34832 Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bifemoral prosthesis

Name of the Procedure:

Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bifemoral prosthesis. Commonly referred to as an open aortic aneurysm repair with aorto-bifemoral graft placement.

Summary

In this procedure, surgeons repair a damaged section of the aorta located below the renal arteries by opening the abdominal cavity. This is usually performed when an endovascular repair has failed. An aorto-bifemoral graft is used to replace the damaged aortic segment and restore proper blood flow.

Purpose

This procedure addresses conditions such as an infrarenal aortic aneurysm (a bulging or weakened area in the lower part of the aorta) or an aortic dissection (a tear in the aorta's inner layer). The primary goal is to prevent rupture and restore normal blood flow, ensuring the patient's safety and improving life expectancy.

Indications

• Presence of an infrarenal aortic aneurysm or dissection.
• Failure of previous endovascular repair.
• Associated arterial trauma requiring repair.
• Symptoms like severe abdominal or back pain, pulsating abdominal mass, or leg pain due to blood flow obstruction.

Preparation

• The patient may need to fast overnight before surgery.
• Medication adjustments, such as stopping blood thinners.
• Preoperative imaging studies like CT scan or MRI to assess the aorta.
• Blood tests and cardiac evaluation to ensure fitness for surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. A large incision is made in the abdomen to access the aorta.
3. Clamps are placed on the aorta to control blood flow.
4. The damaged section of the aorta is removed.
5. An aorto-bifemoral graft (a synthetic tube) is sewn in place to replace the damaged aorta and extend blood flow to both femoral arteries.
6. Any associated arterial trauma is repaired.
7. The clamps are removed to restore blood flow.
8. The incision is closed with sutures or staples.

Tools and equipment: Surgical clamps, synthetic graft material, suturing tools, surgical staples.

Duration

The procedure typically takes 4 to 6 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Vascular surgeons
• Anesthesiologists
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: Infection, bleeding, blood clots.
• Rare complications: Kidney failure, heart attack, graft infection or failure, lower limb ischemia.
• Complications are managed with medications, additional procedures, or supportive care.

Benefits

• Prevention of aortic rupture, which can be life-threatening.
• Restoration of normal blood flow to the lower body.
• Improved life expectancy and quality of life.

Recovery

• Hospital stay of 5 to 10 days.
• Pain management with medications.
• Gradual return to normal activities over 4 to 8 weeks.
• Follow-up appointments to monitor recovery and graft function.
• Potential restrictions on heavy lifting and strenuous activities for several months.

Alternatives

• Continued endovascular repair attempts, though less likely if prior failures occurred.
• Medical management with close monitoring, though risky for large aneurysms.
• Alternative surgical approaches, but with varying degrees of complexity and risk.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Postoperatively, the patient may experience significant pain at the incision site, managed with painkillers. Discomfort and fatigue are normal during the initial recovery period. Gradual improvement is expected as the patient recovers mobility and strength, with ongoing medical support and follow-up.