34717 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

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

1. Anesthesia: The patient receives local or general anesthesia.
2. Access: The vascular surgeon gains entry through a small incision in the groin.
3. Catheterization: Using fluoroscopic guidance, the surgeon selectively catheterizes the iliac artery.
4. Sizing & Device Selection: Precise measurements are taken to choose the correct size of the iliac branched endograft.
5. Placement: The endograft is carefully deployed within the iliac artery.
6. Endograft Deployment: Simultaneously, the aorto-iliac endograft is placed and secured.
7. 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.