33889 Open subclavian to carotid artery transposition performed in conjunction with endovascular repair of descending thoracic aorta, by neck incision, unilateral

Name of the Procedure:

Open Subclavian to Carotid Artery Transposition in Conjunction with Endovascular Repair of Descending Thoracic Aorta (Unilateral Neck Incision)

Summary

This procedure involves surgically moving the subclavian artery and connecting it to the carotid artery, combined with repairing the descending thoracic aorta using endovascular techniques. It is performed through an incision in the neck on one side of the body.

Purpose

This combined surgical and endovascular procedure addresses conditions affecting the thoracic aorta and its branches. The goals are to improve blood flow, prevent complications like aneurysms, and enhance overall vascular health.

Indications

Indications for this procedure include:

• Thoracic aortic aneurysms
• Aortic dissection
• Complicated aortic pathologies Patients may be candidates based on factors such as the location and size of the aneurysm, symptoms, and overall health status.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Medication adjustments might be necessary, especially for blood thinners.
• Pre-procedure diagnostics could include CT scan, MRI, blood tests, and cardiac evaluations.

Procedure Description

1. Anesthesia is administered to ensure the patient is comfortable and pain-free.
2. A unilateral neck incision is made to access the subclavian and carotid arteries.
3. The subclavian artery is carefully detached and transposed to the carotid artery, ensuring proper blood flow alignment.
4. Through a separate access point, typically via the groin, an endovascular graft is placed in the descending thoracic aorta to repair or support the aortic structure.
5. The incisions are closed, and the patient is monitored in a recovery area.

Duration

The procedure usually takes between 3 to 5 hours, depending on complexity.

Setting

This procedure is performed in a hospital setting, specifically in an operating room equipped for both surgical and endovascular procedures.

Personnel

• Vascular surgeons
• Anesthesiologists
• Surgical nurses
• Radiologists or technicians (for endovascular imaging)

Risks and Complications

• Risks include bleeding, infection, and adverse reactions to anesthesia.
• Potential complications: nerve damage, blood clots, stroke, graft failure, and issues related to the transposition.
• Management involves immediate medical intervention and possibly additional surgeries.

Benefits

Expected benefits include improved blood circulation, reduced risk of aortic rupture or dissection, and enhanced vascular stability. Benefits might be noticeable soon after surgery with ongoing improvements over weeks to months.

Recovery

• Patients may stay in the hospital for a few days.
• Post-procedure care includes pain management, monitoring for complications, and wound care.
• Recovery time varies but typically involves several weeks of restricted activity.
• Follow-up appointments are essential for monitoring vascular health and graft integrity.

Alternatives

• Medical management with medications
• Endovascular repair without artery transposition
• Open surgical repair of the thoracic aorta alone Each alternative has different risks and benefits; the choice depends on individual patient factors and severity of the condition.

Patient Experience

• During the procedure, the patient will be under general anesthesia and unaware of the surgery.
• Post-procedure, patients may experience discomfort at the incision site, temporary numbness, and limited mobility.
• Pain is managed with medications, and physical comfort measures are provided to support recovery.