34705 Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretat

Name of the Procedure:

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

Summary

Endovascular repair of the infrarenal aorta and/or iliac arteries is a minimally invasive procedure where a tube-like graft is inserted through the blood vessels to reinforce the artery wall and exclude aneurysms or aortic dissections.

Purpose

This procedure addresses conditions like abdominal aortic aneurysms and iliac artery aneurysms. The goal is to prevent the aneurysm from rupturing, which can be life-threatening, and to improve blood flow by reinforcing the artery walls.

Indications

• Presence of an abdominal aortic aneurysm
• Diagnosed iliac artery aneurysm
• Aneurysm size reaching a risky threshold
• Symptomatic aneurysm (e.g., pain, pressure)
• Patient unsuitable for open surgical repair due to comorbidities

Preparation

• Fasting for 8 hours before the procedure
• Adjustment of medications (e.g., blood thinners may need to be paused)
• Pre-procedure imaging tests such as CT angiography for sizing and device selection
• Blood tests to assess kidney function and clotting parameters

Procedure Description

1. The patient is given general or local anesthesia.
2. Small incisions are made in the groin area to access the femoral arteries.
3. A catheter is inserted through the incision and guided to the location of the aneurysm under radiological supervision.
4. The aorto-bi-iliac endograft is carefully deployed, covering the aneurysm and extending into the iliac arteries.
5. Confirmation of proper placement through radiological imaging.
6. The catheters are removed, and the incisions are closed.

Duration

The procedure typically takes about 2 to 4 hours.

Setting

This procedure is performed in a hospital catheterization lab or surgical suite equipped with radiological imaging technology.

Personnel

• Vascular Surgeon or Interventional Radiologist
• Surgical/Interventional Team (nurses, technologists)
• Anesthesiologist or Nurse Anesthetist

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma
• Endoleak (leak around the graft)
• Graft migration or kinking
• Damage to surrounding blood vessels
• Contrast-induced kidney injury
• Rarely, graft thrombosis or rupture

Benefits

• Lower risk compared to open surgical repair
• Shorter hospital stay and faster recovery
• Reduced anaesthesia risk
• Good long-term outcomes for aneurysm exclusion

Recovery

• Hospital stay of 1-2 days post-procedure
• Activity restrictions for 1-2 weeks (avoid heavy lifting)
• Follow-up imaging to ensure proper graft placement
• Regular monitoring for endoleaks or other complications

Alternatives

• Open surgical repair (more invasive but may be necessary if endovascular repair is not suitable).
  • Pros: Direct access, no graft migration.
  • Cons: Longer recovery time, higher risk of complications.
• Medical management (monitoring and medications).
  • Pros: Non-invasive, no surgical risks.
  • Cons: Increased risk over time if aneurysm grows or ruptures.

Patient Experience

During the procedure, sedation ensures no pain is felt. Post-procedure, patients may experience mild discomfort at the incision sites, which is managed with analgesics. Patients are encouraged to walk soon after to prevent blood clots but should avoid strenuous activities for a few weeks.