37227 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed

Name of the Procedure:

Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.

Summary

This procedure is a minimally invasive surgery to restore blood flow in the femoral and popliteal arteries. It involves inserting a stent, removing plaque with atherectomy, and may include balloon angioplasty to widen the arteries.

Purpose

This procedure is used to treat peripheral artery disease (PAD) in the femoral and popliteal arteries, which can cause leg pain, poor circulation, and increase the risk of severe complications like ulcers or gangrene. The goal is to improve blood flow, alleviate symptoms, and prevent future complications.

Indications

• Severe leg pain or discomfort while walking (claudication)
• Non-healing ulcers on the lower extremities
• Tissue damage or gangrene
• Poor circulation in the leg arteries as indicated by diagnostic imaging
• Patients who have not responded to conservative treatments like medication and lifestyle changes

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Blood tests, imaging studies (e.g., ultrasound, CT angiography), and an evaluation of kidney function may be required.
• Medication adjustments, particularly blood thinners, as advised by the doctor.
• Arrangements for transportation, as patients will not be able to drive post-procedure.

Procedure Description

1. The patient is sedated or given local anesthesia, depending on the specifics of the case.
2. A small incision is made, usually in the groin.
3. A catheter is inserted into the artery to reach the blocked area.
4. Atherectomy is performed to remove plaque from the arterial wall.
5. A balloon angioplasty may be utilized to widen the artery.
6. One or more stents are placed to keep the artery open.
7. The catheter is removed, and the incision is closed.

Duration

The procedure typically takes 1-3 hours to complete.

Setting

Usually performed in a hospital's catheterization lab or a specialized outpatient surgical center.

Personnel

• Vascular surgeon or interventional radiologist
• Anesthesiologist or nurse anesthetist
• Registered nurses and radiologic technologists

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma
• Blood vessel injury
• Allergic reaction to contrast dye
• Blood clots
• Restenosis (re-narrowing of the artery)
• Kidney damage (especially if contrast dye is used)

Benefits

• Improved blood flow and circulation in the legs
• Reduction in pain and discomfort
• Enhanced ability to walk and perform daily activities
• Prevention of serious complications like ulcers or gangrene

Recovery

• Patients may go home the same day or after a short hospital stay.
• Mild discomfort and bruising at the incision site are common.
• Patients should refrain from strenuous activities for about a week.
• Follow-up appointments and possibly imaging tests to monitor the success of the procedure.
• Compliance with prescribed medications, particularly blood thinners, is crucial.

Alternatives

• Conservative management with medication and lifestyle changes
• Other surgical options like bypass surgery
• Pros and cons: Conservative management may be less invasive but less effective for severe cases; bypass surgery is more invasive and involves a longer recovery time but may be more suitable for extensive blockages.

Patient Experience

• Mild pain and discomfort during and after the procedure, managed with pain relievers.
• A feeling of pressure or slight pain when the catheter is inserted.
• Post-procedure soreness at the incision site, usually subsides within a few days.
• Immediate or gradual improvement in symptoms and leg function post-recovery.