34834 Open brachial artery exposure for delivery of endovascular prosthesis, unilateral (List separately in addition to code for primary procedure)

Name of the Procedure:

Open brachial artery exposure for delivery of endovascular prosthesis, unilateral

Summary

This is a surgical procedure in which an incision is made to access the brachial artery in one arm to place an endovascular prosthesis (a type of graft or stent). This approach is often used in conjunction with other endovascular procedures.

Purpose

The procedure is used to treat vascular conditions, such as arterial blockages or aneurysms, by allowing the placement of a prosthesis within the blood vessel. The goal is to restore proper blood flow or to reinforce weakened sections of the artery.

Indications

• Peripheral artery disease (PAD) with significant blockage.
• Aneurysms in the brachial artery that risk rupture.
• Traumatic injuries to the brachial artery.
• Other conditions necessitating vascular grafting or stenting.

Preparation

• Fasting for at least 8 hours prior to the procedure.
• Discontinuation or adjustment of certain medications (e.g., blood thinners).
• Pre-procedure diagnostic tests such as blood work, imaging studies (e.g., Doppler ultrasound, CT angiography).
• Obtaining detailed medical history and physical examination.

Procedure Description

1. The patient is positioned, and the surgical site is sterilized.
2. General or regional anesthesia is administered.
3. An incision is made over the brachial artery, typically in the upper arm.
4. The artery is carefully dissected and exposed.
5. An endovascular prosthesis is guided and positioned within the artery with the aid of imaging techniques.
6. The prosthesis is deployed to treat the underlying condition.
7. The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and patient's condition.

Setting

This procedure is usually performed in a hospital operating room or specialized vascular surgery center.

Personnel

• Vascular Surgeon
• Anesthesiologist
• Surgical Nurses
• Radiologic Technicians (for imaging support)

Risks and Complications

• Bleeding at the incision site.
• Infection.
• Injury to surrounding tissues or nerves.
• Blood clots.
• Reaction to anesthesia.
• Prosthesis failure or migration.

Benefits

• Improved blood flow to the affected limb.
• Reduced risk of aneurysm rupture.
• Relief from symptoms such as pain and numbness.
• Prevention of further vascular complications.

Recovery

• Hospital stay of 1-2 days for monitoring.
• Follow-up appointments to assess healing and prosthesis function.
• Limitations on arm movement and heavy lifting for a few weeks.
• Pain management with medications.
• Gradual return to normal activities as recommended by the healthcare provider.

Alternatives

• Medication management (antiplatelets, statins).
• Minimally invasive endovascular procedures without open exposure.
• Lifestyle modifications (diet, exercise).
• Observation and regular monitoring for asymptomatic cases.
• Surgical bypass of the affected artery.

Patient Experience

During the procedure under anesthesia, the patient will not feel pain. Post-procedure, the patient may experience some discomfort or pain around the incision, manageable with prescribed pain medications. They might also feel tired or weak for a few days but will gradually regain strength. Careful adherence to post-operative care instructions ensures optimal recovery.