34713 Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed, unilateral (List separately in addition to code for primary procedure)

Name of the Procedure:

Percutaneous Access and Closure of Femoral Artery for Delivery of Endograft through a Large Sheath (12 French or Larger), Including Ultrasound Guidance, When Performed, Unilateral

Summary

This procedure involves accessing the femoral artery through the skin using a needle and introducing a large sheath (12 French or larger) to deliver an endograft. It uses ultrasound for guidance to ensure precision. The procedure is performed on one leg (unilateral) and typically complements a primary vascular procedure.

Purpose

This procedure addresses the need to deliver an endograft into the vascular system for repairing aneurysms, blockages, or other vascular conditions. The primary goal is to provide a minimally invasive means to position the endograft accurately. Expected outcomes include improved blood flow, reduced risk of aneurysm rupture, and stabilization of the vascular structure.

Indications

• Aneurysms in the aorta or peripheral arteries
• Severe arterial blockages
• Prior unsuccessful attempts at endovascular repair
• Patients needing extensive vascular reconstruction

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustments to current medications as advised by the doctor, particularly blood thinners
• Pre-procedure imaging tests like CT scans or MRIs to map the vascular anatomy

Procedure Description

1. Anesthesia: The patient is administered local anesthesia at the access site and possibly mild sedation.
2. Access: A needle punctures the skin and targets the femoral artery under ultrasound guidance.
3. Sheath Insertion: A guide wire is placed followed by the insertion of a large sheath (12 French or larger).
4. Endograft Delivery: The endograft is delivered through the sheath to the target site within the vascular system.
5. Closure: After the endograft is deployed, the sheath is removed, and the femoral artery access site is closed using a closure device to prevent bleeding.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity.

Setting

Usually performed in a hospital’s catheterization lab or a specialized surgical center.

Personnel

• Vascular surgeons or interventional radiologists
• Nurses and specialized technicians
• Anesthesiologists (if sedation is used)

Risks and Complications

• Bleeding or hematoma at the access site
• Infection
• Arterial damage or dissection
• Thrombosis or embolism
• Allergic reactions to contrast dye or anesthesia

Benefits

• Minimally invasive with faster recovery times compared to open surgery
• Accurate placement of the endograft
• Reduced risk of complications compared to traditional surgical methods

Recovery

• Monitoring in a recovery room for a few hours post-procedure
• Instructions regarding activity limitations, typically for 24 to 48 hours
• Follow-up appointments for imaging to ensure proper placement of the endograft

Alternatives

• Open surgical repair
• Observation and medical management for less severe cases
• Other endovascular repair methods without large sheath access Benefits of this procedure include less invasiveness and quicker recovery times, though it may not be suitable for all patients compared to open surgery.

Patient Experience

During the procedure, the patient may feel pressure at the access site but should not feel pain due to local anesthesia. Post-procedure, mild soreness at the insertion site is common, and pain can be managed with over-the-counter medications. Comfort measures in the recovery area ensure a smooth transition home.