34714 Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure)

Name of the Procedure:

Open Femoral Artery Exposure with Creation of Conduit for Delivery of Endovascular Prosthesis or for Establishment of Cardiopulmonary Bypass, by Groin Incision, Unilateral

Summary

This procedure involves surgically accessing the femoral artery through a groin incision to create a pathway (conduit) for inserting an endovascular prosthesis or establishing cardiopulmonary bypass.

Purpose

The procedure addresses conditions requiring the delivery of endovascular prostheses, such as stents or grafts, or the initiation of cardiopulmonary bypass for heart or major vessel surgeries. The goal is to secure a reliable access point to the circulatory system for these interventions.

Indications

• Severe blockages or aneurysms in blood vessels that need stenting or graft placement.
• Requirement for cardiopulmonary bypass in cardiac surgeries.
• Emergency situations where swift vascular access is essential.

Preparation

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

Procedure Description

1. The patient is positioned, and general anesthesia or regional block is administered.
2. A sterile field is created around the groin area.
3. A small incision is made in the groin to expose the femoral artery.
4. The artery is carefully accessed, and a conduit is created for the placement of an endovascular device or to attach cardiopulmonary bypass lines.
5. Once the primary procedure (like stent placement or bypass) is complete, the incision is closed.

Tools/Technology: Surgical instruments for dissection, specialized conduits, imaging support if necessary.

Duration

The procedure typically takes 1 to 2 hours, depending on its complexity and the primary procedure's requirements.

Setting

This procedure is usually performed in a hospital's operating room.

Personnel

• Vascular surgeon or cardiothoracic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologist

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Damage to surrounding structures, including nerves and veins
• Blood clots
• Complications related to anesthesia

Benefits

• Provides necessary access for life-saving interventions
• Directly addresses vascular issues such as blockages or aneurysms
• Can ensure successful cardiopulmonary bypass setup

Recovery

• Post-procedure monitoring in a recovery room
• Pain management with medications as needed
• Gradual resumption of activities over a few weeks
• Follow-up appointments to check incision healing and procedure success

Alternatives

• Percutaneous (through the skin) approaches for vascular access
• Use of upper limb arteries for conduit creation
• Less invasive endovascular techniques depending on case specifics
• Conservative management with medications, if suitable

Patient Experience

During the procedure: Patient will be under anesthesia or sedation and should feel no pain.

After the procedure: Mild to moderate pain at the incision site, managed with prescribed pain medications. Instructions for activity restrictions, wound care, and follow-up visits will be provided to facilitate recovery.