34709 Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, penetrating ulcer, including pre-proced

Name of the Procedure:

Placement of Extension Prosthesis(es) for Endovascular Repair of Infrarenal Abdominal Aortic or Iliac Aneurysm, False Aneurysm, Dissection, Penetrating Ulcer

Summary

In this procedure, extension prostheses (small tubes) are placed inside blood vessels near the kidneys or common iliac arteries. This helps to repair issues like aneurysms or dissections in the abdominal aorta or iliac arteries, preventing potential life-threatening ruptures.

Purpose

This procedure addresses vascular problems such as infrarenal abdominal aortic aneurysms, iliac aneurysms, false aneurysms, arterial dissections, and penetrating ulcers. The primary goal is to strengthen the weakened area of the artery and restore proper blood flow, thereby preventing ruptures and other complications.

Indications

• Presence of an infrarenal abdominal aortic aneurysm
• Presence of iliac artery aneurysm
• False aneurysm
• Vascular dissection
• Penetrating ulcer
• Symptoms may include abdominal or back pain, pulsating feeling near the navel, or evidence from imaging studies indicating arterial weakness.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Adjustments to medications, especially blood thinners.
• Pre-procedural imaging tests like CT scans or MRIs to assess the condition of the arteries.
• Blood tests and electrocardiogram (ECG) may also be required.

Procedure Description

1. The patient receives local anesthesia with sedation, or general anesthesia.
2. A small incision is made in the groin or arm.
3. Using imaging guidance, a catheter is threaded through the arteries to the affected area.
4. The extension prosthesis is positioned and deployed in the diseased artery.
5. The insertion point is stitched and bandaged.

Duration

The procedure typically takes about 2 to 4 hours.

Setting

This procedure is usually performed in a hospital’s angiography suite or a specialized endovascular surgical center.

Personnel

• Vascular or endovascular surgeons
• Interventional radiologists
• Anesthesiologists
• Surgical nurses and technicians

Risks and Complications

• Infection at the incision site
• Allergic reactions to the contrast dye
• Blood vessel damage
• Endoleak (leakage around the prosthesis)
• Blood clots
• Kidney damage (rare) These risks are managed with antibiotics, careful monitoring, and prompt intervention if complications arise.

Benefits

• Reduced risk of aneurysm rupture or arterial dissection
• Less invasive than open surgery
• Shorter recovery period
• Immediate reinforcement of weakened artery segments

Recovery

• Most patients stay in the hospital for 1-2 days.
• Instructions include avoiding heavy lifting and strenuous activities.
• Follow-up appointments for imaging studies to ensure the prosthesis is functioning properly.
• Pain management with prescribed medications.

Alternatives

• Open surgical repair
• Medication management and lifestyle changes (in milder cases)
• Non-surgical imaging and monitoring Open surgical repair has a longer recovery time and higher risk of complications compared to endovascular repair.

Patient Experience

During the procedure, the patient may feel pressure when the catheter is inserted but should not feel pain due to anesthesia. Post-procedure, there may be some discomfort or bruising at the incision site, managed with pain relief medications. Most patients can return to normal activities within a few weeks.