0255T Endovascular repair of iliac artery bifurcation (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using bifurcated endoprosthesis from the common iliac artery into both the external and internal iliac artery, unilateral; radiological supe

Name of the Procedure:

Endovascular Repair of Iliac Artery Bifurcation (E.g., Aneurysm, Pseudoaneurysm, Arteriovenous Malformation, Trauma) using Bifurcated Endoprosthesis from the Common Iliac Artery into both the External and Internal Iliac Artery, Unilateral; Radiological Supervision

Summary

This minimally invasive procedure repairs issues in the iliac artery bifurcation, such as aneurysms or arteriovenous malformations. It involves placing a bifurcated endoprosthesis (stent-graft) to re-establish proper blood flow, guided by advanced imaging techniques.

Purpose

The procedure addresses damaged or malformed vessels in the iliac artery bifurcation, restoring normal blood flow and preventing complications like ruptures. The goal is to stabilize the blood vessel, reduce pain, and improve overall vascular function.

Indications

• Presence of iliac artery aneurysm
• Pseudoaneurysm in the iliac artery
• Arteriovenous malformations
• Trauma impacting the iliac artery
• Symptoms such as swelling, pain, or risk of rupture

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Adjustments to medications, particularly blood thinners, may be required.
• Pre-procedure diagnostics may include blood tests, imaging studies like CT or MRI scans, and an overall health assessment.

Procedure Description

1. Under local or general anesthesia, a small incision is made in the groin.
2. A catheter is inserted into the femoral artery and navigated to the iliac artery bifurcation under radiological guidance.
3. A bifurcated endoprosthesis is deployed from the common iliac artery into both the external and internal iliac arteries.
4. The placement is confirmed using real-time imaging, and the endoprosthesis is expanded to fit the vessel walls.
5. The catheter is removed, and the incision is closed.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital, often in a specialized operating room or interventional radiology suite.

Personnel

• Vascular surgeon or interventional radiologist
• Anesthesiologist
• Surgical nurses and technicians
• Radiology technologist

Risks and Complications

• Infection at the incision site
• Bleeding
• Blood clots
• Stent migration or malposition
• Damage to the blood vessels
• Rare risk of nerve damage or organ injury

Benefits

• Minimally invasive with a shorter recovery time compared to open surgery
• Immediate stabilization of the blood vessel and reduced risk of rupture
• Relief from symptoms like pain and swelling

Recovery

• Patients may need to stay in the hospital for 1-2 days.
• Follow-up includes imaging studies to check the stent placement.
• Activity restrictions for the first few weeks, including avoiding heavy lifting.
• Medications may be prescribed for pain management and to prevent clotting.
• Regular visits to the vascular specialist for monitoring.

Alternatives

• Open surgical repair, which involves a larger incision and longer recovery
• Medical management and monitoring for less severe cases
• Pros and cons: Open surgery is more invasive but may be necessary for complicated cases, whereas medical management avoids surgery but may not address severe issues.

Patient Experience

During the procedure, patients under local anesthesia may feel pressure but should not feel pain. Post-procedure, there might be some discomfort at the incision site, which can be managed with pain medications. Most patients can expect to resume normal activities within a few weeks, with careful monitoring to ensure proper healing.