34813 Placement of femoral-femoral prosthetic graft during endovascular aortic aneurysm repair (List separately in addition to code for primary procedure)

Name of the Procedure:

Placement of Femoral-Femoral Prosthetic Graft During Endovascular Aortic Aneurysm Repair (EVAR)

Summary

This procedure involves placing a synthetic graft to create a bypass between the femoral arteries in both legs during the repair of an aortic aneurysm using minimally invasive techniques. The graft helps ensure proper blood flow if the natural arteries are blocked or damaged.

Purpose

The procedure aims to correct blood flow issues that may arise during the endovascular repair of an aortic aneurysm. An aortic aneurysm is a dangerous bulge in the main artery of the body, and this graft placement helps ensure the arteries continue to supply blood effectively.

Indications

• Presence of an abdominal or thoracic aortic aneurysm.
• Narrowing or blockage of the femoral arteries.
• Previous artery repair that has compromised blood flow.

• Patient is a candidate for endovascular rather than open surgery.

  Preparation

• Fasting for 8 hours before the procedure.
• Potential cessation or adjustment of certain medications, especially blood thinners.
• Pre-procedure imaging tests like CT scans or ultrasounds to assess the extent of the aneurysm and femoral arteries' condition.
• Blood tests to check overall health status.

Procedure Description

1. Anesthesia: The patient will be given general or regional anesthesia.
2. Incisions: Small incisions are made in the groin areas to access the femoral arteries.
3. Guidewire Insertion: A guidewire is threaded through the incision to the appropriate location.
4. Graft Placement: A synthetic graft is inserted and maneuvered into place, connecting the femoral arteries.
5. EVAR Procedure: The primary endovascular aneurysm repair is then carried out, placing a stent graft in the aorta to support it.
6. Closure: All incisions are closed with sutures or staples.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

This procedure is performed in a hospital's operating room equipped with advanced imaging technology.

Personnel

• Vascular Surgeon
• Anesthesiologist
• Surgical Nurse
• Radiologic Technologist

Risks and Complications

• Infection at the incision site
• Blood clots or bleeding
• Graft blockage or failure
• Damage to surrounding blood vessels or tissues
• Adverse reaction to anesthesia

Benefits

• Prevents rupture of the aortic aneurysm, which can be life-threatening.
• Minimally invasive compared to open surgery, resulting in quicker recovery.
• Improved blood flow in femoral arteries.

Recovery

• Hospital stay for 1-2 days post-procedure.
• Monitoring for any immediate complications.
• Instructions for wound care and restrictions on physical activity.
• Follow-up appointments for imaging tests to check the graft and aneurysm repair.

Alternatives

• Open surgical repair of the aortic aneurysm.
• Medical management and monitoring of smaller aneurysms.
• Lifestyle changes and medications to manage aneurysm size and risk factors.

Pros and Cons:

• Open Surgery: More invasive, longer recovery; suitable for patients unsuitable for EVAR.
• Medical Management: Non-invasive; suitable for smaller, lower-risk aneurysms; does not fix larger or high-risk aneurysms.

Patient Experience

• Patients may experience discomfort and pain at incision sites post-procedure, managed with pain relief medications.
• Some bruising and swelling in the groin area.
• Gradual return to normal activities, usually within a few weeks.

Pain management and comfort measures, such as ice packs and prescribed pain relief, will be provided to ensure patient comfort during the recovery period.