37232 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)

Name of the Procedure:

Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)

Summary

This procedure is a minimally invasive technique used to restore blood flow in blocked or narrowed tibial or peroneal arteries, located in the lower leg. The process involves the use of a catheter with a balloon that is inflated to open up the artery.

Purpose

Revascularization with transluminal angioplasty is performed to treat peripheral artery disease (PAD) in the lower extremities. The goal is to improve blood flow, alleviate pain, and prevent complications such as limb amputation.

Indications

• Symptoms of PAD, such as leg pain while walking (claudication), leg numbness, or sores that do not heal.
• Critical limb ischemia, which is marked by severe blockage in the arteries of the lower extremities.
• Patients with non-healing ulcers or gangrene caused by poor blood circulation.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Blood tests, imaging studies like an ultrasound or angiography, and a physical examination may be required.
• Adjustments to current medications, including blood thinners, may be necessary.

Procedure Description

1. The patient is positioned on an operating table and given a sedative or local anesthesia.
2. A catheter is inserted through a small incision, usually in the groin, and guided to the affected artery using X-ray imaging.
3. Once in place, a balloon on the catheter is inflated to widen the artery, allowing better blood flow.
4. The balloon is then deflated and removed, and in some cases, a stent (a small mesh tube) is placed to keep the artery open.
5. The insertion site is closed and bandaged.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity and the number of vessels being treated.

Setting

Revascularization with transluminal angioplasty is usually performed in a hospital or an outpatient surgical center equipped with a catheterization lab.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Nurses
• Anesthesia team, if sedation is required
• Radiologic Technologist

Risks and Complications

• Bleeding or bruising at the insertion site
• Infection
• Blood vessel damage or artery re-narrowing (restenosis)
• Blood clots
• Kidney damage from contrast dye used in imaging
• Allergic reactions to medications or dyes

Benefits

• Improved blood flow to the lower extremities
• Relief from symptoms like pain and numbness
• Enhanced ability to walk and perform daily activities
• Reduced risk of complications such as ulcers or amputation

Recovery

• Patients may need to stay in the hospital for observation for a few hours to a day.
• Movement may be restricted for the first 24 hours to avoid bleeding at the insertion site.
• Most patients can return to normal activities within a week, but they should follow their doctor's instructions regarding physical activity and wound care.
• Follow-up appointments are necessary to monitor the success of the procedure.

Alternatives

• Lifestyle changes, such as quitting smoking, exercising, and eating a healthy diet.
• Medications to manage symptoms or prevent blood clots.
• Bypass surgery, which is more invasive and has a longer recovery period.
• Other minimally invasive procedures like atherectomy or stenting without prior angioplasty.

Patient Experience

• During the procedure, patients may feel pressure but should not feel pain due to anesthesia.
• Post-procedure, mild discomfort or soreness at the insertion site is common but manageable with pain relievers.
• It’s normal to feel tired or have minor bruising, which usually subsides within a few days.