Name of the Procedure:

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

Summary

This procedure involves the placement of an additional extension prosthesis into a previously treated section of the aorta or iliac artery to address complications or ensure proper fitting of the initial device. It includes all pre-procedure sizing and device selection steps to ensure a tailored fit.

Purpose

The procedure is designed to manage and rectify issues such as aneurysms, false aneurysms, dissections, endoleaks, or migrations of an existing stent-graft. The goal is to prevent rupture, ensure blood flow stability, and improve overall patient outcomes.

Indications

• Persistent or recurrent aneurysm
• False aneurysm development
• Arterial dissection
• Endoleak (persistent blood flow outside the graft)
• Migration or displacement of the original endograft
• Patients who have previously undergone endovascular aneurysm repair (EVAR)

Preparation

• Patient must fast for 6-8 hours before the procedure.
• Adjustments in medication, particularly blood thinners, as instructed by the physician.
• Pre-procedure imaging tests such as CT angiography to assess the vascular anatomy and plan for device placement.

Procedure Description

1. Initial assessment and imaging to determine the appropriate size and position for the prosthesis.
2. Administration of local or general anesthesia, depending on the patient's condition.
3. Insertion of a catheter through a small incision in the groin area.
4. Navigation of the catheter to the target area using fluoroscopic guidance.
5. Placement of the extension prosthesis into the existing stent-graft.
6. Deployment and expansion of the prosthesis to ensure proper sealing and fixation.
7. Final imaging to confirm correct placement and functionality.

Duration

Usually takes 1 to 2 hours, but can vary based on complexity.

Setting

Typically performed in a hospital's endovascular suite or an interventional radiology lab.

Personnel

• Vascular surgeon or interventional radiologist
• Nurses specializing in vascular procedures
• Anesthesiologist or nurse anesthetist
• Radiologic technologist

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Injury to blood vessels
• Prosthesis misplacement or migration
• Endoleak persistence or new development
• Kidney problems due to contrast dye
• Leg pain or numbness

Benefits

• Stabilizes and securely seals the aneurysm or dissection
• Prevents potential rupture and associated complications
• Potentially extends the longevity of the original graft
• Improved blood flow through the arteries
• Symptom relief and enhanced quality of life

Recovery

• Monitoring in a recovery area for a few hours post-procedure.
• Overnight hospital stay may be required.
• Gradual return to normal activities within a week.
• Follow-up appointments for imaging studies to confirm graft stability.

Alternatives

• Open surgical repair, which involves a larger incision and longer recovery.
• Conservative management with regular monitoring, though carries a risk of rupture.
• Medications to control underlying conditions, though they may not address mechanical issues.

Patient Experience

Patients typically experience mild discomfort at the incision site and local bruising. Pain management is provided as needed. Most patients can resume light activities within a few days and full activities in about a week. Long-term follow-up is crucial to monitor the success of the procedure.