Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis (2 docking limbs)
CPT4 code
Name of the Procedure:
Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm or Dissection Using Modular Bifurcated Prosthesis (2 Docking Limbs)
Summary
This is a minimally invasive procedure to fix an abnormal bulge (aneurysm) or tear (dissection) in the abdominal part of the aorta using a specially designed prosthesis. The prosthesis, a kind of fabric-covered stent with two branches, helps reinforce the weakened section of the aorta and redirects blood flow to prevent rupture.
Purpose
This procedure addresses abdominal aortic aneurysms or dissections located below the kidneys. The main goal is to prevent the aneurysm from rupturing or the dissection from worsening, both of which can be life-threatening. Expected outcomes include reduced risk of rupture and stabilization of the aorta with a quicker recovery compared to open surgery.
Indications
- Detection of an infrarenal abdominal aortic aneurysm larger than 5 cm in diameter.
- Expansion of an existing aneurysm.
- Presence of a dissection in the infrarenal abdominal aorta.
- Symptoms such as abdominal or back pain associated with the aneurysm.
- Patients with high surgical risk for open repair.
Preparation
- Fasting for at least 8 hours before the procedure.
- Stopping certain medications as advised by the physician.
- Pre-procedure imaging tests including CT scans or MRIs to assess the size and shape of the aneurysm or dissection.
- Lab tests to check overall health and kidney function.
Procedure Description
- The procedure is performed under general anesthesia or regional sedation.
- Small incisions are made near the groin to access the femoral arteries.
- A catheter is inserted and guided through the blood vessels to the location of the aneurysm or dissection.
- Through the catheter, a modular bifurcated prosthesis (consisting of a main body and two docking limbs) is delivered and positioned to cover the aneurysm or dissection.
- The prosthesis is expanded, creating a stable channel for blood flow and reinforcing the arterial wall.
- Imaging techniques like fluoroscopy are used throughout the procedure to ensure accurate placement.
Duration
The procedure typically takes between 2 to 3 hours.
Setting
The procedure is usually performed in a hospital's operating room or a specialized endovascular suite.
Personnel
- Vascular surgeons
- Interventional radiologists
- Anesthesiologists
- Surgical nurses
- Radiology technologists
Risks and Complications
- Infection at the incision sites.
- Bleeding or hematoma formation.
- Blood clots or embolism.
- Endoleak (leakage of blood around the graft).
- Injury to surrounding blood vessels or organs.
- Kidney complications due to contrast dye.
- Possible need for additional procedures or follow-up interventions.
Benefits
- Minimally invasive approach with smaller incisions.
- Reduced recovery time compared to open surgery.
- Lower risk of complications such as infection and blood loss.
- Decreased hospital stay.
- Immediate protection against aneurysm rupture or dissection extension.
Recovery
- Hospital stay typically ranges from 1 to 3 days.
- Patients are advised to avoid strenuous activities and heavy lifting for a few weeks post-procedure.
- Regular follow-up appointments and imaging tests to ensure the graft is functioning properly.
- Gradual return to normal activities within 4 to 6 weeks.
Alternatives
- Open surgical repair, which involves a larger incision and direct replacement of the affected aorta segment.
Medical management with regular monitoring for smaller or asymptomatic aneurysms or dissections.
Pros of Endovascular Repair:
Less invasive, faster recovery, fewer immediate complications.
Cons of Endovascular Repair:
- Requires follow-up imaging, risk of endoleak, possible need for re-interventions.
Patient Experience
During the procedure, patients are generally under anesthesia and will not feel pain. Post-procedure, patients may experience mild discomfort or pain at the incision sites which is manageable with prescribed pain relievers. Patients should report any unusual symptoms such as severe pain, fever, or signs of infection to their healthcare provider promptly.