34715 Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure)

Name of the Procedure:

Open Axillary/Subclavian Artery Exposure for Delivery of Endovascular Prosthesis (Infraclavicular or Supraclavicular Incision, Unilateral)

Summary

In this procedure, a surgeon will make an incision either below or above the collarbone to expose the axillary or subclavian artery. This allows the placement of an endovascular prosthesis (a type of tubular medical device) intended to treat issues with blood flow in these arteries.

Purpose

This procedure addresses conditions such as blockages or aneurysms in the axillary or subclavian arteries. The goal is to restore proper blood flow and prevent complications like strokes or limb ischemia.

Indications

• Peripheral artery disease with significant blockage.
• Aneurysms in the axillary or subclavian arteries.
• Trauma or injury to these arteries that require surgical intervention.
• Situations where minimally invasive endovascular approaches are not viable.

Preparation

• Patients may need to fast for several hours before the procedure.
• Blood tests and imaging studies like CT scans or MRIs may be required.
• Discussions about current medications, especially blood thinners, may lead to adjustments.

Procedure Description

1. The patient will be administered general anesthesia.
2. An incision is made either below (infraclavicular) or above (supraclavicular) the collarbone.
3. The surgeon carefully dissects down to the axillary or subclavian artery.
4. Once exposed, the artery is prepared for the placement of an endovascular prosthesis.
5. The prosthesis is delivered and deployed to treat the targeted artery issue.
6. The incision is then closed with sutures or staples.

Duration

The procedure typically takes about 2 to 4 hours, depending on the complexity.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Vascular surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses

Risks and Complications

• Infection at the incision site.
• Bleeding or hematoma formation.
• Injury to surrounding nerves or structures.
• Thrombosis or occlusion of the treated artery.
• Potential for adverse reactions to anesthesia.

Benefits

• Restoration of proper blood flow in the affected artery.
• Reduced risk of stroke or limb ischemia.
• Relief from symptoms like pain or restricted arm movement.

Recovery

• Patients may need to stay in the hospital for 1-3 days for monitoring.
• Instructions will include wound care, activity restrictions, and follow-up visits.
• Full recovery can take several weeks, during which heavy lifting and strenuous activities are typically restricted.

Alternatives

• Conservative management with medications and lifestyle changes.
• Minimally invasive endovascular procedures (although not viable in all cases).
• Surgical bypass or other open surgical interventions.

Patient Experience

During the procedure, patients will be under general anesthesia and thus will not feel pain. Post-procedure, patients might experience discomfort at the incision site, managed with pain medications. Physical sensations such as tiredness and limited movement in the shoulder and arm area are common, and pain management strategies will be provided.