34805 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-uniiliac or aorto-unifemoral prosthesis

Name of the Procedure:

Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm or Dissection using Aorto-Uniiliac or Aorto-Unifemoral Prosthesis

Common Name(s): EVAR, Endovascular Aortic Repair, Aorto-Uniiliac Stent-Graft, Aorto-Unifemoral Stent-Graft.

Summary

In layman's terms, this procedure involves using a catheter to insert a special tube (a stent-graft) into the abdominal aorta—the largest artery in the abdomen—to treat an aneurysm (a bulging, weak section) or a tear (dissection) in the artery. This stent-graft helps reinforce the artery wall and maintain blood flow.

Purpose

The procedure addresses abdominal aortic aneurysms or dissections, which can lead to life-threatening internal bleeding if they rupture. The primary goals are to prevent rupture, manage symptoms, and improve blood flow.

Indications

• Presence of an infrarenal abdominal aortic aneurysm larger than 5.5 cm
• Rapidly expanding aneurysm
• Symptomatic aneurysm causing pain or pressure
• Dissection of the abdominal aorta
• Patients typically selected for this procedure are not candidates for open surgical repair due to comorbidities or anatomical factors.

Preparation

• Patients may be asked to fast for several hours before the procedure.
• Medications, especially anticoagulants, might need adjustment.
• Pre-procedure assessments include blood tests, imaging studies like CT scans or ultrasounds, and cardiac evaluations.

Procedure Description

1. The patient is given regional or general anesthesia.
2. A small incision is made in the groin.
3. Using X-ray guidance, a catheter is inserted through the femoral artery and advanced to the aorta.
4. The stent-graft is positioned across the aneurysm or dissection site.
5. The stent-graft is expanded to fit within the aorta, securing it in place.
6. Blood flow is redirected through the stent-graft, reducing pressure on the weakened artery section.
7. The catheter is removed, and the incision is closed.

Tools/Equipment: Catheter, stent-graft, X-ray imaging technology.

Duration

The procedure typically takes 2 to 4 hours.

Setting

This procedure is performed in a hospital, specifically in an operating room or a specialized interventional radiology suite.

Personnel

• Vascular surgeons
• Interventional radiologist
• Anesthesiologist
• Surgical nurses
• Radiology technicians

Risks and Complications

Common Risks:

• Infection
• Blood vessel injury
• Bleeding at the incision site

Rare Risks:

• Endoleak (leakage around the graft)
• Renal failure
• Graft migration or blockage
• Need for additional interventions

Benefits

• Minimally invasive compared to open surgery
• Reduced recovery time
• Lower risk of complications
• Effective aneurysm or dissection management

Recovery

• Patients typically stay in the hospital for 1-3 days.
• Initial activity limitations, gradually easing back to normal activity within a week or two.
• Follow-up imaging tests to ensure the graft is functioning properly.
• Long-term lifestyle modifications and routine monitoring.

Alternatives

• Open surgical repair: Higher risk, longer recovery but may be more durable for some patients.
• Medical management: Monitoring aneurysm size and controlling blood pressure, used for smaller or less risky aneurysms.

Patient Experience

During the procedure, patients will be sedated or under anesthesia, feeling no pain. Post-procedure, there may be mild discomfort or groin bruising. Pain management includes medication as needed. Full recovery can take a few weeks, with most patients experiencing a significant improvement in symptoms once recovered.