CPT® Code 35480

Deleted

1. Indications

The procedure is indicated for patients with significant atherosclerotic disease affecting the renal or other visceral arteries, which may lead to compromised blood flow and associated symptoms. The following conditions may warrant the performance of this procedure:

• Renal Artery Stenosis - Narrowing of the renal artery that can lead to hypertension and renal impairment.
• Visceral Artery Occlusion - Blockage in the arteries supplying blood to the abdominal organs, which can cause ischemia and abdominal pain.
• Atherosclerosis - The buildup of plaque in the arteries that can restrict blood flow and lead to various complications.

2. Procedure

The procedure involves several critical steps to ensure successful atherectomy of the affected artery:

• Step 1: Preparation and Incision - The physician begins by preparing the skin over the access artery, ensuring a sterile environment. An incision is made to expose the artery, allowing for direct access.
• Step 2: Artery Access - Once the artery is exposed, it is carefully nicked, and a sheath is placed within the artery to facilitate the introduction of further instruments.
• Step 3: Guidewire Insertion - A guidewire is inserted through the sheath and advanced from the access artery to the occluded renal or visceral artery, or the aorta, providing a pathway for the atherectomy catheter.
• Step 4: Atherectomy Catheter Advancement - The atherectomy catheter is then advanced over the guidewire. The guidewire is subsequently withdrawn, allowing the atherectomy device to operate directly on the arterial plaque.
• Step 5: Plaque Removal - The atherectomy device utilizes a specialized balloon catheter with a cutting piston that shaves plaque from the arterial wall. The shaved plaque is collected into the device for removal.
• Step 6: Multiple Passes - The physician may perform several passes with the atherectomy device to ensure thorough removal of plaque and achieve optimal results.
• Step 7: Angiography - After the atherectomy, the device is exchanged for a guidewire, and an angiography catheter is advanced over the guidewire. The guidewire is then withdrawn, and contrast material is injected to perform a completion angiography.
• Step 8: Completion and Closure - The completion angiography is conducted to confirm that the renal or visceral artery or aorta is patent. Following this, the angiography catheter is withdrawn, and the access artery is repaired before closing the skin incision.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications, such as bleeding or infection at the incision site. Patients may be advised to rest and avoid strenuous activities for a specified period. Follow-up appointments are typically scheduled to assess the success of the procedure and monitor the patient's recovery. Additionally, the physician may provide guidelines on medication management, including antiplatelet therapy, to prevent future vascular events.