34847 Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modula

Name of the Procedure:

Endovascular repair of the visceral aorta and infrarenal abdominal aorta with a fenestrated visceral aortic endograft and concomitant unibody or modular endograft.

Summary

Endovascular repair of the visceral aorta and infrarenal abdominal aorta is a minimally invasive procedure to treat conditions like aneurysms, dissections, or traumatic damage to the aorta. It involves placing a special fenestrated endograft inside the aorta to reinforce the vessel wall and restore proper blood flow.

Purpose

This procedure is performed to:

• Treat aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions of the aorta.
• Prevent rupture or complications of these conditions.
• Improve blood flow and reduce risk of life-threatening events.

Indications

• Symptoms such as abdominal pain, back pain, or a pulsating mass in the abdomen.
• Diagnosis of aneurysm, dissection, or other aortic pathology via imaging tests.
• Patients with genetic disorders affecting the aorta, such as Marfan syndrome.
• Individuals unfit for open surgical repair due to other health conditions.

Preparation

• Fasting for 6-8 hours prior to the procedure.
• Adjustment of certain medications as advised by the healthcare provider.
• Pre-procedure imaging tests like CT angiography to plan the repair.

Procedure Description

1. The patient is positioned on the operating table.
2. Under anesthesia, a small incision is made in the groin.
3. A catheter is inserted through the incision and guided to the aorta using X-ray imaging.
4. The fenestrated endograft is carefully positioned in the aorta, covering the damaged section.
5. The graft is expanded and secured, reinforcing the aorta.
6. The catheter is removed, and the incision is closed.

Duration

The procedure typically takes 2 to 4 hours.

Setting

Performed in a hospital operating room or specialized endovascular suite.

Personnel

• Vascular surgeon or interventional radiologist.
• Anesthesiologist.
• Surgical nurses and technicians.
• Radiologic technologists.

Risks and Complications

• Common: Bleeding, infection, pain at the incision site.
• Rare: Endoleak (leakage around the graft), migration of the graft, injury to surrounding organs, blood clots.

Benefits

• Minimally invasive compared to open surgery.
• Reduced recovery time and hospital stay.
• Lower risk of complications and faster return to normal activities.
• Immediate improvement in symptoms and stabilization of the aorta.

Recovery

• Post-procedure monitoring in the hospital for 1-2 days.
• Instructions on wound care, activity restrictions, and medications.
• Follow-up imaging tests to ensure graft placement and function.
• Gradual return to normal activities over 4-6 weeks.

Alternatives

• Open surgical repair, which is more invasive and involves a longer recovery.
• Endovascular stent-grafting without fenestrations, though not suitable for all patients.
• Medical management with blood pressure control and regular monitoring.

Patient Experience

• During the procedure, the patient is under anesthesia and will not feel pain.
• Post-procedure discomfort at the incision site and mild pain managed with medications.
• Gradual improvement in symptoms like pain and pulsating sensation in the abdomen.
• Full recovery expected within a few weeks, with most patients resuming normal activities.