34710 Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all n

Name of the Procedure:

Delayed Placement of Distal or Proximal Extension Prosthesis for Endovascular Repair of Infrarenal Abdominal Aortic or Iliac Aneurysm, False Aneurysm, Dissection, Endoleak, or Endograft Migration

Summary

This procedure involves the delayed placement of a prosthetic extension to an existing endovascular graft. It is performed to address complications such as endoleaks or migrations after the initial endovascular repair of aneurysms or dissections in the infrarenal abdominal aorta or iliac arteries.

Purpose

The procedure aims to manage and correct issues related to previous endovascular repairs, such as insufficient sealing, device migration, or the development of further aneurysms or dissections. The primary goal is to ensure durable and effective treatment of the vascular condition, preventing rupture or further complications.

Indications

• Persistent or new endoleak post-initial repair
• Migration or displacement of an existing endograft
• Expansion of treated aneurysm or development of a new aneurysm nearby
• Vascular dissection requiring additional support
• Inadequate sealing of the original endograft

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustments or temporary cessation of certain medications (under physician guidance)
• Pre-procedure imaging tests such as CT angiography to assess the vascular anatomy and plan for the extension
• Blood tests to check kidney function and clotting status

Procedure Description

1. Pre-procedure imaging and measurements are taken to select the appropriate prosthesis size.
2. Under general anesthesia or regional sedation, a catheter is inserted through a small incision in the groin (femoral artery).
3. Using fluoroscopic guidance, the catheter is navigated to the site of the original endograft.
4. The prosthetic extension is deployed from the catheter to the target location.
5. The extension is carefully positioned and expanded to ensure a secure fit and proper sealing.
6. Final imaging is conducted to confirm the successful placement.

Duration

Approximately 2-4 hours, depending on the complexity of the case.

Setting

Typically performed in a hospital's vascular or interventional radiology suite.

Personnel

• Vascular surgeon or interventional radiologist
• Assisting surgical team (nurses, technicians)
• Anesthesiologist for sedation or anesthesia

Risks and Complications

• Bleeding or hematoma at the catheter insertion site
• Infection
• Damage to blood vessels
• Graft migration or endoleak
• Renal impairment from contrast dye
• Adverse reactions to anesthesia

Benefits

• Improved sealing and stability of the endograft
• Reduction or elimination of aneurysm expansion
• Prevention of vascular rupture
• Enhanced overall success of the initial endovascular repair

Recovery

• Monitoring in a recovery room for several hours post-procedure
• Possible overnight hospital stay for observation
• Pain management with prescribed medications
• Follow-up imaging to confirm success
• Gradual return to normal activities over a few days; avoiding heavy lifting or strenuous exercise for a few weeks

Alternatives

• Open surgical repair (more invasive with longer recovery)
• Continued monitoring without intervention (risk of aneurysm growth or rupture)

Patient Experience

During the procedure, the patient is typically under general anesthesia and will not feel any pain or discomfort. Post-procedure, mild discomfort or soreness at the catheter insertion site is common. Pain management strategies, including medications, will be provided. Full recovery from mild symptoms could take a few days, with a return to normal activities as advised by the healthcare team.