35082 Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta

Name of the Procedure:

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta.

Summary

This surgical procedure is designed to repair a ruptured aneurysm in the abdominal aorta. It involves removing the damaged section of the aorta and replacing it with a graft to restore normal blood flow.

Purpose

This procedure addresses a ruptured aneurysm in the abdominal aorta, a life-threatening condition where the weakened wall of the artery has burst. The main goals are to stop internal bleeding, prevent future rupture, and ensure blood flow through the aorta is restored.

Indications

• Sudden, severe abdominal or back pain
• Signs of shock, such as low blood pressure, rapid heart rate, and dizziness
• Diagnosed ruptured abdominal aortic aneurysm via imaging or clinical assessment
• Immediate need to control life-threatening bleeding

Preparation

• Patients will typically fast for several hours before surgery.
• Discontinue certain medications like blood thinners as advised by the healthcare team.
• Pre-operative imaging studies, such as CT scans or ultrasounds, to assess the aneurysm.
• Blood tests, EKG, and other standard pre-surgical evaluations.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A large incision is made in the abdomen to access the aorta.
3. Isolation: The aneurysm is isolated, and clamps are placed to control blood flow.
4. Excision and Graft Insertion: The aneurysm or pseudoaneurysm is excised, and a synthetic graft or patch is sewn in place to replace the damaged segment.
5. Closure: The incision is closed with sutures or staples.

Duration

The procedure typically takes 3-6 hours, depending on the complexity of the aneurysm and the patient's condition.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Bleeding
• Infection
• Blood clots
• Kidney failure
• Heart attack or stroke
• Graft leakage or failure
• Nerve damage

Benefits

• Immediate control of bleeding from the ruptured aneurysm
• Restoration of normal blood flow
• Significant reduction in the risk of death from the aneurysm

Recovery

• Intensive care monitoring post-surgery.
• Pain management with medications.
• Gradual return to normal activities over 4-6 weeks.
• Follow-up appointments to monitor graft function and overall recovery.

Alternatives

• Endovascular aneurysm repair (EVAR), a less invasive surgical option.
• Conservative management, although not viable for ruptured aneurysm due to high mortality risk.
• Pros: EVAR offers shorter recovery and less immediate risk; Cons: Not suitable for all aneurysm types and locations.

Patient Experience

Patients will feel no pain during the procedure due to general anesthesia. Post-procedure, there will be pain and discomfort managed with medications. Hospital stay usually spans several days to a week, with continuous monitoring and support. Full recovery can take several weeks, with limitations on heavy lifting and rigorous activities during this period.