34718 Endovascular repair of iliac artery, not associated with placement of an aorto-iliac artery endograft at the same session, by deployment of an iliac branched endograft, including pre-procedure sizing and device selection, all ipsilateral selective iliac a

Name of the Procedure

Endovascular Repair of Iliac Artery
Common name(s): Iliac artery endovascular repair, Iliac branched endograft placement
Medical term: Endovascular iliac artery repair without aorto-iliac endograft placement

Summary

Endovascular repair of the iliac artery involves using a minimally invasive approach to place a specialized branched endograft in the iliac artery. This procedure helps to reinforce and repair the artery without needing a larger aorto-iliac endograft.

Purpose

The procedure addresses conditions such as iliac artery aneurysms or severe atherosclerosis. Its primary goal is to stabilize and strengthen the iliac artery, thereby reducing the risk of rupture and improving blood flow.

Indications

• Presence of an iliac artery aneurysm
• Severe atherosclerosis causing significant vessel narrowing
• Symptoms such as leg pain, claudication, or swelling due to arterial problems
• Patients who are at high risk for open surgical repair

Preparation

• Fasting for 6-8 hours prior to the procedure
• Adjusting or stopping certain medications, particularly blood thinners, as advised by the healthcare provider
• Pre-procedure assessments may include blood tests, imaging studies like CT angiography, and vascular ultrasound to determine the size and location of the aneurysm or arterial narrowing

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Access: A small incision is made in the groin area to access the femoral artery.
3. Catheter Insertion: A catheter is threaded through the femoral artery under X-ray guidance to reach the iliac artery.
4. Endograft Deployment: An iliac branched endograft, tailored to the patient’s artery measurements obtained during pre-procedure sizing, is deployed at the affected artery site.
5. Placement Verification: The position and expansion of the endograft are checked using contrast dye and X-ray imaging.
6. Completion: The catheter is withdrawn, and the incision site is closed.

Duration

The procedure typically takes 2 to 3 hours.

Setting

This procedure is performed in a hospital setting, usually in a specialized endovascular surgery suite or catheterization lab.

Personnel

• Vascular surgeon or interventional radiologist
• Anesthesiologist
• Surgical nurses and technicians
• Radiologic technologists

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Endograft leakage or migration
• Blood clots (thrombosis)
• Vessel damage or rupture
• Reaction to contrast dye
• Kidney complications

Benefits

• Minimally invasive with smaller incisions compared to open surgery
• Shorter recovery time and hospital stay
• Reduced risk of complications associated with open surgical repair
• Immediate stabilization of aneurysm or improved blood flow in the affected artery

Recovery

• Monitoring in the recovery room for a few hours post-procedure
• Hospital stay typically lasts 1-2 days
• Instructions to avoid heavy lifting and strenuous activity for a few weeks
• Follow-up appointments for imaging studies to ensure the endograft is functioning properly

Alternatives

• Open surgical repair of the iliac artery, which involves a large incision and longer recovery
• Conservative management with lifestyle modifications and medications for patients at lower risk
• Regular imaging to monitor the artery condition without immediate intervention

Patient Experience

Patients might experience some discomfort at the incision site and may be groggy from anesthesia initially. Pain management typically includes prescribed medications. Most patients are able to return to light activities within a few days and resume normal activities within a few weeks, depending on their overall health and recovery progress.