CPT® Code 0524T

1. Indications

The endovenous catheter directed chemical ablation with balloon isolation procedure is indicated for the treatment of various conditions related to venous incompetency. The following are the explicitly provided indications for this procedure:

• Venous Obstruction - This procedure is performed to alleviate blockages within the veins that can impede normal blood flow.
• Venous Reflux - It addresses the backward flow of blood in the veins, which can lead to increased venous pressure and associated complications.
• Venous Hypertension - The procedure is indicated for patients experiencing elevated pressure within the venous system, which can contribute to various symptoms and complications.
• Symptoms of Venous Incompetency - Patients presenting with leg pain, fatigue, edema, and ulceration may benefit from this intervention to improve their quality of life.

2. Procedure

The procedure for endovenous catheter directed chemical ablation with balloon isolation involves several critical steps, each designed to ensure effective treatment of the incompetent vein. The following procedural steps are outlined:

• Step 1: Identification of the Compromised Vein - The procedure begins with the use of duplex ultrasound to identify the affected vein(s) and determine the optimal target point for the injection of the chemical sclerosant. This imaging technique provides real-time visualization of the venous anatomy and any abnormalities present.
• Step 2: Accessing the Vein - Access to the vein can be achieved through either an open approach, which involves a small skin incision for direct visualization, or a percutaneous needle puncture. The choice of method depends on the specific clinical scenario and the physician's preference.
• Step 3: Insertion of Guidewire and Vascular Sheath - Once access is established, a guidewire is inserted through the needle into the vein. A vascular sheath is then introduced over the guidewire, allowing for easier manipulation of the catheter. After the sheath is in place, the guidewire is removed.
• Step 4: Catheter Advancement - Under ultrasonic guidance, the catheter is carefully advanced to the saphenofemoral junction, which is a critical anatomical landmark in the treatment of venous incompetency.
• Step 5: Balloon Inflation - Once the catheter is positioned correctly, a balloon is inflated to occlude the vessel. This step is essential for isolating the target area for the chemical sclerosant injection.
• Step 6: Injection of Chemical Sclerosant - With the balloon inflated, the chemical sclerosant is injected at the predetermined target site. The balloon remains inflated during the prescribed dwell time to ensure effective action of the sclerosant on the vein.
• Step 7: Deflation and Catheter Removal - At the end of the dwell time, the balloon is deflated, and the catheter is carefully removed from the vein.
• Step 8: Closure of Access Site - The skin incision or percutaneous puncture site is then closed appropriately to promote healing.
• Step 9: Post-Procedure Ambulation - After the procedure, the patient is encouraged to ambulate, which aids in recovery and promotes circulation.

3. Post-Procedure

Post-procedure care following endovenous catheter directed chemical ablation with balloon isolation is crucial for optimal recovery. Patients are typically monitored for any immediate complications and are advised on care for the access site. It is common for patients to experience some discomfort or swelling in the treated area, which can be managed with over-the-counter pain relief as needed. Patients are encouraged to ambulate shortly after the procedure to enhance circulation and facilitate recovery. Follow-up appointments may be scheduled to assess the effectiveness of the treatment and monitor for any potential complications or recurrence of symptoms. Additionally, patients should be educated on signs of complications, such as increased pain, swelling, or changes in skin color, and instructed to report these to their healthcare provider promptly.