Descending thoracic aorta graft, with or without bypass
CPT4 code
Name of the Procedure:
Descending Thoracic Aorta Graft
Also known as: Thoracic Endovascular Aortic Repair (TEVAR), Thoracic Aortic Aneurysm Repair
Summary
A descending thoracic aorta graft is a surgical procedure aimed at repairing a damaged or weakened section of the descending thoracic aorta, which is the part of the aorta that runs through the chest. This procedure may involve the use of a synthetic graft to replace or reinforce the affected area, with or without the use of a bypass mechanism to ensure proper blood flow during the operation.
Purpose
This procedure is primarily performed to address problems such as thoracic aortic aneurysms, which involve the bulging and weakening of the aorta's wall. The goals are to prevent aortic rupture or dissection, which can be life-threatening, and to restore normal aortic function and blood flow.
Indications
- Presence of a thoracic aortic aneurysm
- Symptomatic aortic dissections
- Trauma to the thoracic aorta
- Severe atherosclerosis of the thoracic aorta
- Marfan syndrome or other connective tissue disorders affecting the aorta
Preparation
- Patients will typically be advised to fast for at least 8 hours before the procedure.
- Certain medications may need to be adjusted or paused temporarily.
- Pre-operative diagnostic tests may include CT scans, MRI, echocardiograms, and blood tests.
- A thorough medical evaluation and consultations, particularly with a cardiologist and anesthesiologist, are usually required.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: An incision is made, either in the chest (open repair) or minimally via small incisions in the groin (endovascular repair).
- Graft Placement:
- Open Repair: The affected section of the aorta is exposed, and a synthetic graft is sewn into place.
- Endovascular Repair: A catheter is inserted through the femoral artery, and the graft is delivered and placed inside the aorta using imaging guidance.
- Bypass (if needed): A secondary pathway for blood flow may be established temporarily or permanently.
- Closure: The incision(s) are closed, and the patient is moved to recovery.
Duration
The procedure typically takes between 2 to 6 hours, depending on the complexity and method used.
Setting
The procedure is performed in a hospital setting, usually in a specialized operating room equipped for cardiac surgery.
Personnel
- Cardiothoracic Surgeon
- Vascular Surgeon
- Anesthesiologist
- Surgical Nurses
- Radiologic Technologists (for imaging guidance in endovascular repair)
Risks and Complications
- Bleeding
- Infection
- Blood clots or embolism
- Graft leakage or failure
- Stroke
- Spinal cord ischemia leading to paralysis (rare)
- Kidney failure
- Complications related to anesthesia
Benefits
- Preventing aortic rupture or dissection
- Alleviating symptoms caused by the aortic aneurysm
- Improved blood flow and aortic function
- The durability of the repair, potentially reducing the need for further interventions
Recovery
- Close monitoring in the intensive care unit (ICU) for 1–2 days post-surgery.
- Hospital stay of about 5–10 days in total.
- Pain management with medications.
- Gradual return to normal activities within 4–6 weeks.
- Follow-up appointments to monitor graft function and overall recovery.
- Restrictions on heavy lifting and strenuous activities for several weeks.
Alternatives
- Medical Management: Monitoring and controlling blood pressure with medications.
- Open Surgical Repair: More invasive and with a longer recovery time compared to endovascular methods.
- Hybrid Procedures: Combining open and endovascular techniques.
- Lifestyle Modifications: Dietary changes, exercise, and smoking cessation to manage risk factors.
Patient Experience
- During the procedure: The patient will be under general anesthesia and not conscious.
- Post-procedure: Expect some pain and discomfort at the incision sites. Medications will be provided to manage pain.
- Recovery phase: Fatigue and need for rest are common; gradual improvement is expected.
Pain management strategies and support from healthcare providers are crucial to ensuring comfort throughout the recovery process. Frequent assessments and patient education on activities and signs of complications will help smooth the recovery period.