37214 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up ca

Name of the Procedure:

Transcatheter Therapy, Arterial or Venous Infusion for Thrombolysis (Other than Coronary)

Summary

This procedure involves using a catheter to deliver medication directly into an artery or vein to dissolve blood clots. It includes radiological supervision and interpretation and is continued on subsequent days as needed during the course of thrombolytic therapy.

Purpose

Transcatheter therapy with thrombolysis is used to treat blood clots in the arteries or veins. The goal is to dissolve the clots, restore normal blood flow, and prevent damage to tissues or organs.

Indications

• Acute blood clots in arteries or veins (excluding coronary arteries)
• Deep vein thrombosis (DVT)
• Pulmonary embolism (PE)

• Peripheral artery disease causing clots

  Candidates for the procedure typically have significant blockages affecting blood flow or are at high risk for clot-associated complications.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Adjustments to anticoagulant medications might be necessary.
• Baseline blood tests and imaging studies (like ultrasounds or CT scans) are commonly done.

Procedure Description

1. The patient is positioned and prepared in a sterile environment.
2. Local anesthesia is applied to numb the insertion site.
3. A small incision is made, and a catheter is inserted into a blood vessel.
4. Under radiological guidance, the catheter is navigated to the site of the blood clot.
5. Thrombolytic medication is infused directly into the clot.
6. The catheter may be left in place for several hours or days, with continued medication delivery.
7. Regular imaging checks are performed to assess the clot's dissolution.

Duration

The initial setup procedure typically takes 1-2 hours. Medication infusion can continue for several hours or days, depending on the clot's response.

Setting

The procedure is performed in a hospital setting, often in the interventional radiology suite or a dedicated angiography suite.

Personnel

• Interventional radiologist or vascular surgeon
• Radiologic technologists
• Registered nurses
• Anesthesiologist (if sedation beyond local anesthesia is required)

Risks and Complications

• Bleeding at the catheter insertion site or internally
• Infection
• Allergic reaction to the medication
• Damage to blood vessels
• Kidney damage due to contrast dye

Benefits

• Restores normal blood flow
• Reduces the risk of tissues or organs damage
• Minimally invasive compared to surgical alternatives
• Rapid relief of symptoms once the clot dissolves

Recovery

• Patients may need to stay in the hospital for observation.
• Regular monitoring of blood work and imaging to ensure clot dissolution.
• Instructions for limited physical activity and follow-up visits.
• Possible continuation of anticoagulant therapy as prescribed.

Alternatives

• Systemic thrombolytic therapy (medication given through an IV drip)
• Surgical clot removal (embolectomy)
• Long-term anticoagulant medication
• Mechanical thrombectomy

Each alternative has various effectiveness, risks, and recovery profiles, making individualized patient evaluation crucial.

Patient Experience

During the procedure, most patients feel minimal discomfort due to local anesthesia. They may feel some pressure or mild pain at the catheter insertion site. After the procedure, patients may experience bruising and minor pain at the site, with pain management provided as needed. Regular monitoring and imaging can feel invasive but are crucial for successful treatment.