37222 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)

Name of the Procedure:

Revascularization, endovascular, iliac artery transluminal angioplasty (Percutaneous or Open)

Summary

Revascularization of the iliac artery involves restoring blood flow through an artery in the pelvic area using a minimally invasive technique called angioplasty. This often includes inflating a small balloon inside the artery to widen it and can involve placing a stent to help keep the artery open.

Purpose

This procedure treats blockages or narrowing of the iliac artery, which can cause leg pain, poor circulation, or other symptoms of peripheral artery disease (PAD). The goal is to improve blood flow and alleviate symptoms.

Indications

• Chronic leg pain or cramps during activity (claudication)
• Severe leg pain at rest
• Poor wound healing in the legs or feet
• Confirmed iliac artery blockage via imaging studies like an angiogram

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustments to medications (e.g., stopping blood thinners)
• Blood tests and imaging studies (e.g., Doppler ultrasound, CT angiography) to confirm blockage and plan the procedure

Procedure Description

1. Sedation/Anesthesia: Local anesthesia with sedation, or general anesthesia in some cases.
2. Access: Small incision made in the groin to access the femoral artery.
3. Guidewire Insertion: A thin wire (guidewire) is passed through the artery to the site of the blockage.
4. Balloon Angioplasty: A balloon catheter is advanced over the guidewire to the blockage site and inflated to widen the artery.
5. Stent Placement: In some cases, a stent may be placed to keep the artery open.
6. Completion: The catheter and guidewire are removed, and the incision is closed.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in a hospital or outpatient surgical center, often in a specialized interventional radiology or vascular surgery suite.

Personnel

• Interventional radiologist or vascular surgeon
• Nursing staff
• Anesthesiologist or nurse anesthetist (if general anesthesia is used)
• Technicians assisting with imaging and equipment

Risks and Complications

• Common: Bruising or bleeding at the puncture site
• Rare: Artery damage, blood clots, infection, allergic reaction to contrast dye, kidney damage due to contrast dye, artery re-narrowing (restenosis)

Benefits

• Improved blood flow to the legs
• Relief of pain and symptoms associated with PAD
• Enhanced ability to walk and perform daily activities
• Improved wound healing

Recovery

• Monitor in a recovery area for a few hours post-procedure
• Instructions to avoid heavy lifting or strenuous activity for a few days
• Pain management with prescribed medications
• Follow-up appointments to assess artery patency and overall health

Alternatives

• Lifestyle changes and medications for mild symptoms
• Surgical bypass of the blocked artery, which may be more invasive but effective
• Endarterectomy, a surgical removal of plaque from the artery

Patient Experience

Patients may feel a brief sting during anesthesia administration and pressure during balloon inflation but should not feel pain. Post-procedure discomfort at the puncture site is common, often managed with oral pain medication. Full recovery usually occurs within a few days, with most patients resuming normal activities quickly.