacological Injection: Thrombolytic (clot-dissolving) medications are injected to ensure complete removal.
- Multiple Vessels: Steps repeated for any additional affected vessels.
- Completion: The catheter is removed, and the incision is closed.
Duration
The procedure typically takes 1-3 hours, depending on the number of vessels treated and the complexity.
Setting
The procedure is performed in a hospital's interventional radiology or cardiac catheterization lab.
Personnel
- Interventional radiologist or vascular surgeon
- Nurses
- Radiologic technologists
- Anesthesiologist or sedation nurse
Risks and Complications
- Bleeding or hematoma at the puncture site
- Infection
- Damage to the artery
- Allergic reaction to contrast dye
- Re-occlusion of the vessel
- Rarely, stroke or heart attack
Benefits
- Immediate improvement in blood flow
- Relief of symptoms like pain and numbness
- Prevention of tissue damage or loss
- Increased mobility and function in affected limbs
Recovery
- Post-procedure monitoring in a recovery area
- Bed rest for several hours or overnight
- Instructions on wound care and activity restrictions
- Follow-up appointments for imaging to ensure vessels remain clear
Alternatives
- Thrombolytic therapy alone, though this may take longer and be less effective in severe cases
- Surgical thrombectomy, which is more invasive
- Anticoagulant medications to manage clot risk
Patient Experience
- Mild discomfort or pressure during the procedure
- Post-procedure pain managed with medications
- Temporary soreness at the incision site
- Gradual improvement in symptoms over a few days to weeks