37228 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty

Name of the Procedure:

Revascularization, Endovascular, Open or Percutaneous, Tibial, Peroneal Artery, Unilateral, Initial Vessel; with Transluminal Angioplasty

Summary

This procedure involves restoring blood flow through a blocked or narrowed tibial or peroneal artery in the leg. It can be done through endovascular (within the blood vessel) methods, including open surgery or minimally invasive percutaneous techniques, with the use of transluminal angioplasty to widen the artery.

Purpose

The procedure addresses peripheral artery disease (PAD) where arteries in the legs become narrowed or blocked. The main goal is to improve blood flow, thus reducing pain, enhancing mobility, and preventing severe complications such as limb ischemia or amputation.

Indications

• Symptoms such as leg pain (claudication), numbness, or weakness.
• Diagnosis of significant arterial blockages via imaging studies.
• Non-healing wounds or ulcers on the legs or feet.
• Poor peripheral circulation that doesn't respond to conservative treatments.
• Patients with a high risk of limb loss due to severe PAD.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medications may need to be adjusted; blood-thinning medications are often temporarily stopped.
• Pre-procedure tests such as blood work, an EKG, and imaging studies (like an angiogram) to evaluate the arterial blockages.

Procedure Description

1. Anesthesia: The procedure is typically done under local anesthesia with sedation or sometimes under general anesthesia.
2. Access: A small incision is made to access the femoral artery.
3. Guide Wire and Catheter: A guide wire and catheter are threaded through the artery to the site of the blockage.
4. Angioplasty: A balloon catheter is advanced to the blockage and inflated to widen the artery; sometimes, a stent is placed to keep the artery open.
5. Imaging: Real-time X-ray imaging (fluoroscopy) is used to guide the instruments.

Duration

The procedure typically takes between 1 to 3 hours.

Setting

The procedure is performed in a hospital, specifically in a cardiac catheterization lab or an operating room equipped for endovascular procedures.

Personnel

• Vascular surgeon or interventional radiologist
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Radiologic technologist

Risks and Complications

Common risks:

• Bleeding or bruising at the catheter insertion site.
• Infection.
• Artery damage.

Rare risks:

• Blood clots.
• Renal complications from contrast dye.
• Allergic reactions to medications or contrast material used.
• Re-narrowing of the artery (restenosis).

Benefits

• Improved blood flow and reduced symptoms from PAD.
• Decreased risk of limb amputation.
• Enhanced ability to walk and perform daily activities with less pain.
• Quick recovery time compared to open surgery.

Recovery

• Patients typically stay in the hospital for a few hours to overnight for monitoring.
• Instructions may include taking antiplatelet medications to prevent clot formation.
• Avoid heavy lifting and strenuous activities for a few days.
• Follow-up appointments for monitoring and additional imaging may be needed.

Alternatives

• Conservative management with medications and lifestyle changes.
• Surgical bypass, creating a new route for blood flow around the blockage.
• Atherectomy, where the plaque is mechanically removed.

Pros of alternatives:

• Bypass surgery may provide longer-lasting results for some patients.

Cons of alternatives:

• Atherectomy and surgical bypass typically involve more extensive recovery times and higher immediate risks compared to angioplasty.

Patient Experience

During the procedure, patients might feel slight pressure or mild discomfort at the catheter insertion site. Post-procedure, there could be some soreness or bruising. Pain is generally manageable with over-the-counter pain relievers. Most patients experience significant symptom relief within days to weeks, allowing for improved mobility and quality of life.