Endovascular repair of iliac artery at the time of aorto-iliac artery endograft placement by deployment of an iliac branched endograft including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all asso
CPT4 code
Name of the Procedure:
Endovascular Repair of Iliac Artery at the Time of Aorto-Iliac Artery Endograft Placement by Deployment of an Iliac Branched Endograft
Summary
This procedure involves using a specialized endograft to repair the iliac artery during the placement of a larger endograft in the aorto-iliac arteries. It includes detailed preparation, precise device sizing, and selective catheterization of the iliac artery to ensure proper deployment.
Purpose
Medical Condition: This procedure addresses issues such as aneurysms, severe arterial blockages, or structural weaknesses in the iliac and aorto-iliac arteries. Goals: The primary goal is to restore proper blood flow and prevent complications like aneurysm rupture or severe ischemia.
Indications
- Presence of an iliac or aorto-iliac aneurysm.
- Significant arterial blockages or occlusions.
- Structural weaknesses in the iliac artery.
- Patients with complex vascular anatomy requiring specialized endografts.
Preparation
- Fasting: Patients may need to fast for 6-8 hours before the procedure.
- Medications: Some medications may need to be adjusted or paused.
- Diagnostics: Pre-procedure imaging tests such as a CT scan or MRI to assess artery size and structure.
Procedure Description
- Anesthesia: The patient receives local or general anesthesia.
- Access: The vascular surgeon gains entry through a small incision in the groin.
- Catheterization: Using fluoroscopic guidance, the surgeon selectively catheterizes the iliac artery.
- Sizing & Device Selection: Precise measurements are taken to choose the correct size of the iliac branched endograft.
- Placement: The endograft is carefully deployed within the iliac artery.
- Endograft Deployment: Simultaneously, the aorto-iliac endograft is placed and secured.
- Verification: Imaging technologies ensure the grafts are properly positioned and functioning.
Duration
The procedure typically takes about 2-4 hours.
Setting
Performed in a hospital's specialized vascular surgery suite or interventional radiology room.
Personnel
- Vascular surgeon or interventional radiologist
- Surgical nurses
- Anesthesiologist
- Radiologic technologist
Risks and Complications
- Common Risks: Bruising, infection at the incision site, allergic reactions to contrast dye.
- Rare Risks: Endograft migration, arterial rupture, kidney damage from contrast dye.
- Management: Immediate intervention if complications arise, close post-op monitoring.
Benefits
- Expected Benefits: Restoration of normal blood flow, reduced risk of aneurysm rupture, and stabilization of arterial walls.
- Timeline: Benefits are typically immediate, though full recovery may take several weeks.
Recovery
- Post-Procedure Care: Monitoring in the recovery area for several hours.
- Instructions: Avoiding strenuous activities, routine follow-up appointments, and taking prescribed medications.
- Recovery Time: Most patients recover within 2-4 weeks.
Alternatives
- Surgical Repair: Open surgical repair may be an option, though it carries a longer recovery time.
- Lifestyle Changes & Medications: In less severe cases, lifestyle changes or medications may be adequate.
- Comparison: Endovascular repair is less invasive with a quicker recovery compared to open surgery.
Patient Experience
- During the Procedure: Patients may feel pressure or discomfort, but pain is generally managed with anesthesia.
- After the Procedure: Some groin discomfort and mild pain may occur, usually managed with pain relief medications.
- Comfort: Patients are closely monitored to ensure comfort and proper healing.