33881 Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending t

Name of the Procedure:

Endovascular Repair of Descending Thoracic Aorta (e.g., Aneurysm, Pseudoaneurysm, Dissection, Penetrating Ulcer, Intramural Hematoma, or Traumatic Disruption); Not Involving Coverage of Left Subclavian Artery Origin, Initial Endoprosthesis

Summary

Endovascular repair of the descending thoracic aorta is a minimally invasive procedure to fix problems in the aorta, such as aneurysms, without covering the origin of the left subclavian artery. This is done by placing a stent-graft (endoprosthesis) inside the affected part of the aorta through a small incision.

Purpose

This procedure addresses issues like aneurysms, dissection, and other aortic defects, which can be life-threatening if not treated. The goal is to reinforce the weakened area of the aorta, prevent rupture, and improve blood flow, thereby reducing the risk of serious complications.

Indications

• Symptomatic aortic aneurysm or dissection
• Asymptomatic aneurysms larger than 5.5 centimeters or growing rapidly
• Traumatic disruption of the aorta
• Intramural hematoma or penetrating aortic ulcer posing a significant risk of rupture

Preparation

• Patients may need to undergo imaging tests such as CT scans or MRIs for precise assessment.
• Fasting for 8 hours prior to the procedure.
• Temporary discontinuation of certain medications, as advised by the healthcare provider.
• Blood tests and physical examination to evaluate overall health.

Procedure Description

1. Anesthesia: General anesthesia is commonly used.
2. Access: A small incision is made in the groin to access the femoral artery.
3. Guidance: Using imaging guidance, a catheter is threaded through the artery to the affected part of the aorta.
4. Placement: The stent-graft is delivered through the catheter and expanded at the site of the aortic defect.
5. Positioning: The stent-graft is positioned accurately to reinforce the aorta and restore proper blood flow.
6. Closure: The catheter is removed, and the incision in the groin is closed.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity of the aortic condition.

Setting

Usually performed in a hospital operating room or a specialized vascular surgery suite.

Personnel

• Vascular surgeons or interventional radiologists
• Anesthesiologists
• Surgical nurses and technologists
• Radiologic technologists for imaging guidance

Risks and Complications

• Risks: Bleeding, infection, allergic reaction to contrast dye, kidney issues due to dye, stroke, or heart attack.
• Rare complications: Stent migration, graft leakage (endoleak), or injury to surrounding organs and tissues.
• Management: Complications are managed by the surgical team, with additional interventions if necessary.

Benefits

• Minimally invasive, with smaller incisions and quicker recovery.
• Reduced risk of aneurysm rupture.
• Improved stability of the aorta.
• Symptoms relief and enhanced quality of life.

Recovery

• Monitoring in the hospital for 1-2 days.
• Pain management with prescribed medications.
• Instructions on wound care, activity restrictions, and follow-up appointments.
• Gradual return to normal activities within a few weeks.

Alternatives

• Open surgical repair: More invasive, longer recovery, but effective for extensive or complicated cases.
• Medical management: Regular monitoring and medication, suitable for small, asymptomatic aneurysms not requiring immediate intervention.

Patient Experience

• During: Patient is under general anesthesia and won’t feel anything.
• After: Some bruising and discomfort at the incision site, managed with pain relief measures.
• Overall: Patients often experience a quick return to normal activities with minimal lasting discomfort.