Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta
CPT4 code
Name of the Procedure:
Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta.
- Common Name: Aortic Aneurysm Repair
- Technical Term: Abdominal Aortic Aneurysm (AAA) Repair
Summary
Aortic aneurysm repair involves the surgical correction of a weakened area in the abdominal aorta. This procedure can involve removing part or all of the weakened artery section and replacing it with a synthetic graft. The procedure aims to prevent aneurysm rupture and restore normal aortic function.
Purpose
- Medical Condition: Abdominal Aortic Aneurysm (AAA), pseudoaneurysm, and associated occlusive disease.
- Goals: To prevent rupture of the aneurysm, restore normal blood flow, and prevent complications such as ischemia.
Indications
- Symptoms like severe abdominal or back pain, a pulsating sensation in the abdomen.
- Diagnosis of an abdominal aortic aneurysm larger than 5 cm or one that is growing quickly.
- Detection of a pseudoaneurysm or occlusive disease in the abdominal aorta.
- High risk of aneurysm rupture.
Preparation
- Pre-operative fasting (usually 8-12 hours before surgery).
- Adjustment of certain medications as advised by the physician.
- Diagnostic tests: CT scan, MRI, ultrasound, blood tests, ECG.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
- Incision: A large incision is made in the abdomen (open repair).
- Repair:
- The surgeon identifies the aneurysm, occlusive disease, or pseudoaneurysm.
- Partial or total removal of the affected aortic segment.
- Insertion of a synthetic graft to replace or support the weakened artery.
- A patch graft may also be used for additional support.
- Closure: The incision is closed with sutures or staples.
Duration
Typically, the procedure lasts between 3 to 6 hours, depending on the complexity.
Setting
- Performed in a hospital operating room.
Personnel
- Surgeons specialized in vascular surgery.
- Anesthesiologists.
- Surgical nurses and assistants.
- Radiological techs may be on standby for imaging support.
Risks and Complications
- Common Risks: Infection, bleeding, blood clots, and complications from anesthesia.
- Rare Risks: Graft failure, renal complications, heart attack or stroke, and bowel ischemia.
Benefits
- Prevents aneurysm rupture, which can be life-threatening.
- Restores proper blood flow and reduces symptoms associated with aneurysm or occlusive disease.
- Improved overall cardiovascular health.
Recovery
- Hospital Stay: Typically 5-10 days.
- Post-Procedure Care: Pain management with medications, wound care, and limited physical activity.
- Recovery Time: Full recovery can take several weeks to a few months.
- Follow-up: Regular check-ups and imaging to monitor graft and aortic health.
Alternatives
- Endovascular Aneurysm Repair (EVAR): A minimally invasive procedure where a stent graft is inserted through small groin incisions.
- Pros: Shorter recovery time, less invasive.
- Cons: May not be suitable for all aneurysm types and sizes.
Patient Experience
- During: Patient is under general anesthesia and will not feel anything during the procedure.
- After: Patients may experience pain and discomfort post-surgery, managed with pain medications. They will have restricted activity during the recovery period and may feel fatigued.
Pain management and comfort measures include medications, appropriate positioning, and gradual reintroduction of physical activities.