37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty

Name of the Procedure:

Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty.

Summary

This procedure involves restoring blood flow to the iliac artery on one side of the body using a balloon catheter to widen the artery. It's a minimally invasive technique performed through a small incision.

Purpose

Revascularization aims to treat narrowed or blocked arteries in the pelvis, often due to atherosclerosis. The goals are to improve blood flow, relieve symptoms like pain and cramping, and reduce the risk of further complications such as tissue damage or limb loss.

Indications

• Claudication (pain or cramping in the legs while walking)
• Critical limb ischemia (severe blockage in the arteries of the lower extremities)
• Non-healing ulcers or wounds due to poor blood flow
• Symptoms of pelvic ischemia

Preparation

• Fasting for at least 6 hours before the procedure
• Adjustment of medications per doctor's advice, possibly stopping blood thinners or other specific drugs
• Preliminary tests such as blood work, imaging studies, and a physical examination

Procedure Description

1. The patient will be positioned on an operating table, and local anesthesia or conscious sedation will be administered.
2. A small incision is made, usually in the groin area, to access the femoral artery.
3. A catheter is guided through the blood vessels to the site of the blockage in the iliac artery.
4. A balloon attached to the catheter is inflated to widen the artery.
5. The balloon is deflated and removed, and if needed, a stent may be placed to keep the artery open.
6. The catheter is withdrawn, and the incision site is closed and bandaged.

Duration

The procedure typically takes around 1 to 2 hours.

Setting

Performed in a hospital, specifically in an interventional radiology or cardiology suite.

Personnel

• Interventional radiologist or vascular surgeon
• Nurse(s)
• Anesthesiologist or nurse anesthetist (if sedation is used)
• Surgical technologist

Risks and Complications

Common risks:

• Bleeding at the incision site
• Infection
• Allergic reaction to contrast dye

Rare risks:

• Blood vessel damage
• Blood clots
• Persistent or recurrent artery narrowing

Benefits

• Improved blood flow to the limbs or pelvis
• Relief from symptoms such as pain and cramping, typically within days to weeks
• Reduced risk of serious complications like limb loss

Recovery

• Close monitoring in a recovery area for a few hours post-procedure
• Keeping the leg straight and avoiding heavy lifting for 24-48 hours
• Instructions on wound care and activity restrictions
• Follow-up appointments to monitor the success of the procedure

Alternatives

• Medications such as antiplatelets or cholesterol-lowering drugs
• Lifestyle changes including diet and exercise
• Open surgical revascularization
  • Pros: Effective for severe blockages
  • Cons: More invasive, longer recovery time

Patient Experience

• Minimal discomfort during the procedure due to local anesthesia or sedation
• Possible mild pain or bruising at the incision site post-procedure
• Pain management with over-the-counter pain relievers and prescribed medications
• Gradual improvement in symptoms following the recovery period