34701 Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft ext

Name of the Procedure:

Endovascular Repair of Infrarenal Aorta by Deployment of an Aorto-Aortic Tube Endograft
Common Name(s): Endovascular aneurysm repair (EVAR), Aorto-aortic endograft

Summary

Endovascular repair of the infrarenal aorta involves placing a fabric-covered metal tube (endograft) within the aorta to reinforce its weakened section, preventing aneurysms from rupturing. This minimally invasive procedure is guided through blood vessels using catheters and imaging techniques.

Purpose

The medical condition or problem it addresses:

• Abdominal aortic aneurysm (AAA) located below the kidneys (infrarenal).

The goals or expected outcomes of the procedure:

• To prevent aneurysm rupture.
• To strengthen the aortic wall and restore normal blood flow.

Indications

Specific symptoms or conditions that warrant the procedure:

• Large or symptomatic infrarenal abdominal aortic aneurysms.
• Rapidly growing aneurysms.
• Aneurysms at risk of rupture.

Patient criteria or factors that make the procedure appropriate:

• Suitable anatomy for endograft placement.
• Patients who are high risk for open surgical repair.

Preparation

Pre-procedure instructions for the patient:

• Fasting for 6-8 hours before the procedure.
• Stopping certain medications as advised by the doctor.

Any diagnostic tests or assessments required beforehand:

• CT scan or MRI to assess the aneurysm and vessel anatomy.
• Blood tests.
• Pre-procedure assessment to evaluate cardiac and renal function.

Procedure Description

Detailed step-by-step explanation of what the procedure involves:

1. The patient is given local or general anesthesia.
2. Catheters are inserted through small incisions in the groin and guided to the aorta using fluoroscopy (live X-ray imaging).
3. Pre-procedure sizing and device selection are made based on imaging.
4. The endograft is placed over the aneurysm.
5. Once in position, the endograft is expanded and secured.
6. Radiological supervision ensures correct placement.
7. All nonselective catheterizations and necessary imaging are completed.
8. Incisions are closed.

Tools, equipment, or technology used:

• Catheters, endograft, fluoroscopy, contrast dye.

Anesthesia or sedation details:

• Local or general anesthesia, depending on patient and procedure specifics.

Duration

How long the procedure typically takes:

• Approximately 2-3 hours.

Setting

Where the procedure is performed:

• Hospital operating room or specialized vascular surgery center.

Personnel

Healthcare professionals involved:

• Vascular surgeon or interventional radiologist.
• Anesthesiologist.
• Surgical nurses and technologists.
• Radiology technician.

Risks and Complications

Common and rare risks associated with the procedure:

• Infection.
• Endoleak (leakage around the graft).
• Graft migration or blockage.
• Bleeding.
• Complications related to anesthesia.

Possible complications and their management:

• Immediate surgical intervention for severe complications.
• Monitoring and follow-up imaging to detect and manage endoleaks or graft issues.

Benefits

Expected benefits and how soon they might be realized:

• Reduced risk of aneurysm rupture.
• Shorter recovery time compared to open surgery.
• Benefits usually realized within weeks post-procedure.

Recovery

Post-procedure care and instructions:

• Observation in hospital for 1-2 days.
• Limited physical activity for a few weeks.
• Regular follow-up appointments and imaging to ensure graft stability.

Expected recovery time and any restrictions:

• Full recovery typically within 4-6 weeks.
• Avoid heavy lifting and strenuous activities during recovery.

Alternatives

Other treatment options available:

• Open surgical repair of the aneurysm.
• Medical management for those unfit for surgery.

Pros and cons of alternatives compared to the described procedure:

• Open repair has a longer recovery time but may be more durable for certain patients.
• Medical management poses continued risk of aneurysm rupture.

Patient Experience

What the patient might feel or experience during and after the procedure:

• Sedation or general anesthesia will prevent pain during the procedure.
• Minor discomfort at the catheter site post-procedure.
• Pain management involves medications and rest.
• Gradual return to normal activities guided by healthcare providers.