37239 Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (List separately in addition to code f

Name of the Procedure:

Transcatheter Placement of an Intravascular Stent(s), Open or Percutaneous, Including Radiological Supervision and Interpretation and Including Angioplasty Within the Same Vessel, When Performed; Each Additional Vein (List Separately in Addition to Code)

Common name(s): Stent Placement, Angioplasty with Stenting

Summary

In this procedure, a stent—a small mesh tube—is placed inside a vein to keep it open and maintain proper blood flow. This involves inserting a catheter through the skin or during an open surgery, guiding it to the affected area, and deploying the stent. It may also include angioplasty, which widens the narrowed vein.

Purpose

This procedure addresses blocked or narrowed veins that impede blood flow. The goal is to improve blood circulation, relieve symptoms (such as swelling and pain), and prevent serious complications like deep vein thrombosis or chronic venous insufficiency.

Indications

• Symptoms of vein blockage, such as swelling, pain, or discoloration.
• Chronic venous insufficiency.
• Deep vein thrombosis.
• Venous stenosis (narrowing of the veins).
• Patients who have not responded to conservative treatments (e.g., medication, compression therapy).

Preparation

• Patients may need to fast for several hours before the procedure.
• Discontinue certain medications as advised by the physician.
• Blood tests and imaging studies (e.g., ultrasound, venogram) to assess the vein’s condition.

Procedure Description

1. The patient is given local anesthesia or sedation.
2. A catheter is inserted through a small incision in the skin (percutaneous) or as part of an open surgical approach.
3. The catheter is guided to the affected vein using radiological imaging for precise placement.
4. A balloon (angioplasty) may be inserted and inflated to widen the vein.
5. A stent is deployed from the catheter to hold the vein open.
6. The catheter and any other instruments are removed.
7. The incision site is closed and bandaged.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity and number of stents placed.

Setting

The procedure is performed in a hospital’s catheterization laboratory (cath lab) or an outpatient surgical center specialized in endovascular treatments.

Personnel

• Interventional radiologist or vascular surgeon
• Anesthesiologist or nurse anesthetist
• Radiologic technicians
• Surgical nurses

Risks and Complications

• Bleeding or infection at the incision site
• Blood vessel damage
• Allergic reaction to contrast dye
• Stent migration or failure
• Blood clots

Management of complications involves medications, additional procedures, or extended hospital stay for monitoring.

Benefits

• Improved blood circulation
• Reduced symptoms like pain and swelling
• Prevention of further vein-related complications
• Quick recovery relative to open surgery

Patients often notice benefits a few days to a few weeks after the procedure.

Recovery

• Rest and limited physical activity for a few days.
• Regular follow-up appointments to monitor the stent’s function.
• Medications such as blood thinners to prevent clots.
• Compression stockings may be recommended to improve circulation.

Alternatives

• Conservative treatments: compression therapy, medications.
• Surgical options: vein bypass or vein stripping.
• Non-invasive interventions using laser or radiofrequency.

Alternatives vary in invasiveness, recovery time, and effectiveness based on the specific condition and patient health.

Patient Experience

During the procedure, patients may feel pressure or mild discomfort, but pain is typically managed with anesthesia. Post-procedure, slight soreness at the incision site is common, and pain management includes over-the-counter pain relievers or prescribed medication. Most patients resume regular activities within a few days to a week, with instructions to avoid strenuous activities until fully recovered.