CPT® Code 0236T

1. Indications

The procedure described by CPT® Code 0236T is indicated for patients experiencing significant occlusion of the abdominal aorta due to atherosclerotic plaque buildup. This condition may manifest through various symptoms and clinical presentations, which can include:

• Peripheral Artery Disease (PAD) - A common circulatory problem where narrowed arteries reduce blood flow to the limbs, often leading to pain and discomfort.
• Intermittent Claudication - Pain or cramping in the legs or buttocks during physical activities, such as walking or climbing stairs, which typically resolves with rest.
• Critical Limb Ischemia - Severe obstruction of blood flow to the extremities, which can lead to pain at rest, non-healing wounds, or gangrene.
• Abdominal Aortic Aneurysm (AAA) - A bulging or dilation of the abdominal aorta that may require intervention if it becomes symptomatic or reaches a critical size.

2. Procedure

The procedure for CPT® Code 0236T involves several critical steps, whether performed via an open or percutaneous approach. Each step is designed to ensure the safe and effective removal of plaque from the abdominal aorta.

• Step 1: Access Preparation - For an open approach, the physician begins by prepping the skin over the access artery, typically the femoral artery, and making an incision to expose the artery. In a percutaneous approach, the skin is similarly prepped, but a needle is used to puncture the artery directly.
• Step 2: Sheath Placement - Following access, a sheath is placed in the artery to facilitate the introduction of other instruments. This step is crucial for maintaining access to the vascular system during the procedure.
• Step 3: Guidewire Insertion - Under radiological supervision, a guidewire is inserted through the sheath and advanced into the occluded section of the abdominal aorta. This guidewire serves as a pathway for subsequent devices.
• Step 4: Atherectomy Catheter Advancement - An 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 The guidewire is subsequently withdrawn, allowing the atherectomy device to operate directly on the arterial plaque.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, equipped with a specialized balloon catheter featuring a cutting piston, is utilized to shave the plaque from the arterial wall. As the plaque is removed, it is collected in the device for extraction upon completion of the procedure.
• 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: Completion Angiography - After the atherectomy, the device is exchanged for a guidewire, and an angiography catheter is advanced. Contrast material is injected, and completion angiography is performed to confirm that the artery is patent and blood flow is restored.
• Step 8: Closure - If an open approach was used, the access artery is repaired, and the skin incision is closed. In the case of a percutaneous approach, pressure is applied to the puncture site to control bleeding, followed by the application of a pressure dressing.

3. Post-Procedure

Post-procedure care for patients undergoing the atherectomy of the abdominal aorta includes monitoring for any complications such as bleeding or infection at the access site. If an open approach was utilized, the patient may require additional care for the incision site to ensure proper healing. Patients are typically advised to rest and may be monitored for signs of improved blood flow to the lower extremities. Follow-up appointments are essential to assess the success of the procedure and to determine if further interventions are necessary. Additionally, lifestyle modifications and medical management may be recommended to address underlying conditions contributing to atherosclerosis.