Name of the Procedure:

Catheter, Transluminal Atherectomy, Directional (HCPCS C1714)

• Common Names: Directional Atherectomy
• Technical Terms: Directional Transluminal Atherectomy

Summary

Directional atherectomy is a minimally invasive procedure used to remove atherosclerotic plaque from blood vessels. It involves the use of a specialized catheter designed to cut away or shave off the plaque, improving blood flow.

Purpose

• Medical Conditions: Treats Peripheral Artery Disease (PAD) or other conditions causing narrowed or blocked arteries due to plaque buildup.
• Goals:
  • Restore adequate blood flow in the affected artery.
  • Alleviate symptoms like pain or cramping in the limb.
  • Reduce the risk of serious complications like heart attack or stroke.

Indications

• Claudication or pain while walking due to blocked arteries.
• Critical limb ischemia, where blood flow to a limb is severely restricted.
• Non-healing wounds or ulcers on the legs or feet.
• Angiographic evidence of significant arterial blockage.

Preparation

• Fasting: Patients may be required to fast for several hours before the procedure.
• Medications: Adjustments to medications such as blood thinners may be necessary.
• Diagnostic Tests: Imaging studies such as angiograms, blood tests, and a physical exam will be conducted prior to the procedure.

Procedure Description

1. Anesthesia: Local or regional anesthesia may be used, sometimes with mild sedation.
2. Insertion: A sheath is inserted into the blood vessel through a small puncture site, usually in the groin.
3. Catheter Navigation: The directional atherectomy catheter is guided to the site of the plaque using fluoroscopy (real-time X-ray imaging).
4. Plaque Removal: The catheter's cutting device is activated to shave or cut away the plaque.
5. Debris Removal: The device collects and removes the plaque debris from the body.
6. Completion: Once sufficient plaque is removed, the catheter and sheath are withdrawn, and the puncture site is closed.

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

Performed in a hospital's catheterization lab (cath lab) or an outpatient surgical center.

Personnel

• Interventional Cardiologist or Vascular Surgeon
• Nurse
• Radiologic Technologist
• Anesthesiologist, if sedation or general anesthesia is used

Risks and Complications

• Common Risks: Bruising or bleeding at the puncture site, infection.
• Rare Risks: Vessel perforation, dissection, embolism (plaque causing a new blockage elsewhere), allergic reaction to contrast dye.
• Management: Most complications can be managed with medication or additional interventions.

Benefits

• Improved blood flow and reduced symptoms (pain, cramping).
• Enhanced wound healing in affected limbs.
• Reduced risk of severe cardiovascular events.
• Benefits often realized within days to weeks post-procedure.

Recovery

• Post-Procedure Care: Monitoring in a recovery area; compression bandage or device on the puncture site.
• Instructions: Avoid strenuous activities for a few days, take prescribed medications, keep the puncture site clean and dry.
• Recovery Time: Most patients can resume normal activities within a week.
• Follow-Up: Routine follow-up to monitor the treated artery and overall vascular health.

Alternatives

• Medication Therapy: Use of drugs to manage symptoms and reduce plaque buildup.
• Angioplasty: Balloon catheter to widen the artery.
• Stenting: Placement of a stent to keep the artery open.
• Bypass Surgery: Creating a detour around the blocked artery.
• Pros and Cons: Atherectomy is less invasive than bypass surgery, but may not be as effective as a stent in some cases.

Patient Experience

• During the Procedure: Mild discomfort at the insertion site, minimal pain due to anesthesia.
• After the Procedure: Mild soreness or bruising at the puncture site, typically manageable with over-the-counter pain relief.
• Pain Management: Local anesthetics, mild sedatives during the procedure, and pain relievers post-procedure.

Patients are encouraged to discuss individual risks, benefits, and suitability with their healthcare provider.