Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies), with intravascular lithotripsy, includes angioplasty within the same vessel (s), when performed
HCPCS code
Name of the Procedure:
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies), with intravascular lithotripsy (C9772)
Summary
This procedure is designed to improve blood flow in the lower leg by opening up blocked arteries using a combination of balloon angioplasty and intravascular lithotripsy, a technique that breaks up hard, calcified plaque within the arteries.
Purpose
This procedure addresses conditions such as peripheral artery disease (PAD), where the arteries in the lower legs are narrowed or blocked by plaque. The goal is to restore adequate blood flow to the affected area, alleviating symptoms like pain and improving overall limb function.
Indications
- Severe leg pain (claudication) affecting daily activities
- Non-healing leg ulcers or wounds
- Critical limb ischemia (CLI)
- Significant arterial calcification
Preparation
- Fasting for 8-12 hours prior to the procedure
- Adjustments to current medications, especially blood thinners
- Pre-procedure imaging tests such as Duplex ultrasound or angiography to assess artery condition
Procedure Description
- Anesthesia: Local anesthesia or sedation is administered.
- Access: A small incision is made, often in the groin, to access the femoral artery.
- Guide wire: A thin wire is threaded through the artery to the site of the blockage.
- Balloon angioplasty: A balloon catheter is advanced to the narrowed area and inflated to open the artery.
- Intravascular lithotripsy: Shockwaves are delivered via a specialized catheter to break up the calcified plaque.
- Confirmation: Imaging is used to confirm the artery is adequately opened.
- Closure: The access site is closed, and a dressing is applied.
Duration
The procedure typically takes 1-2 hours.
Setting
Performed in a hospital catheterization lab, outpatient clinic, or a specialized surgical center.
Personnel
- Interventional Radiologist or Vascular Surgeon
- Nursing staff specialized in perioperative care
- Anesthesiologist (if sedation is used)
- Radiologic technologist
Risks and Complications
- Bleeding or hematoma at the access site
- Artery damage or dissection
- Infection
- Allergic reaction to contrast dye
- Rarely, failure to relieve symptoms or need for repeat procedure
Benefits
- Relief from pain and improvement in limb function
- Healing of non-healing wounds or ulcers
- Reduced risk of limb amputation
Recovery
- Close monitoring for several hours post-procedure
- Instructions to keep the puncture site clean and dry
- Avoiding strenuous activities for a few days
- Follow-up appointment scheduled within a week
- Gradual return to normal activities based on doctor's advice
Alternatives
- Medical management with medications and lifestyle modifications
- Surgical bypass of the blocked artery
- Other endovascular techniques such as stenting
- Each option has different risk and benefit profiles; discussion with a physician is essential.
Patient Experience
- May feel some pressure or mild discomfort during the procedure
- Post-procedure soreness at the access site
- Pain management tailored to individual needs
- Overall improvement in symptoms often noticed within a few weeks
Your healthcare team will provide you with detailed instructions tailored to your specific condition and needs.