34800 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-aortic tube prosthesis

Name of the Procedure:

Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm or Dissection using Aorto-Aortic Tube Prosthesis
Common Name: Endovascular Aortic Repair (EVAR)

Summary

Endovascular Aortic Repair (EVAR) is a minimally invasive procedure used to treat aneurysms or dissections in the abdominal aorta, close to the kidneys. The surgeon inserts a tube-shaped graft (prosthesis) through the blood vessels to reinforce the weakened area, without the need for open surgery.

Purpose

This procedure addresses the issue of an abdominal aortic aneurysm or dissection, which is a bulging or tear in the aorta that can cause life-threatening bleeding if it ruptures. The goal of EVAR is to prevent rupture by stabilizing the weakening aorta with a graft.

Indications

• Presence of an infrarenal abdominal aortic aneurysm larger than 5.5 cm in diameter.
• Rapidly expanding aneurysms.
• Symptomatic aneurysm (e.g., pain or tenderness).
• Aortic dissection.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjusting or stopping certain medications as directed by the doctor.
• Pre-procedure imaging tests like CT scans or ultrasounds to plan the procedure.
• Blood tests and assessments to ensure fitness for surgery.

Procedure Description

1. The patient is given general or local anesthesia.
2. Catheter tubes are inserted through small incisions in the groin area.
3. Using X-ray guidance, the surgeon threads the catheter through the blood vessels to reach the affected area of the aorta.
4. A tube-shaped graft is deployed from the catheter and expanded to fit securely inside the aorta, above and below the aneurysm or dissection.
5. The graft stays in place to reinforce the aorta, redirecting blood flow through the graft instead of the weakened vessel wall.
6. The catheters are removed, and the incisions are closed.

Duration

The procedure typically takes 2-4 hours.

Setting

EVAR is usually performed in a hospital's operating room or a specialized interventional radiology suite.

Personnel

• Vascular Surgeon or Interventional Radiologist
• Anesthesiologist
• Surgical Nurses
• Radiologic Technicians

Risks and Complications

• Bleeding or infection at the incision sites.
• Graft migration or failure.
• Leakage around the graft (endoleak).
• Kidney complications.
• Blood clots or embolism.
• Need for additional procedures or surgeries.

Benefits

• Reduced risk of aneurysm rupture.
• Minimally invasive with shorter recovery time compared to open surgery.
• Less postoperative pain and shorter hospital stay.
• Higher success rates for appropriate patients.

Recovery

• Monitoring in a recovery area or ICU for a short period.
• Pain management typically with over-the-counter pain relievers.
• Instructions on managing incision sites and activity restrictions.
• Gradual return to normal activities within a few weeks.
• Follow-up imaging tests to ensure the graft is functioning correctly.

Alternatives

• Open Surgical Repair: Involves a large abdominal incision and longer recovery times but can be more definitive in some cases.
• Medical Management: Regular monitoring and blood pressure control for smaller aneurysms.
• Watchful Waiting: Regular imaging to monitor changes in the aneurysm size.

Patient Experience

During the procedure, anesthesia will ensure the patient does not feel pain. Post-procedure, the patient might experience mild discomfort and soreness at the incision sites. Pain is generally manageable with medications, and most patients can return to normal activities within a few weeks, although heavy lifting and strenuous activities should be avoided for some time. Regular follow-up is crucial to monitor the success of the repair and the integrity of the graft.