Name of the Procedure:

Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed (C9764).

Common Names:

• Endovascular Revascularization with Intravascular Lithotripsy
• Arterial Revascularization with Lithotripsy

Summary

This minimally invasive procedure treats blocked or narrowed arteries in the lower extremities (legs) by breaking down calcium deposits in the arterial walls using intravascular lithotripsy (IVL). It also includes an angioplasty, a process to widen the artery, within the same vessel.

Purpose

This procedure aims to improve blood flow in the legs caused by conditions like Peripheral Artery Disease (PAD) and to reduce symptoms such as pain and cramping. The goal is to restore adequate circulation, prevent further complications like ulcers or gangrene, and improve walking ability and quality of life.

Indications

• Severe Peripheral Artery Disease (PAD)
• Claudication (painful walking due to poor circulation)
• Critical Limb Ischemia (severe obstruction of the arteries which drastically reduces blood flow)
• Non-healing leg ulcers
• Presence of significant arterial calcifications

Preparation

• Patients may need to fast for several hours before the procedure.
• Medications may need adjustments; particularly blood thinners or insulin.
• Pre-procedure diagnostics include blood tests, imaging studies like ultrasound or angiography, and physical examinations.

Procedure Description

1. Access: A small incision is made, usually in the groin, to insert a catheter into the affected artery.
2. Navigation: The catheter is guided through the artery to the blockage site.
3. Lithotripsy: Special balloons equipped with ultrasound emitters create shockwaves to break up calcium deposits.
4. Angioplasty: A balloon at the catheter’s tip is inflated to widen the artery and restore blood flow.
5. Completion: The catheter is removed, and the incision is closed.

Tools & Equipment:

• Catheter systems
• Intravascular Lithotripsy equipment
• Angioplasty balloons

Anesthesia: Local anesthesia and possibly mild sedatives are used.

Duration

The procedure typically takes 1 to 2 hours but could vary based on complexity.

Setting

Performed in a hospital, usually in a specialized catheterization or interventional radiology lab.

Personnel

• Interventional cardiologist or vascular surgeon
• Radiologic technologist
• Nursing staff
• Anesthesiologist or sedation nurse

Risks and Complications

• Bleeding or hematoma at the incision site
• Infection
• Allergic reactions to contrast dye
• Blood vessel damage or dissection
• Embolism (blockage caused by dislodged debris)
• Need for additional procedures if initial treatment is not successful

Benefits

Patients can expect improved blood circulation, relief from pain and other symptoms, faster healing of leg ulcers, and a reduced risk of severe complications like limb loss. Benefits are often noticed within days to weeks post-procedure.

Recovery

• Monitoring in recovery area for several hours post-procedure
• Instructions for wound care and activity restrictions
• Gradual return to normal activities within a few days
• Follow-up appointments to assess progress and possible imaging to ensure artery patency

Alternatives

• Medications (blood thinners, anti-claudication drugs)
• Lifestyle changes (diet, exercise)
• Other minimally invasive procedures like stenting without lithotripsy
• Surgical bypass of the blocked artery

Pros and Cons: Medications and lifestyle changes are less invasive but may take longer to show benefits. Surgeries involve more risks and longer recovery times compared to endovascular procedures.

Patient Experience

Patients generally feel mild discomfort during the procedure due to local anesthesia. Post-procedure, there may be soreness at the incision site, mild bruising, and restricted movement initially. Pain management strategies include prescribed pain relief and instructions for wound care to enhance comfort and aid recovery.