Repair of thoracoabdominal aortic aneurysm with graft, with or without cardiopulmonary bypass
CPT4 code
Name of the Procedure:
Repair of Thoracoabdominal Aortic Aneurysm with Graft
- Common Names: Aneurysm Repair, TAAA Repair
- Medical Terms: Thoracoabdominal Aortic Aneurysm (TAAA) Repair
Summary
A repair of a thoracoabdominal aortic aneurysm involves surgically correcting a weakened or bulging section of the aorta (the large artery that runs from the chest to the abdomen) with a synthetic graft. This procedure may or may not utilize cardiopulmonary bypass, a technique that temporarily takes over the function of the heart and lungs during surgery.
Purpose
The procedure aims to:
- Prevent rupture of the aneurysm, which can be life-threatening.
- Restore normal blood flow through the aorta.
- Alleviate symptoms caused by the aneurysm pressing on surrounding tissues.
Indications
This procedure is indicated for:
- Large aneurysms (typically over 5-5.5 cm in diameter).
- Rapidly expanding aneurysms.
- Symptomatic aneurysms causing pain or pressure symptoms.
- Aneurysms at risk of rupture based on their size and growth rate.
Preparation
- Patients may be instructed to fast for at least 8 hours before surgery.
- Certain medications, particularly blood thinners, might need to be adjusted or stopped.
- Preoperative testing may include blood tests, imaging studies (like CT or MRI scans), and cardiac evaluations.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is fully asleep and pain-free during the procedure.
- Incision: A large incision is made in the chest and/or abdomen to access the aneurysm.
- Aneurysm Isolation: The blood flow is temporarily rerouted or controlled.
- Graft Placement: The affected section of the aorta is replaced with a synthetic graft.
- Tools: Surgical instruments, synthetic graft, possibly cardiopulmonary bypass machine.
- Closing: The incision is closed with sutures or staples, and dressings are applied.
Duration
The procedure typically takes 4 to 8 hours, depending on the complexity of the aneurysm and whether cardiopulmonary bypass is used.
Setting
The procedure is performed in a hospital, specifically in an operating room equipped for major vascular surgeries.
Personnel
- Cardiovascular Surgeons
- Anesthesiologists
- Surgical Nurses
- Perfusionists (if cardiopulmonary bypass is used)
Risks and Complications
- Common Risks: Infection, bleeding, lung complications, heart complications.
- Rare Risks: Organ damage, nerve injury, graft failure, stroke.
- Management of Complications: May require additional medications, procedures, or surgeries.
Benefits
- Reduces the risk of aneurysm rupture.
- Improves quality of life by alleviating symptoms.
- Most benefits are realized immediately after recovery from surgery.
Recovery
- Hospital Stay: Typically 7-10 days post-surgery.
- Instructions: Avoid heavy lifting, follow-up imaging, wound care.
- Full Recovery: Usually takes several weeks to a few months.
- Follow-up: Regular check-ups to monitor graft and overall health.
Alternatives
- Endovascular Aneurysm Repair (EVAR): Less invasive but not suitable for all aneurysm locations.
- Medical Management: Monitoring and managing risk factors if surgery is not immediately necessary.
- Pros and Cons: EVAR has a shorter recovery but might not be as durable as open surgical repair.
Patient Experience
- During Procedure: The patient will be under general anesthesia and will not feel any pain.
- After Procedure: Pain at the incision site managed with pain relief medications, some discomfort as the body heals.
- Pain management: Includes prescribed medications and possibly techniques like physical therapy to assist recovery.