33883 Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); initial extension

Name of the Procedure:

Placement of Proximal Extension Prosthesis for Endovascular Repair of Descending Thoracic Aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); Initial Extension

Summary

This procedure involves placing a synthetic tube (prosthesis) inside the upper part of the descending thoracic aorta via a minimally invasive method. It is primarily done to strengthen the weakened section of the aorta and restore normal blood flow.

Purpose

The procedure addresses conditions like aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions of the descending thoracic aorta. The goal is to prevent rupture or complications by reinforcing the aorta, thus ensuring safe and effective blood flow.

Indications

• Symptoms like chest or back pain stemming from aortic conditions.
• Diagnosed with aneurysm or pseudoaneurysm in the descending thoracic aorta.
• Aortic dissection.
• Penetrating aortic ulcers.
• Intramural hematoma.
• Traumatic disruption of the aorta.
• High-risk patients for open surgical repair.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjusting certain medications as per doctor's advice (especially blood thinners).
• Pre-procedure imaging tests like CT scans or MRIs.
• Blood tests and cardiovascular assessments.

Procedure Description

1. Pre-Anesthesia: Patient receives anesthesia to ensure comfort and pain management.
2. Access Site Prep: The groin area is cleaned and prepped for catheter insertion.
3. Catheter Insertion: A catheter is inserted into a blood vessel and guided to the aorta using fluoroscopic imaging.
4. Prosthesis Deployment: The prosthetic extension is carefully maneuvered and positioned in the affected area of the aorta.
5. Sealing: The prosthesis is deployed and expanded to fit the aortic walls securely.
6. Closure: The catheter is removed, and the incision site is closed and bandaged.

Tools: Catheter, guidewire, synthetic graft (prosthesis), imaging equipment (fluoroscopy).

Anesthesia: General or regional anesthesia is used.

Duration

Typically, the procedure takes about 2 to 4 hours.

Setting

The procedure is performed in a hospital, specifically in a catheterization lab or an operating room equipped for endovascular surgery.

Personnel

• Vascular Surgeon or Interventional Radiologist
• Anesthesiologist
• Nursing Staff
• Radiologic Technologist

Risks and Complications

• Infection at the insertion site.
• Bleeding or hematoma.
• Damage to blood vessels.
• Endoleaks (leakage around the graft).
• Graft migration.
• Renal impairment due to contrast dye.
• Rarely, paralysis due to spinal cord ischemia.

Benefits

• Reduced risk of aortic rupture.
• Less invasive than open surgery.
• Shorter recovery time.
• Improved survival rate for high-risk patients.

Recovery

• Initial post-op monitoring in a recovery room or ICU.
• Pain management with prescribed medications.
• Gradual reintroduction of normal activities over weeks.
• Follow-up imaging to check the graft and aortic condition.
• Avoid heavy lifting and strenuous activities for several weeks.

Alternatives

• Open surgical repair (more invasive with longer recovery).
• Medical management (less effective for large aneurysms or severe cases).
• Pros: Non-surgical options may have fewer immediate risks.
• Cons: May not provide a long-term solution for severe aortic conditions.

Patient Experience

During the Procedure:

• The patient will be under anesthesia and should not feel pain.
• Mild discomfort at the catheter insertion site may be experienced.

After the Procedure:

• Mild to moderate pain or discomfort at the incision site.
• Restricted movement and activity initially to ensure proper healing.
• Follow-up appointments essential for monitoring progress.
• Pain relief medications can manage discomfort effectively.