34712 Transcatheter delivery of enhanced fixation device(s) to the endograft (eg, anchor, screw, tack) and all associated radiological supervision and interpretation

Name of the Procedure:

Transcatheter delivery of enhanced fixation device(s) to the endograft (e.g., anchor, screw, tack)

Summary

This minimally invasive procedure involves securing an endograft (a type of stent) within a blood vessel using specialized fixation devices, like anchors, screws, or tacks, to ensure it stays in place. It also includes all necessary radiological supervision and interpretation to guide the placement.

Purpose

The procedure addresses issues related to the stability of endografts used in treating aneurysms or repairing damaged blood vessels. The main goal is to firmly secure the endograft to the vessel wall, preventing it from shifting or leaking, which could lead to serious complications.

Indications

• Abdominal or thoracic aortic aneurysms
• Blood vessel damage requiring an endograft
• Patients who have experienced or are at risk of endograft migration or leaks

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to medications, especially blood thinners, might be necessary.
• Pre-procedure imaging tests like CT scans or ultrasounds to assess the blood vessels.

Procedure Description

1. The patient is sedated or put under general anesthesia.
2. A catheter is inserted through a small incision, typically in the groin, and navigated to the site where the endograft is placed.
3. Using radiological imaging for guidance, the fixation devices (e.g., anchors, screws, or tacks) are delivered through the catheter to secure the endograft to the vessel wall.
4. The placement is checked with imaging to ensure stability.
5. The catheter is removed, and the incision is closed.

Duration

The procedure typically takes 1-3 hours.

Setting

It is performed in a hospital, often in a specialized interventional radiology or catheterization lab.

Personnel

• Interventional radiologist or vascular surgeon
• Nursing staff
• Radiologic technologist
• Anesthesiologist

Risks and Complications

• Infection at the incision site
• Blood vessel damage
• Migration of the fixation devices
• Allergic reaction to contrast dye
• Blood clots
• Rarely, organ damage due to inadequate blood flow

Benefits

• Better stabilization of the endograft
• Reduced risk of complications like graft migration or endoleaks
• Enhanced long-term success of the endograft treatment

Recovery

• Patients typically stay in the hospital for observation, usually 1-2 days.
• Instructions include managing the incision site, activity restrictions, and any prescribed medications.
• Full recovery might take a few weeks, with follow-up appointments to monitor the endograft’s stability.

Alternatives

• Open surgical repair of the aneurysm or blood vessel
• Watchful waiting with regular monitoring for smaller aneurysms
• Lifestyle changes and medication management

Pros:

• Open surgery may be more appropriate for complex cases.
• Non-invasive options may avoid procedural risks.

Cons:

• Open surgery involves a longer recovery and more significant risks.
• Watchful waiting may not provide immediate protection against complications.

Patient Experience

• During the procedure, the patient might feel mild pressure but generally will be under sedation or anesthesia.
• Post-procedure, soreness or bruising at the incision site is common.
• Pain management includes over-the-counter pain relievers or prescribed medication.
• Most patients can resume normal activities within a few weeks with careful adherence to post-procedure care instructions provided by healthcare professionals.