33987 Arterial exposure with creation of graft conduit (eg, chimney graft) to facilitate arterial perfusion for ECMO/ECLS (List separately in addition to code for primary procedure)

Name of the Procedure:

Arterial Exposure with Creation of Graft Conduit (e.g., Chimney Graft) to Facilitate Arterial Perfusion for ECMO/ECLS

Summary

Arterial exposure with the creation of a graft conduit is a surgical procedure aimed at improving blood flow for patients undergoing extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS). This involves exposing an artery and creating a bypass (conduit) to ensure adequate blood supply.

Purpose

This procedure is necessary for patients requiring ECMO/ECLS, which are advanced life support technologies used for severe cardiac and respiratory failure. The main goal is to ensure proper perfusion (blood flow) to the body's vital organs while the ECMO/ECLS provides necessary support.

Indications

• Severe cardiac or respiratory failure unresponsive to conventional treatments
• Patients who need prolonged ECMO/ECLS support where natural arterial access is insufficient

Preparation

• Patients may need to fast for several hours before the procedure.
• Pre-procedural imaging studies like CT scans or ultrasounds may be required to assess vascular anatomy.
• Adjustment of current medications as directed by the healthcare provider.

Procedure Description

1. Anesthesia: The patient is given general anesthesia.
2. Arterial Exposure: The surgeon makes an incision to access the target artery.
3. Creation of Graft Conduit: A suitable graft material (e.g., synthetic tube) is prepared and connected to the artery, forming a bypass to improve blood flow.
4. Connection to ECMO/ECLS: The graft is then connected to the ECMO/ECLS circuit to facilitate arterial perfusion.

Duration

The procedure typically takes several hours, depending on the complexity and patient's condition.

Setting

This procedure is performed in a hospital's operating room or a specialized surgical center.

Personnel

• Cardiovascular Surgeon
• Surgical Nurses
• Anesthesiologist
• Perfusionist

Risks and Complications

• Infection at the incision site
• Bleeding
• Blood clots or embolism
• Damage to nearby organs or tissues
• Graft failure or blockage
• Complications related to anesthesia

Benefits

• Improved arterial perfusion, which is critical for organ function during ECMO/ECLS
• Enhanced chances of survival and better clinical outcomes for patients in severe cardiac or respiratory failure

Recovery

• Intensive monitoring in the ICU immediately post-procedure
• Pain management as required
• Gradual mobilization and physical therapy
• Follow-up appointments for wound care and to ensure graft patency
• Recovery times vary but can take several weeks to months

Alternatives

• Conventional vascular access techniques (e.g., femoral cannulation)
• Non-surgical interventions, though these may not be suitable for all patients and may have lower efficacy compared to the described procedure

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel pain. Postoperatively, mild to moderate pain at the incision site can be expected, managed with medications. Patients might experience a period of immobility and need assistance with daily activities initially, progressing to increased independence as recovery continues.