34831 Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bi-iliac prosthesis

Name of the Procedure:

Open Repair of Infrarenal Aortic Aneurysm or Dissection, Plus Repair of Associated Arterial Trauma, Following Unsuccessful Endovascular Repair; Aorto-Bi-Iliac Prosthesis

Summary

This is a surgical procedure used to repair a weakened or torn section of the aorta below the kidneys (infrarenal) when an initial endovascular repair was not successful. It involves the use of a graft to replace the damaged aorta and restore normal blood flow.

Purpose

The procedure addresses infrarenal aortic aneurysms or dissections, which are dangerous conditions where the artery wall weakens or tears. The goals are to prevent rupture, restore normal blood flow, and repair any associated arterial trauma.

Indications

• Presence of an infrarenal aortic aneurysm or dissection
• Failed previous endovascular repair
• Symptoms like severe abdominal or back pain
• Evidence of arterial trauma

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustment or temporary discontinuation of certain medications
• Preoperative blood tests, imaging studies (like CT or MRI scans)
• Preoperative assessment of overall health and cardiovascular status

Procedure Description

1. Patient is put under general anesthesia.
2. An incision is made in the abdomen to access the aorta.
3. The damaged section of the aorta is identified and clamped to control blood flow.
4. The aneurysm or dissection is removed, and an aorto-bi-iliac prosthesis (a special type of graft) is sewn into place.
5. Any associated arterial trauma is also repaired.
6. Blood flow is restored, and the incision is closed.

Duration

The procedure typically takes between 4-6 hours.

Setting

The procedure is performed in a hospital surgical suite or operating room.

Personnel

• Vascular surgeons
• Anesthesiologists
• Surgical nurses
• Support staff

Risks and Complications

• Common risks: Infection, bleeding, reaction to anesthesia
• Rare risks: Blood clots, kidney damage, spinal cord injury, complications with heart or lungs
• Potential complications are managed with medications, additional surgeries, or supportive care as needed.

Benefits

• Prevents rupture of the aneurysm or worsening of the dissection
• Restores blood flow and improves symptoms
• Long-term durability of the aorto-bi-iliac prosthesis

Recovery

• Hospital stay of about 7-10 days
• Initial intensive monitoring in an ICU setting
• Pain management using medications
• Gradual return to normal activities over several weeks
• Follow-up appointments to monitor healing and graft function

Alternatives

• Repeat endovascular repair (if feasible)
• Medical management and monitoring (for those unable to undergo surgery)
• Less invasive procedures like stent placement
• Each alternative has its own risks and benefits, generally less effective for large or complex aneurysms and dissections.

Patient Experience

• During the procedure: Under general anesthesia, will not feel or remember anything.
• After the procedure: Some pain and discomfort managed with medications, possible ICU stay for close monitoring, gradual recovery, and fatigue.
• Pain management through IV, oral medications, and patient-controlled analgesia (PCA) devices.

Ultimately, this procedure aims to significantly improve the patient's quality of life and prevent life-threatening complications associated with aortic aneurysms and dissections.