34842 Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and inte

Name of the Procedure:

Endovascular Repair of Visceral Aorta using Fenestrated Visceral Aortic Endograft
Common Name(s): Fenestrated aortic endograft repair, Visceral aorta endovascular repair

Summary

Endovascular repair of the visceral aorta involves using a special type of stent graft called a fenestrated endograft, which is inserted into the aorta through the blood vessels to repair damage or abnormalities such as aneurysms, dissections, or traumatic injuries. The procedure is minimally invasive and involves radiological guidance.

Purpose

This procedure is primarily done to treat conditions affecting the visceral aorta, which includes:

• Aneurysms (ballooning of the arterial wall)
• Pseudoaneurysms (false aneurysm due to vessel wall injury)
• Dissections (tear in the aortic wall)
• Penetrating ulcers (erosions in the aortic wall)
• Intramural hematomas (blood clots within the aortic wall)
• Traumatic disruptions

The main goal is to reinforce the weakened section of the aorta, prevent rupture, and restore proper blood flow.

Indications

• Presence of a visceral aortic aneurysm or pseudoaneurysm
• Dissection of the visceral aorta
• Penetrating aortic ulcer
• Detection of an intramural hematoma
• Traumatic injury to the visceral aorta

Candidates typically include patients with these conditions who are at risk for aortic rupture and have suitable anatomy for endovascular repair.

Preparation

• Patients may need to fast for several hours prior to the procedure.
• Certain medications, especially blood thinners, may need to be adjusted.
• Pre-operative assessments include blood tests, imaging studies like CT or MRI scans, and physical examination.
• Consent and discussion about risks, benefits, and alternatives will be obtained.

Procedure Description

1. The procedure begins with the patient under anesthesia or sedation.
2. An access point is made, typically in the groin, to insert a catheter into the femoral artery.
3. Using radiological guidance, the catheter is advanced to the affected area of the aorta.
4. A fenestrated endograft is carefully positioned and deployed to cover the damaged section of the aorta.
5. The graft is then expanded to fit snugly against the vessel wall, creating a stable new pathway for blood flow.
6. The catheter is removed, and the insertion site is closed.

Duration

The procedure usually takes between 2 to 4 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital, typically in a specialized operating room equipped with advanced imaging technology.

Personnel

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

Risks and Complications

Common Risks:

• Infection
• Bleeding at the insertion site
• Allergic reaction to contrast dye Rare Complications:
• Endoleaks (leakage of blood around the graft)
• Migration or dislodgement of the endograft
• Injury to the surrounding organs or arteries
• Renal complications due to contrast dye

Benefits

• Minimally invasive compared to open surgery
• Shorter hospital stay
• Faster recovery time
• Reduced risk of aortic rupture
• Improved blood flow and symptom relief typically soon after the procedure

Recovery

• Patients usually stay in the hospital for 1-2 days.
• Post-procedure care includes monitoring for signs of complications, pain management, and activity restrictions.
• Patients are advised to avoid heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments are necessary to monitor the graft and overall aortic health.

Alternatives

• Open surgical repair: involves a larger incision and longer recovery period but may be necessary for some patients.
• Medical management: involves surveillance and blood pressure control, suitable for small aneurysms or patients unfit for surgery.
• Lifestyle modifications: may help in managing risk factors.

Pros of Endovascular Repair:

• Less invasive with faster recovery

Cons of Endovascular Repair:

• May not be suitable for all patients

Patient Experience

During the Procedure:

• Patients will generally be under anesthesia, therefore not conscious during the procedure. After the Procedure:
• Some discomfort at the incision site which is managed with pain medication.
• Possible feelings of fatigue which typically improve within a few days.
• Close monitoring by healthcare staff to ensure no complications arise.

Pain and discomfort are usually mild to moderate and well-controlled with medication.