Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending t
CPT4 code
Name of the Procedure:
Endovascular Repair of Descending Thoracic Aorta (e.g., Aneurysm, Pseudoaneurysm, Dissection, Penetrating Ulcer, Intramural Hematoma, or Traumatic Disruption); Not Involving Coverage of Left Subclavian Artery Origin, Initial Endoprosthesis plus Descending T
Summary
Endovascular repair of the descending thoracic aorta is a minimally invasive procedure to fix issues such as an aneurysm or tear in the aorta. This involves placing a stent graft to reinforce the artery wall without covering the left subclavian artery, which supplies blood to the left arm.
Purpose
- Medical Condition: Addresses conditions like aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions in the descending thoracic aorta.
- Goals: To stabilize the affected section of the aorta, prevent rupture, and improve blood flow.
Indications
- Symptoms: Persistent chest pain, back pain, or symptoms of compromised blood circulation.
- Conditions: Diagnosed aortic aneurysm, dissection, or traumatic disruption via imaging studies.
- Criteria: Suitable anatomy for endovascular stent placement and overall patient health that supports undergoing the procedure.
Preparation
- Instructions: May include fasting for 6-8 hours before the procedure and stopping certain medications like blood thinners.
- Diagnostics: Pre-procedure imaging like CT scans or MRIs to evaluate the aorta.
Procedure Description
- Anesthesia: Patient is given general anesthesia or local anesthesia with sedation.
- Incision: A small incision is made in the groin area to access the femoral artery.
- Guidewire Insertion: A guidewire is threaded through the femoral artery to the site of the aortic problem.
- Stent Graft Placement: A catheter delivering the stent graft is navigated to the affected aorta. The stent is deployed to span the damaged section.
- Confirmation: Imaging techniques like fluoroscopy are used to ensure proper placement.
- Closure: Incision sites are closed, and sterile dressings are applied.
Duration
Typically takes about 2-4 hours.
Setting
Performed in a hospital's operating room or an advanced interventional radiology suite.
Personnel
- Vascular surgeons or interventional radiologists
- Anesthesiologists
- Surgical nurses and technologists
Risks and Complications
- Common Risks: Bleeding, infection, and reaction to anesthesia.
- Rare Risks: Stent migration, endoleak (blood leaking outside the graft), kidney damage, or spinal cord injury.
Benefits
- Minimally invasive with a quicker recovery time compared to open surgery.
- Reduced risk of complications such as infection.
- Stability of the aorta segment and reduction of symptoms.
Recovery
- Care: Monitoring in the ICU initially, followed by observation in a regular hospital room.
- Instructions: Limited physical activity, wound care, and avoiding heavy lifting for a few weeks.
- Follow-up: Regular imaging tests to ensure the graft is functioning properly.
Alternatives
- Open Surgical Repair: Involving a large incision and direct repair of the aorta.
- Medical Management: For patients who cannot undergo surgery, involving blood pressure control and regular monitoring.
Pros and Cons:
- Open Repair: Longer recovery, higher risk but may be necessary for unsuitable anatomy for endovascular repair.
- Medical Management: Less invasive but does not correct the underlying problem.
Patient Experience
- During: While under anesthesia, the patient will not feel anything during the procedure.
- After: Mild discomfort or groin pain at the incision site, managed with pain medication. Possible mild, temporary restriction on certain activities.
Pain management strategies and support from healthcare providers ensure a comfortable recovery period.