34802 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis (1 docking limb)

Name of the Procedure:

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis (1 docking limb)

Summary

This minimally invasive procedure repairs a weakened or dissected portion of the abdominal aorta below the kidneys using a modular, bifurcated (branching) prosthesis, which includes one primary limb that "docks" with the other segments to form a stable graft.

Purpose

The procedure addresses abdominal aortic aneurysms or dissections to prevent rupture and subsequent life-threatening internal bleeding. The goal is to reinforce the damaged aorta and restore normal blood flow.

Indications

• Large or rapidly growing infrarenal abdominal aortic aneurysm
• Symptomatic aneurysm with pain or tenderness
• Risk factors that make open surgery too dangerous
• Evidence of aortic dissection

Preparation

• Fasting for 8 hours prior to the procedure
• Adjustments to medication, especially blood thinners
• Pre-procedure imaging tests, such as an abdominal ultrasound or CT scan

Procedure Description

1. Patient is administered local anesthesia with sedation or general anesthesia.
2. A small incision is made in the groin area.
3. A catheter is inserted through the femoral artery and guided to the site of the aneurysm.
4. Contrast dye is injected to visualize the arteries.
5. The modular bifurcated prosthesis is deployed from the catheter and positioned to span the aneurysm.
6. The docking limb connects to other graft segments to form a bifurcated Y-shaped structure, anchoring securely within the aorta.
7. The catheter is removed and incisions are closed.

Duration

Approximately 2-4 hours.

Setting

The procedure is usually performed in a hospital's specialized endovascular suite or operating room.

Personnel

• Interventional radiologist or vascular surgeon
• Surgical nurses
• Anesthesiologist
• Radiologic technologist

Risks and Complications

• Infection at the incision site
• Endoleak (persistent blood flow into the aneurysm sac)
• Graft migration or blockage
• Injury to surrounding blood vessels or organs
• In rare cases, paralysis or kidney failure

Benefits

• Minimally invasive approach reduces recovery time
• Lower risk compared to open surgery
• Reduced pain and blood loss
• Shorter hospital stay

Recovery

• Hospital stay of 1-2 days
• Gradual return to normal activities within 1-2 weeks
• Follow-up imaging tests to ensure proper graft placement
• Avoid heavy lifting for several weeks

Alternatives

• Open surgical repair (more invasive but may be necessary for certain patients)
• Medical management and surveillance (for small, asymptomatic aneurysms)
• Pros: Open surgery provides direct visualization and is suitable for complex aneurysms.
• Cons: Longer recovery time, higher risk of complications compared to endovascular repair.

Patient Experience

• During the procedure: patients might feel minimal discomfort due to anesthesia.
• Post-procedure: mild pain at the incision site, managed with painkillers.
• Follow-up: regular monitoring for graft health and potential complications.