CPT® Code 62294

1. Indications

The injection procedure for occlusion of an arteriovenous malformation (AVM) in the spinal region is indicated for the following conditions:

• Spinal Arteriovenous Malformation (AVM) - This procedure is performed to treat congenital or acquired AVMs that pose a risk of hemorrhage or neurological impairment.

2. Procedure

The procedure for the arterial occlusion of a spinal AVM involves several critical steps to ensure successful treatment.

• Preparation of the Access Site - The skin over the access artery, typically the femoral artery, is thoroughly cleaned and prepped to minimize the risk of infection. This preparation is essential for maintaining a sterile environment during the procedure.
• Puncture of the Artery - A needle is carefully inserted into the femoral artery to gain access to the vascular system. This step requires precision to ensure that the needle is correctly positioned within the artery.
• Placement of the Sheath - Once the artery is punctured, a sheath is placed over the needle. The needle is then removed, leaving the sheath in place to facilitate the introduction of other instruments into the vascular system.
• Insertion of the Guidewire - A guidewire is inserted through the sheath and advanced through the access artery, navigating through the aorta and into the spinal artery that supplies the AVM. This guidewire serves as a pathway for subsequent instruments.
• Threading the Catheter - A catheter is threaded over the guidewire and advanced to the target location. Once the catheter is in position, the guidewire is withdrawn, leaving the catheter in place for the injection of occlusive materials.
• Occlusion of the Spinal Artery - The spinal artery is occluded by injecting it with a liquid tissue adhesive, micro-coils, micro-particles, or other occlusive materials. This step is crucial for effectively blocking the abnormal blood flow associated with the AVM.
• Verification of Occlusion - Following the injection, contrast material is injected to confirm that the AVM is completely occluded. This verification step is essential to ensure the success of the procedure.
• Removal of Catheter and Sheath - After confirming successful occlusion, the catheter and sheath are carefully removed from the access site.
• Application of Pressure Dressing - A pressure dressing is applied over the access artery to control bleeding and promote healing at the puncture site.

3. Post-Procedure

After the procedure, patients are typically monitored for any complications, such as bleeding or neurological changes. The application of a pressure dressing helps to minimize the risk of hematoma formation at the access site. Patients may be advised to rest and avoid strenuous activities for a specified period to facilitate recovery. Follow-up imaging may be required to assess the effectiveness of the occlusion and ensure that the AVM remains adequately treated.