34703 Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpreta

Name of the Procedure:

Endovascular Repair of Infrarenal Aorta and/or Iliac Artery(ies) by Deployment of an Aorto-Uni-Iliac Endograft

Summary

This minimally invasive procedure is performed to repair aneurysms or blockages in the lower part of the aorta, the large artery that runs from the heart through the abdomen, and/or the iliac arteries using a specialized endograft. The procedure involves inserting a graft through a small incision in the groin and guiding it into place using X-ray imaging.

Purpose

The procedure addresses conditions such as aneurysms (widening of the artery that can lead to rupture) or blockages (which can limit blood flow) in the infrarenal aorta and/or iliac arteries. The primary goal is to reinforce the artery walls and restore proper blood flow, reducing the risk of aneurysm rupture or ischemia.

Indications

• Abdominal aortic aneurysm (AAA) below the kidneys.
• Iliac artery aneurysm.
• Blockages or significant narrowing in these arteries.
• Patients who are not candidates for open surgical repair due to age, comorbidities, or other risk factors.

Preparation

• Patients may be required to fast for a certain period before the procedure.
• Specific medication adjustments may be necessary, such as stopping blood thinners.
• Imaging studies, like a CT scan or ultrasound, are performed for pre-procedure sizing and device selection.

Procedure Description

1. Anesthesia: The procedure is usually done under general or regional anesthesia.
2. Incision: A small incision is made in the groin.
3. Catheterization: A catheter is inserted and guided to the affected area using fluoroscopy (a type of X-ray).
4. Deployment: The endograft is delivered through the catheter and positioned across the aneurysm or blockage.
5. Attachment: The graft is expanded and anchors to the healthy parts of the artery.
6. Completion: All catheters are removed, and the incision is closed.

Duration

The procedure typically takes 2 to 4 hours.

Setting

The procedure is performed in a hospital, usually in a specialized operating room equipped with fluoroscopy imaging technology.

Personnel

• Vascular surgeon or interventional radiologist
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Endoleak (leakage around the graft)
• Graft migration or failure
• Damage to surrounding blood vessels
• Allergic reaction to contrast dye

Benefits

• Minimally invasive with smaller incisions and shorter recovery time compared to open surgery.
• Reduced risk of aneurysm rupture or artery blockage.
• Improved blood flow and reduced symptoms.
• Faster return to normal activities.

Recovery

• Hospital stay of 1 to 2 days typically.
• Monitor the incision site for signs of infection.
• Avoid heavy lifting or vigorous activities for a few weeks.
• Follow-up appointments for imaging studies to ensure the graft is working properly.

Alternatives

• Open surgical repair: More invasive with longer recovery but may be more suitable for certain patients.
• Medical management: Control risk factors like hypertension; less effective for large aneurysms or significant blockages.
• Watchful waiting: Regular imaging and monitoring; appropriate for small aneurysms or non-severe blockages.

Patient Experience

During the procedure, patients are under anesthesia and will not feel pain. Post-procedure, mild discomfort at the incision site is typical and can be managed with pain medication. Patients may experience some fatigue but generally return to normal activities within a few weeks.

Pain management involves prescribed pain relief and precautions to avoid excessive strain on the surgical site to ensure a smooth and effective recovery.