34706 Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretat

Name of the Procedure:

Endovascular Repair of Infrarenal Aorta and/or Iliac Artery(ies) by Deployment of an Aorto-Bi-Iliac Endograft

Summary

Endovascular repair of the infrarenal aorta and/or iliac artery(ies) involves placing a specialized graft inside the blood vessels to reinforce their walls and prevent rupture. This procedure is minimally invasive, using a catheter to guide the endograft to the affected area.

Purpose

The procedure addresses aneurysms or significant blockages in the infrarenal aorta and/or iliac arteries. The goal is to reduce the risk of rupture or improve blood flow, thereby preventing serious complications like internal bleeding or inadequate organ perfusion.

Indications

• Aneurysm of the infrarenal aorta or iliac arteries
• Significant arterial blockage or narrowing
• Weakness in the artery wall causing dilation
• Recurrent symptoms like claudication (leg pain due to poor blood flow) or ischemic rest pain

Preparation

• Patients may need to fast for several hours before the procedure.
• Anticoagulant and antiplatelet medications may need adjustment.
• Pre-procedure imaging (e.g., CT scan, MRI) is required to size and select the appropriate endograft.

Procedure Description

1. Sedation or general anesthesia is administered.
2. A small incision is made in the groin to access the femoral artery.
3. A catheter is inserted and guided to the site of the aneurysm or blockage.
4. The endograft is deployed from the catheter and positioned to reinforce the artery.
5. Imaging techniques (fluoroscopy) are used to ensure correct placement.
6. The catheter is removed, and the incision is closed.

Duration

The procedure typically takes 2-4 hours.

Setting

This procedure is performed in a hospital, specifically in a vascular surgery or interventional radiology suite.

Personnel

• Vascular surgeon or interventional radiologist
• Anesthesiologist
• Surgical nurses
• Radiologic technologist

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Endoleak (leakage around the graft)
• Graft migration or failure
• Kidney damage from contrast dye
• Rarely, arterial damage or rupture

Benefits

• Reduced risk of aneurysm rupture
• Improved blood flow in treated arteries
• Minimally invasive with faster recovery compared to open surgery

Recovery

• Patients typically stay in the hospital for 1-2 days.
• Post-procedure imaging to confirm successful placement
• Pain management with prescribed medication
• Avoid heavy lifting or strenuous activity for several weeks
• Follow-up appointments for ongoing monitoring

Alternatives

• Open surgical repair (more invasive with longer recovery)
• Medical management (less effective for large aneurysms)
• Alternative endovascular techniques depending on the specific anatomy and condition

Patient Experience

Patients may feel soreness at the incision site and mild discomfort immediately after the procedure. Pain is usually manageable with medication. Full physical activity can often resume within a few weeks, with most patients experiencing significant improvement in symptoms and risk reduction shortly after the procedure.