CPT® Code 0338T

1. Indications

The transcatheter renal sympathetic denervation procedure is indicated for the following conditions:

• Hypertension - This procedure is primarily performed to manage resistant hypertension that has not responded adequately to lifestyle changes and pharmacologic interventions.
• Heart Failure - It may be indicated in patients with heart failure where sympathetic nervous system activity contributes to the condition.
• Renal Dysfunction - The procedure can be beneficial in cases of renal dysfunction associated with elevated sympathetic activity.
• Glucose Control Issues - It is also indicated for improving glucose control in patients with metabolic disorders.
• Sleep Apnea - The procedure may assist in controlling sleep apnea when other treatments have failed.

2. Procedure

The transcatheter renal sympathetic denervation procedure involves several critical steps to ensure successful intervention:

• Step 1: Preparation and Access - The procedure begins with the preparation of the skin over the access artery, typically one of the femoral arteries. A needle is used to puncture the artery, and a sheath is placed to facilitate access.
• Step 2: Heparin Administration - To prevent clotting during the procedure, heparin is administered via bolus after the sheath is in place.
• Step 3: Guide Wire Insertion - A guide wire is inserted through the sheath and advanced from the access artery into the aorta, positioning it at or below the renal arteries to prepare for imaging.
• Step 4: Imaging and Contrast Injection - A flush catheter is advanced over the guide wire, and the guide wire is then withdrawn. Contrast is injected to visualize the renal arteries and the infrarenal aorta, allowing for the acquisition of images of the renal vasculature.
• Step 5: Catheter Placement - The guide wire is reinserted to the level of the renal artery, and the flush catheter is removed. Using fluoroscopic guidance, a renal double curved (RDC) or left internal mammary artery (LIMA) renal guiding catheter is delivered over the guide wire into the renal artery.
• Step 6: Delivery of Radiofrequency Energy - A soft tip straight delivery catheter with a radiofrequency (RF) energy electrode tip is positioned in the renal artery. The guide wire is removed, and RF energy is delivered at 4-6 carefully selected treatment points along the vessel to disrupt nerve impulses from the renal plexus.
• Step 7: Repeat Procedure if Necessary - If indicated, the same procedure is repeated on the contralateral renal artery to ensure comprehensive treatment.
• Step 8: Intraprocedural Monitoring - Throughout the procedure, intraprocedural roadmapping and pressure gradient measurements are obtained as needed to monitor the effectiveness of the intervention.
• Step 9: Completion and Catheter Removal - After the procedure is completed, the catheters are removed, and pressure is applied to the vascular access site to prevent bleeding.

3. Post-Procedure

Following the completion of the transcatheter renal sympathetic denervation procedure, patients are typically monitored for any immediate complications related to the vascular access site. It is essential to apply pressure to the access site to minimize the risk of bleeding. Patients may experience some discomfort or bruising at the puncture site, which is generally self-limiting. The healthcare team will provide instructions regarding activity restrictions and follow-up appointments to assess the effectiveness of the procedure and monitor blood pressure levels. Additional considerations may include managing any underlying conditions and adjusting medications as necessary based on the patient's response to the intervention.