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, popliteal artery
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, popliteal artery. Commonly referred to as Popliteal Artery Aneurysm Repair.
Summary
Popliteal Artery Aneurysm Repair involves the surgical correction of an aneurysm (a bulging or ballooning of a blood vessel) in the popliteal artery, located behind the knee. This may include direct repair of the vessel, the insertion of a graft, or patching the artery wall to restore proper blood flow and prevent rupture.
Purpose
The procedure addresses aneurysms or pseudoaneurysms in the popliteal artery which can lead to severe complications such as blood clots, limb ischemia, or rupture. The goals are to stabilize the artery, prevent complications, and restore normal blood flow to the leg.
Indications
- Presence of a diagnosed popliteal artery aneurysm or pseudoaneurysm.
- Symptoms of limb ischemia such as pain or numbness.
- Evidence of an enlarging aneurysm via imaging studies.
- Risks of aneurysm rupture.
- Associated occlusive disease that restricts blood flow.
Preparation
Patients may be required to:
- Fast for several hours before the procedure.
- Adjust or discontinue certain medications, especially blood thinners.
- Undergo diagnostic tests such as ultrasound, CT scan, or MRI to assess the aneurysm.
- Provide a full medical history and undergo a physical examination.
Procedure Description
- Anesthesia (usually general) is administered.
- An incision is made behind the knee to access the popliteal artery.
- The surgeon clamps the artery to control blood flow.
- The aneurysmal section of the artery is excised or repaired.
- A graft (often from another part of the patient’s body or synthetic material) is inserted and sewn into place to reconstruct the artery.
- In some cases, a patch graft is used to reinforce the repair.
- The incision is closed, and blood flow is restored.
Duration
The procedure typically takes 2-4 hours.
Setting
A hospital surgical suite.
Personnel
- Vascular surgeon
- Surgical nurses
- Anesthesiologist
- Surgical technologists
Risks and Complications
- Bleeding
- Infection
- Blood clots
- Anesthetic reactions
- Damage to surrounding nerves or tissues
- Graft failure or blockage
- Recurrence of the aneurysm
Benefits
The expected benefits include stabilization of the artery, prevention of aneurysm rupture, and recovery of normal blood flow. Benefits usually become apparent within weeks after surgery.
Recovery
- Hospital stay for 1-3 days post-procedure.
- Pain management with prescribed medications.
- Gradual return to activities, avoiding heavy lifting and strenuous exercise initially.
- Follow-up appointments for monitoring and ultrasound evaluations.
- Possible use of compression stockings to aid healing.
Alternatives
- Watchful waiting with regular imaging for small, asymptomatic aneurysms.
- Endovascular stent grafting, a less invasive procedure.
- Medications to manage atherosclerosis and reduce aneurysm growth. Each alternative has its own risks and benefits compared to open surgical repair.
Patient Experience
During the procedure, the patient is under anesthesia and will not feel pain. Post-procedure, there may be pain and tenderness at the incision site, managed through pain relief medications. Walking and light activities are encouraged shortly after surgery to promote circulation and recovery.