Intraoperative fluorescence angiography for the evaluation of coronary artery bypass graft patency

NICE interventional procedures guidance [IPG98] Published date:

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The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on intraoperative flourescence angiography in coronary artery bypass grafting.

  • Description

    Coronary artery bypass grafting is one of the most common cardiac surgical interventions. In this procedure a section of vessel from another part of the body is used to reroute (bypass) blood around a blocked coronary artery and improve blood flow to the heart. Early blockage of the graft caused by narrowing and poor blood flow may be a significant cause of morbidity and mortality in patients who have undergone coronary artery bypass grafting.

    Several techniques are used intraoperatively to assess graft patency. These include digital palpation, electromagnetic flow measurement, Doppler studies, and conventional and thermal coronary angiography techniques. A limitation with many of the imaging techniques is that they provide poor resolution and definition of the grafts.

    Intraoperative fluorescence angiography allows confirmation of the location of the coronary arteries and assessment of bypass graft function during coronary artery bypass procedures. The intraoperative fluorescence imaging system consists of a video camera and a laser diode that emits monochromatic light. The camera, guided by a range-detector diode, is positioned a safe distance above the heart. A small amount of indocyanine green (ICG) dye is then administered as a central venous injection. This dye fluoresces when illuminated using laser energy and the images are recorded digitally.

  • OPCS4.6 Code(s)

    Y53.8 Other specified approach to organ under image control

    Y37.1 Introduction of photodynamic substance into organ NOC

    Note: Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control: the code for the CABG is assigned in the primary position. OPCS-4 code Y37.1 indicates that indocyanine green (ICG) dye has been administered.

    The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.


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