34825 Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, or dissection; initial vessel

Name of the Procedure:

Placement of Proximal or Distal Extension Prosthesis for Endovascular Repair of Infrarenal Abdominal Aortic or Iliac Aneurysm, False Aneurysm, or Dissection; Initial Vessel

Summary

This procedure involves the insertion of a stent graft extension into the aorta or iliac arteries to treat aneurysms, false aneurysms, or dissections. The stent graft provides structural support to the weakened vessel walls, reducing the risk of rupture.

Purpose

• Medical Condition: Infrarenal abdominal aortic aneurysm, iliac aneurysm, false aneurysm, or arterial dissection.
• Goals/Outcomes: To reinforce the diseased artery walls, prevent aneurysm rupture, and improve blood flow.

Indications

• Symptoms/Conditions: Detections of a large or symptomatic aneurysm, signs of arterial dissection.
• Patient Criteria: Patients with appropriate anatomy for endovascular repair, suitable for patients not eligible for open surgery.

Preparation

• Pre-procedure Instructions: Fasting for 6-8 hours before the procedure, medication adjustments as advised.
• Diagnostic Tests: CT angiography, ultrasound, or MRI to assess the aneurysm/dissection; blood tests.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Access: An incision is made in the groin to access the femoral artery.
3. Insertion: A catheter is guided through the artery to the site of the aneurysm or dissection.
4. Deployment: The stent graft extension is threaded through the catheter and placed within the affected artery.
5. Expansion: The graft is expanded to fit snugly against the artery walls.
6. Imaging: Real-time imaging confirms proper placement.
7. Closure: The access site is closed, typically with sutures or a closure device.

Duration

The procedure typically takes 2-4 hours.

Setting

Performed in a hospital setting, specifically in a surgical or interventional radiology suite.

Personnel

• Vascular surgeons or interventional radiologists
• Anesthesiologists
• Surgical nurses
• Radiologic technologists

Risks and Complications

• Common Risks: Infection at the access site, bleeding, bruising, or pain.
• Rare Risks: Blood vessel damage, stent graft migration, endoleak (leakage around the graft), and organ injury.

Benefits

• Effective in preventing aneurysm rupture.
• Minimally invasive with a shorter recovery time compared to open surgery.
• Immediate improvement in blood flow.

Recovery

• Post-procedure Care: Monitoring in a recovery room, hospital stay of 1-2 days.
• Instructions: Limit physical activity for a few weeks, follow-up imaging to ensure graft stability.
• Expected Recovery Time: Full recovery in 4-6 weeks.

Alternatives

• Open Surgical Repair: More invasive, longer recovery.
• Medical Management: For patients with small aneurysms, includes regular monitoring and medication.
• Pros and Cons: Open surgery is definitive but more invasive; medical management is less invasive but doesn’t eliminate the aneurysm.

Patient Experience

• During Procedure: Under anesthesia, no pain felt.
• After Procedure: Mild to moderate pain at the access site, managed with pain medication. Possible bruising and minor discomfort are common.
• Pain Management: Pain medications prescribed as needed.

This detailed overview helps the patient understand the procedure, its purpose, and what to expect, ensuring they are well-prepared and informed.