34716 Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for p

Name of the Procedure:

Open Axillary/Subclavian Artery Exposure with Creation of Conduit for Delivery of Endovascular Prosthesis or for Establishment of Cardiopulmonary Bypass (infraclavicular or supraclavicular incision, unilateral)

Summary

This surgical procedure involves exposing the axillary or subclavian artery through an incision near the clavicle to create a conduit. This conduit can be used for delivering an endovascular prosthesis (a type of graft or stent) or to set up a cardiopulmonary bypass system.

Purpose

This procedure addresses conditions like artery blockages, aneurysms, or other vascular issues. It aims to provide an access route for treating these issues endovascularly or to establish support for heart and lung functions during surgeries.

Indications

• Severe narrowing or blockage of the axillary/subclavian artery
• Aneurysms in the subclavian or axillary arteries
• Need for cardiopulmonary bypass during heart or lung surgery
• Patients requiring further vascular reconstruction

Preparation

• Patients typically need to fast for several hours before the procedure.
• Certain medications may need to be adjusted or paused.
• Pre-procedure tests include blood tests, imaging studies like CT scans or MRIs, and sometimes a cardiology evaluation.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A surgical incision is made either below (infraclavicular) or above (supraclavicular) the clavicle.
3. Exposure: Muscles and tissues are carefully moved aside to expose the axillary or subclavian artery.
4. Conduit Creation: A conduit is created, which may involve sewing a synthetic graft or vein to the artery.
5. Endovascular Prosthesis or Bypass Setup: The conduit is then used to access the artery for placing a prosthesis or to establish a connection for cardiopulmonary bypass.

Duration

The procedure typically lasts between 2 to 4 hours, depending on complexity.

Setting

This procedure is performed in a hospital, specifically in a sterile operating room.

Personnel

• Vascular surgeon
• Surgical nurses
• Anesthesiologist
• Potentially a cardiologist or perfusionist if a cardiopulmonary bypass is involved

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Blood clots
• Nerve damage leading to sensation or movement issues
• Complications related to anesthesia
• Rarely, issues with heart or lung function

Benefits

• Improved blood flow through the treated artery
• Reduced risk of stroke or other complications from arterial blockages
• Enhanced ability to perform necessary heart or lung surgeries Benefits are typically realized immediately or within a few days post-procedure.

Recovery

• Hospital stay of several days for monitoring
• Pain management with prescribed medications
• Limited movement of the arm on the side of the procedure for a few weeks
• Follow-up appointments to check healing and functionality

Alternatives

• Non-surgical management such as medications or lifestyle changes
• Less invasive procedures like angioplasty or stenting without open surgery
• Other surgical options depending on the specific vascular issue

Patient Experience

Patients will be unconscious during the procedure due to general anesthesia. After waking up, they may experience pain and discomfort at the incision site, which will be managed with medication. Gradual recovery with some physical restrictions will be necessary, and regular follow-up will ensure proper healing and function.