35103 Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving iliac vessels (common, hypogastric, external)

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 involving iliac vessels (common, hypogastric, external).

Summary

In layman's terms, this procedure involves repairing a ruptured aneurysm located in the abdominal aorta and potentially involving the iliac vessels. This type of surgery can include removing the damaged section of the blood vessel and replacing it with a graft to restore normal blood flow.

Purpose

• Medical Condition or Problem: Ruptured aneurysm in the abdominal aorta and/or iliac vessels.
• Goals: The primary goal is to repair the rupture, restore proper blood flow, and prevent life-threatening complications like severe blood loss.

Indications

• Severe abdominal or back pain.
• Hypotension (low blood pressure).
• Signs of internal bleeding.
• Confirmed diagnosis of a ruptured aneurysm via imaging studies.
• Patients with significant risk factors for rupture such as large aneurysm size, rapid aneurysm growth, or symptomatic aneurysms.

Preparation

• Pre-procedure Instructions: Patients are usually advised to fast for at least 8 hours before the procedure.
• Medication Adjustments: Adjustments or discontinuation of certain medications, especially blood thinners and anti-inflammatory drugs.
• Diagnostic Tests: Imaging studies like CT scans or MRIs to assess the aneurysm.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: An abdominal incision is made.
3. Aneurysm Access: The surgeon isolates the aneurysm site.
4. Excision and Repair: The aneurysm or pseudoaneurysm is excised partially or totally.
5. Graft Insertion: A synthetic or biological graft is inserted to replace the damaged vessel section. A patch graft might be used if necessary.
6. Closure: The incision is closed with sutures or staples.

• Tools: Surgical instruments, graft materials, imaging equipment for intraoperative guidance.
• Technology: Advanced imaging tools for precise placement of grafts.

Duration

The procedure typically lasts between 3 to 6 hours, depending on the complexity.

Setting

Performed in a hospital's operating room, often in a specialized cardiovascular or vascular surgery unit.

Personnel

• Surgeon: A vascular or cardiovascular surgeon.
• Anesthesiologist: To administer anesthesia and monitor vitals.
• Surgical Nurses: To assist during the procedure.
• Radiologists: For intraoperative imaging support.

Risks and Complications

• Common Risks: Bleeding, infection, blood clots, and adverse reactions to anesthesia.
• Rare Risks: Organ damage, graft failure, or leakage at the graft site.
• Management: Complications are managed with medications, additional surgery, or other medical interventions as needed.

Benefits

• Expected Benefits: Restoration of normal blood flow, prevention of further rupture, and reduction of life-threatening risks.
• Timeline: Benefits are often immediate post-surgery, with a gradual improvement as recovery progresses.

Recovery

• Post-procedure Care: Intensive monitoring in a hospital (ICU) for the first few days. Pain management is provided.
• Instructions: Gradual return to activities, wound care, medications to prevent infection and manage pain, and follow-up appointments.
• Recovery Time: Full recovery can take several weeks to a few months, depending on individual health and complications.

Alternatives

• Endovascular Aneurysm Repair (EVAR): A less invasive option involving the insertion of a graft via a catheter.
• Medical Management: Monitoring and managing risk factors like high blood pressure.
• Pros and Cons: EVAR has a shorter recovery time but might not be suitable for all types of ruptures. Medical management is less invasive but doesn't repair the aneurysm.

Patient Experience

• During Procedure: The patient will be under general anesthesia and will not feel pain.
• After Procedure: Patients may experience pain, tenderness in the incision area, and will need pain management. Hospital stay for monitoring and gradual return to normal activities is expected.
• Pain Management: Medications and other comfort measures are provided to manage pain effectively.