34826 Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, or dissection; each additional vessel (List separately in addition to code for primary procedure)

Name of the Procedure:

Placement of Proximal or Distal Extension Prosthesis for Endovascular Repair of Infrarenal Abdominal Aortic or Iliac Aneurysm, False Aneurysm, or Dissection; Each Additional Vessel.

Summary

This procedure involves placing an additional extension to an endovascular graft already in place to treat aneurysms or dissections in the abdominal aorta or iliac arteries. It is typically indicated when there's a need to extend coverage to more vessels beyond the initial treatment area.

Purpose

The main purpose of this procedure is to effectively manage and treat conditions like infrarenal abdominal aortic or iliac aneurysms, false aneurysms, or arterial dissections. By securing the aneurysmal vessel walls, the procedure aims to prevent rupture, improve blood flow, and reduce symptoms.

Indications

• Patients with expanding aneurysms or dissections
• Evidence of false aneurysms
• Ongoing vascular complications despite initial endovascular repair

Preparation

• Fasting for several hours prior to the procedure
• Adjustments in medication as advised by the healthcare provider
• Pre-operative imaging studies (e.g., CT scans, ultrasound) to assess vascular structure
• Blood tests to evaluate overall health and clotting function

Procedure Description

1. The patient is anesthetized.
2. Access is gained through the femoral artery with a catheter.
3. Using imaging guidance, the prosthesis (graft extension) is navigated to the target area.
4. The prosthesis is deployed and secured to extend the coverage of the previous graft.
5. The placement is checked using imaging to ensure proper positioning and functionality.
6. The catheter is removed, and the entry site is closed.

Duration

Typically, the procedure takes 1-3 hours, depending on the complexity and number of vessels involved.

Setting

The procedure is usually performed in a hospital’s angiography suite or an operating room equipped with imaging technology.

Personnel

• Vascular surgeon or interventional radiologist
• Nursing staff
• Anesthesiologist
• Radiology technicians

Risks and Complications

• Infection at the entry site
• Bleeding or hematoma formation
• Graft migration or leak
• Vascular injury
• Adverse reactions to anesthesia

Benefits

• Effective management and repair of aneurysms and dissections
• Reduced risk of aneurysm rupture
• Improved vascular function
• Faster recovery compared to open surgery

Recovery

• Monitoring in a recovery area immediately post-procedure
• Pain management with prescribed medications
• Gradual return to normal activities within a few days
• Follow-up imaging to ensure the integrity of the repair

Alternatives

• Open surgical repair of the aneurysm
• Continued monitoring without intervention (watchful waiting)
• Other minimally invasive procedures like percutaneous thrombectomy

Patient Experience

Patients can expect some discomfort at the puncture site and mild grogginess from anesthesia. Pain is generally well-managed with medications, and most patients can resume normal activities within a week, with follow-up visits for imaging to monitor the success of the procedure.