Name of the Procedure:

Iliac and/or Femoral Artery Angiography
Medical Term: Non-selective angiography of the iliac and/or femoral arteries, performed bilaterally or ipsilateral to the catheter insertion, concurrent with cardiac catheterization and/or coronary angiography, including catheter positioning or placement in the distal artery (HCPCS G0278).

Summary

Iliac and/or femoral artery angiography is a diagnostic imaging procedure used to visualize the blood vessels in the lower abdomen and upper legs. It often accompanies cardiac catheterization and coronary angiography, allowing doctors to assess both heart function and peripheral arterial blood flow.

Purpose

Conditions Addressed:

• Suspected peripheral artery disease (PAD)
• Vascular abnormalities or blockages.
• Monitoring of previously diagnosed vascular conditions.

Goals or Expected Outcomes:

• Identification of vascular blockages or abnormalities.
• Assessment of blood flow in the iliac and femoral arteries.
• Aid in the planning of further treatment or surgical interventions.

Indications

Symptoms or Conditions:

• Leg pain or numbness.
• Claudication (pain in legs while walking).
• Non-healing wounds on the legs or feet.
• Symptoms of PAD or other vascular conditions.

Patient Criteria:

• Patients undergoing cardiac catheterization for coronary issues who may also have symptoms suggesting peripheral artery disease.

Preparation

Pre-procedure Instructions:

• Fasting for 6-8 hours prior.
• Disclosure of current medications and allergies.
• Arrangement for transportation post-procedure.

Diagnostic Tests/Assessments:

• Physical examination.
• Blood tests.
• Possibly a non-invasive vascular study (e.g., Doppler ultrasound).

Procedure Description

Step-by-Step Explanation:

1. Preparation: Patient is prepped in a sterile environment and an intravenous (IV) line is inserted.
2. Anesthesia: Local anesthesia at the catheter insertion site; some patients may receive mild sedation.
3. Catheter Insertion: A catheter is inserted through a small incision in the groin area and guided to the iliac or femoral arteries.
4. Imaging: Contrast dye is injected through the catheter while X-ray images are taken.
5. Evaluation: The images are reviewed to identify any blockages or abnormalities.

Tools and Equipment:

• Catheters, contrast dye, fluoroscopy (X-ray imaging) equipment.

Anesthesia or Sedation:

• Local anesthesia with possible mild sedation.

Duration

Typically, the angiography portion of the procedure takes about 30-60 minutes. However, the entire session may last longer if combined with cardiac catheterization.

Setting

The procedure is usually performed in a hospital's catheterization lab (cath lab) or an outpatient surgical center.

Personnel

• Interventional cardiologist or radiologist.
• Nurses and radiologic technologists.
• An anesthesiologist or nurse anesthetist if sedation is used.

Risks and Complications

Common Risks:

• Bleeding at the catheter insertion site.
• Allergic reaction to contrast dye.
• Minor bruising or swelling.

Rare Risks:

• Infection.
• Blood vessel injury.
• Kidney damage from the contrast dye.

• Blood clots.

  Complications Management:

• Monitoring vital signs and insertion site post-procedure.
• Administering medications for allergic reactions.

Benefits

Expected Benefits:

• Accurate diagnosis of vascular conditions.
• Guiding further treatments such as angioplasty or surgery. Timing of Benefits:
• Diagnostic benefits are immediate, aiding quick decision-making for subsequent interventions.

Recovery

Post-procedure Care:

• Monitoring in a recovery area for a few hours post-procedure.
• Keeping the insertion site clean and dry.

Expected Recovery Time:

• Most patients can return to normal activities within a day or two.
• Avoid strenuous activities for several days.

Follow-up:

• Follow-up appointments to review results and discuss further treatment if needed.

Alternatives

Other Treatment Options:

• Non-invasive imaging tests (e.g., magnetic resonance angiography - MRA).
• Lifestyle changes and medical management without invasive testing.

Pros and Cons of Alternatives:

• Non-invasive tests are less risky but may not provide as detailed images.
• Conservative management may not address underlying issues if blockages are present.

Patient Experience

During the Procedure:

• Mild discomfort at the insertion site.
• Sensation of warmth as the contrast dye is injected.

After the Procedure:

• Some soreness or bruising at the catheter site.
• Pain management includes over-the-counter pain relievers and instructions from the healthcare team.

Maintaining a calm and informed approach can greatly enhance the patient's experience and outcome.