34804 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using unibody bifurcated prosthesis

Name of the Procedure:

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection using unibody bifurcated prosthesis

Summary

This procedure involves the placement of a specialized prosthesis inside the aorta to repair an aneurysm or dissection located below the renal arteries. A minimally invasive technique, it uses small incisions and image guidance to deploy the prosthesis, which reinforces the aortic wall and restores normal blood flow.

Purpose

This procedure is used to treat infrarenal abdominal aortic aneurysms or dissections, which are dangerous conditions where the aortic wall is weakened and bulges or tears. The goal is to prevent rupture, manage symptoms, and improve blood flow through the aorta.

Indications

• Patients with an infrarenal abdominal aortic aneurysm larger than 5.5 cm in diameter.
• Rapidly growing aneurysms.
• Symptomatic aneurysms or dissections (pain, tenderness, or signs of rupture).
• Patients at high risk for open surgical repair.

Preparation

• Fasting from midnight before the procedure.
• Adjusting or temporarily discontinuing certain medications as instructed by the doctor.
• Pre-procedure imaging tests (CT scan or ultrasound) to map the anatomy of the aorta and plan the procedure.

Procedure Description

1. The patient is anesthetized, either with general anesthesia or regional anesthesia.
2. Small incisions are made in the groin to access the femoral arteries.
3. A catheter is inserted through the incision and guided to the affected area of the aorta using X-ray imaging.
4. The unibody bifurcated prosthesis is deployed through the catheter and positioned in the aorta.
5. The prosthesis expands to fit the aorta, sealing the aneurysm or dissection.
6. The catheters are removed, and the incisions are closed.

Duration

The procedure typically takes 2 to 3 hours.

Setting

The procedure is performed in a hospital, usually in a specially equipped surgical or interventional radiology suite.

Personnel

• Vascular surgeon or interventional radiologist
• Anesthesiologist
• Surgical nurses and technicians
• Radiologic technologists

Risks and Complications

• Infection
• Bleeding
• Vascular injury
• Endoleak (persistent blood flow into the aneurysm sac)
• Prosthesis migration
• Kidney complications (especially if renal arteries are affected)
• Allergic reactions to contrast dye

Benefits

• Reduced risk of aneurysm rupture.
• Minimally invasive with shorter recovery times compared to open surgery.
• Improved blood flow and decreased symptoms.

Recovery

• Patients typically stay in the hospital for 1-2 days.
• Post-procedure imaging to ensure proper placement of the prosthesis.
• Avoid heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments to monitor the repair and check for endoleaks.

Alternatives

• Open surgical repair: Involves a large abdominal incision to directly repair the aneurysm. This has a longer recovery time but may be necessary for complex aneurysms.
• Medical management: Regular monitoring and control of risk factors (e.g., blood pressure), suitable for small or asymptomatic aneurysms.
• Pros and cons of alternatives: Open surgical repair is more invasive but can be more definitive. Medical management avoids surgery but carries the risk of aneurysm growth or rupture.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Afterward, they may experience some soreness at the incision sites and fatigue. Pain is typically manageable with prescribed medications. A quick return to normal activities is expected, with specific activity restrictions advised by the healthcare team.