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 involving visceral vessels (mesenteric, celiac, ren
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 involving visceral vessels (mesenteric, celiac, renal arteries).
Summary
This surgical procedure involves repairing or removing an abnormal bulge (aneurysm or pseudoaneurysm) in the abdominal aorta and replacing it with a graft. It may also address blockages in associated visceral arteries, such as the mesenteric, celiac, and renal arteries, providing restored blood flow to these critical areas.
Purpose
Medical Condition:
- Aneurysm
- Pseudoaneurysm
- Associated occlusive disease of the abdominal aorta
Goals:
- Prevent rupture of the aneurysm
- Improve blood flow to abdominal organs
- Reduce or eliminate associated symptoms like pain and risk of organ damage
Indications
Symptoms/Conditions:
- Abdominal pain or back pain due to aneurysm
- Detectable aneurysm via imaging
- Threat of aneurysm rupture
- Compromised blood flow to visceral organs due to occlusion
Patient Criteria:
- Diagnosed aneurysm greater than 5.5 cm in diameter or rapidly growing
- Occlusive disease obstructing blood flow to essential organs
- Patients in good general health suitable for surgery
Preparation
Pre-procedure Instructions:
- Fasting (not eating or drinking) for at least 8 hours before the procedure
- Stopping certain medications as advised by the doctor
Diagnostic Tests:
- CT scan or MRI of the abdomen
- Blood tests
- Cardiovascular assessment (e.g., ECG, stress test)
Procedure Description
- Anesthesia: The patient is given general anesthesia to ensure they remain unconscious and pain-free.
- Incision: A large incision is made in the abdomen to access the aorta.
- Repair:
- The aneurysmal or pseudoaneurysmal section of the abdominal aorta is identified.
- Diseased portion is either repaired directly or excised (partially or completely).
- A synthetic graft is inserted to replace the removed section of the artery. If necessary, a patch graft is used to reinforce the vessel.
- Associated visceral vessels are also assessed and treated for any occlusive disease.
- Closure: The incision is closed with sutures or staples and covered with a sterile bandage.
Duration
Typically, the procedure takes 3-6 hours, depending on complexity.
Setting
Performed in a hospital operating room, as it requires intensive care facilities and specialized surgical team.
Personnel
- Lead Surgeon (vascular surgeon)
- Surgical assistants
- Anesthesiologist
- Surgical nurses
- Perfusionist (optional)
Risks and Complications
Common Risks:
- Bleeding
- Infection
- Reaction to anesthesia
Rare Risks:
- Blood clots
- Damage to nearby organs
- Graft infection or failure
- Renal failure
Management:
- Close monitoring in post-operative care
- Medication to prevent blood clots and manage pain
- Antibiotics to prevent or treat infections
Benefits
Expected Benefits:
- Prevents aneurysm rupture
- Restores normal blood flow to abdominal organs
- Reduces risk of life-threatening complications
Timeline:
Benefits are typically realized immediately, but full recovery and stabilization might take several weeks.
Recovery
Post-procedure Care:
- ICU monitoring for 1-2 days
- Gradual reintroduction of food and movement
- Pain management with medication
- Instructions on wound care and activity restrictions
Recovery Time:
- Hospital stay of 7-10 days
- Full recovery within 6-8 weeks
- Follow-up appointments for monitoring graft and overall recovery
Alternatives
Other Treatment Options:
- Endovascular aneurysm repair (EVAR)
- Medical management for smaller aneurysms (e.g., blood pressure control, regular imaging)
Pros and Cons:
- EVAR: Less invasive, shorter recovery, suitable for non-ruptured aneurysms, but may not be feasible for complex cases.
- Medical Management: Suitable for small and stable aneurysms, but doesn’t resolve aneurysms or severe occlusions.
Patient Experience
During Procedure:
- Under general anesthesia, so no sensation or memory of the procedure.
After Procedure:
- Initial discomfort and pain managed with medication
- Gradual improvement in mobility and normal activities
- Possible fatigue and rehabilitation needs during recovery period