34844 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 (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by Deployment of a Fenestrated Visceral Aortic Endograft

Summary

Endovascular repair of the visceral aorta is a minimally invasive procedure used to treat issues like aneurysms, pseudoaneurysms, dissections, ulcers, hematomas, or trauma in the visceral region of the aorta. This is achieved by inserting a specially designed graft into the affected area to stabilize and reinforce the aorta’s wall.

Purpose

The procedure addresses life-threatening conditions such as aneurysms, dissections, or traumatic injuries that compromise the aorta's integrity. The goal is to reinforce the weakened area of the aorta, prevent rupture, and restore normal blood flow.

Indications

• Abdominal aortic aneurysm (AAA)
• Aortic dissections
• Visceral pseudoaneurysms
• Penetrating aortic ulcers
• Intramural hematomas
• Traumatic aortic injuries Candidates typically have symptoms such as abdominal pain, back pain, or evidence of a compromised aorta on imaging studies.

Preparation

• Fasting for 8 hours prior to the procedure.
• Adjustment or temporary cessation of certain medications, particularly blood thinners.
• Pre-procedure imaging tests such as CT scans or MRIs to map the aorta.
• Blood tests and cardiovascular assessments to ensure suitability for the procedure.

Procedure Description

1. Administration of local anesthesia or general anesthesia.
2. Insertion of a catheter through a small incision, usually in the groin.
3. Navigation of the catheter to the affected section of the visceral aorta.
4. Deployment of a fenestrated endograft through the catheter into the aorta.
5. Precise placement of the endograft to cover the affected area.
6. Confirmation of appropriate graft placement using real-time imaging techniques such as fluoroscopy.
7. Removal of the catheter; closure of the insertion site.

Duration

The procedure typically takes 2-4 hours.

Setting

Performed in a hospital operating room or a specialized endovascular suite.

Personnel

• Vascular surgeon or interventional radiologist
• Anesthesiologist
• Surgical nurses
• Radiology technologist

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Graft migration or endoleak
• Organ injury or ischemia
• Allergic reactions to contrast material used in imaging
• Vascular complications such as blood clots

Benefits

• Reduced risk of aortic rupture
• Faster recovery time compared to open surgery
• Lowered incidence of complications
• Immediate improvement in some symptoms

Recovery

• Monitoring in a recovery room for several hours post-procedure.
• Hospital stay may range from 1 to 3 days.
• Follow-up imaging studies to ensure graft stability.
• Avoidance of heavy lifting and strenuous activities for a few weeks.
• Routine follow-up appointments to monitor aortic health.

Alternatives

• Open surgical repair of the aorta
• Medical management with medications and lifestyle changes
• Regular monitoring with imaging studies Alternatives generally have longer recovery times and may be riskier or less effective in certain patients.

Patient Experience

Patients may feel some discomfort at the incision site, but pain is usually manageable with prescribed medications. During the procedure, local anesthesia minimizes pain, and sedation helps to relax. After the procedure, patients are closely monitored, and measures are taken to ensure comfort and manage any pain effectively.