Transluminal Angioplasty with Laser (HCPCS C1885)

Name of the Procedure:

• Common Name(s): Laser Angioplasty
• Technical or Medical Terms: Transluminal Angioplasty, Laser-assisted Angioplasty

Summary

Laser angioplasty is a minimally invasive procedure that uses laser energy to open up narrowed or blocked blood vessels, typically in the heart or legs. The procedure involves threading a catheter through the blood vessels and applying laser energy to vaporize the blockage, thereby improving blood flow.

Purpose

• Medical Conditions: This procedure addresses conditions such as atherosclerosis, peripheral artery disease (PAD), and coronary artery disease (CAD).
• Goals: The primary goal is to restore adequate blood flow through the affected artery to reduce symptoms like chest pain, leg pain, and improve overall cardiovascular health.

Indications

• Symptoms: Chronic leg pain, claudication, chest pain (angina), or critical limb ischemia.
• Patient Criteria: Patients with significant arterial blockages not responsive to medication or less invasive treatments, and those at risk of serious complications from other surgical methods.

Preparation

• Pre-Procedure Instructions: Patients are usually advised to fast for 6-8 hours before the procedure, adjust or stop certain medications (e.g., blood thinners), and may need to undergo blood tests and imaging studies (e.g., angiography) to assess the condition of the arteries.
• Diagnostic Tests: Pre-procedure assessments may include blood tests, electrocardiogram (ECG), and imaging studies like ultrasound or angiography.

Procedure Description

1. Anesthesia: Local anesthesia with sedation or general anesthesia may be used.
2. Insertion: A small incision is made, typically in the groin, to insert a catheter into the artery.
3. Navigation: Using imaging guidance (fluoroscopy), the catheter is threaded through the blood vessels to the site of the blockage.
4. Laser Application: A laser device at the tip of the catheter emits laser energy to precisely vaporize and remove the blockage.
5. Stent Placement: In some cases, a stent (a small mesh tube) may be placed at the site to keep the artery open.

Duration

The procedure typically takes about 1-2 hours, depending on the complexity and location of the blockage.

Setting

Laser angioplasty is usually performed in a hospital, outpatient clinic, or a specialized surgical center within a catheterization lab.

Personnel

• Surgeons or interventional cardiologists perform the procedure.
• Nurses assist with patient care and preparation.
• An anesthesiologist or sedation specialist manages pain and comfort.

Risks and Complications

• Common Risks: Bleeding at the catheter insertion site, infection, allergic reactions to contrast dye.
• Rare Risks: Arterial rupture, blood clots, kidney damage from contrast dye, re-narrowing of the artery (restenosis).

Benefits

• Improved blood flow and reduced symptoms, such as chest pain or leg pain.
• Reduced risk of heart attack or limb loss.
• The benefits may be noticed immediately or within a few days post-procedure.

Recovery

• Post-Procedure Care: Patients may need to stay in the hospital for a few hours or overnight for observation.
• Recovery Time: Most patients can resume normal activities within a week but should avoid strenuous activities for 1-2 weeks.
• Follow-Up: Follow-up appointments are essential to monitor recovery and assess the need for further treatment.

Alternatives

• Other Treatment Options: Medication management, lifestyle changes, traditional balloon angioplasty, bypass surgery.
• Pros & Cons: Medications and lifestyle changes are less invasive but may be less effective for severe blockages; bypass surgery is more invasive but may be necessary for more extensive blockages.

Patient Experience

• During the Procedure: Patients may feel pressure or mild discomfort at the catheter insertion site, and some may feel warmth as the laser is applied.
• After the Procedure: Mild soreness or bruising at the insertion site, managed with over-the-counter pain medication and comfort measures like rest and ice packs.