Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption), radiological supervision and interpretation
CPT4 code
Name of the Procedure:
Placement of Proximal Extension Prosthesis for Endovascular Repair of Descending Thoracic Aorta
Common Name(s): Endovascular Aortic Repair (EVAR) with Proximal Extension, Thoracic Endovascular Aortic Repair (TEVAR)
Summary
This procedure involves the placement of a prosthesis (a synthetic graft) into the descending thoracic aorta to repair anomalies such as aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions. It is minimally invasive and is guided by radiological imaging.
Purpose
The purpose of this procedure is to treat anomalies in the descending thoracic aorta to prevent rupture or further complications. It aims to restore normal blood flow, relieve symptoms, and improve overall cardiovascular health.
Indications
- Aortic aneurysms (ballooning) or pseudoaneurysms
- Aortic dissection (tearing of the aorta)
- Penetrating atherosclerotic ulcers
- Intramural hematomas (bleeding within the wall of the aorta)
- Traumatic aortic disruptions
Preparation
- Fasting for 6-8 hours prior to the procedure
- Medication adjustments as advised by the doctor
- Pre-procedure imaging tests like CT scans or MRIs to assess the aorta
- Blood tests to ensure proper kidney function and coagulation status
Procedure Description
- The patient is positioned and given general anesthesia.
- An access site is created, typically in the femoral artery in the groin.
- A catheter is introduced into the artery and guided up to the aorta.
- Radiological imaging is used to visualize the aorta.
- The prosthesis is delivered through the catheter and positioned at the target site in the descending thoracic aorta.
- The prosthesis is then expanded to attach to the aortic walls, sealing off the aneurysm or affected area.
- The catheter is removed, and the access site is closed.
Tools/Equipment: Catheters, guidewires, endovascular stent graft, radiological imaging equipment (fluoroscopy).
Duration
The procedure typically takes 2 to 4 hours.
Setting
Hospital operating room or specialized endovascular surgical suite.
Personnel
- Vascular surgeon or interventional radiologist
- Surgical nurses
- Anesthesiologist
- Radiology technician
Risks and Complications
- Bleeding or infection at the access site
- Endoleak (leakage of blood into the aneurysm)
- Blood clots or embolism
- Damage to surrounding blood vessels
- Kidney damage due to contrast dye
- Potential need for additional procedures
Benefits
- Minimally invasive with shorter recovery time compared to open surgery
- Reduced risk of aortic rupture
- Improved blood flow and reduced symptoms
- Hospital discharge often within a few days
Recovery
- Monitoring in a recovery room followed by a hospital stay of 1-2 days
- Gradual return to normal activities within a few weeks
- Follow-up appointments for imaging to ensure proper placement and function of the prosthesis
- Instructions on wound care at the access site and activity restrictions
Alternatives
- Open surgical repair (more invasive with longer recovery)
- Medical management and surveillance (for those not suitable for surgery)
- Each alternative has specific benefits and risks that should be discussed with the healthcare provider.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel pain. Post-procedure, patients may experience some discomfort or soreness at the access site, which can be managed with pain medication. Patients are generally encouraged to move around gently to promote circulation and will receive detailed instructions on care and activity levels during the recovery period.