34839 Physician planning of a patient-specific fenestrated visceral aortic endograft requiring a minimum of 90 minutes of physician time

Name of the Procedure:

Physician Planning of a Patient-Specific Fenestrated Visceral Aortic Endograft
Common Name: Fenestrated endograft planning
Technical/Mediacl Term: Endovascular aneurysm repair (EVAR) planning

Summary

The physician planning of a patient-specific fenestrated visceral aortic endograft involves developing a customized treatment plan that uses a stent-graft to reinforce the walls of a weakened abdominal aorta. The procedure requires detailed planning to ensure the endograft fits the patient's unique vascular anatomy, a process that typically takes at least 90 minutes.

Purpose

This procedure aims to address abdominal aortic aneurysms (AAA), a condition where a section of the aorta becomes weakened and bulges outward. By reinforcing the aortic wall with a customized endograft, the procedure helps prevent the aneurysm from rupturing, which can lead to severe internal bleeding and potentially fatal outcomes.

Indications

• Presence of an abdominal aortic aneurysm (AAA)
• Patients with complex aortic anatomy involving visceral arteries
• High risk for open surgical repair
• Symptoms such as abdominal pain, back pain, or a pulsating sensation near the navel

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustments to current medications, particularly blood thinners
• Pre-procedure imaging studies such as a CT scan or MRI to map the aortic anatomy
• Blood tests to check kidney function and blood clotting

Procedure Description

1. Comprehensive review of the patient's vascular anatomy using imaging studies.
2. Detailed measurements taken from CT or MRI scans.
3. Digital planning using specialized software to design an endograft that matches the patient’s anatomy.
4. Custom endograft is ordered from a specialized manufacturer.
5. Collaborative discussions between the physician, radiologists, and endograft manufacturer.
6. Finalizing the plan and rapid prototyping to ensure the perfect fit.

Duration

The planning procedure typically takes at least 90 minutes to complete.

Setting

The procedure is carried out in a hospital or a specialized vascular surgery center.

Personnel

• Vascular surgeons
• Interventional radiologists
• Technicians specializing in imaging and digital modeling
• Clinical coordinators

Risks and Complications

• Human error in measurement or planning, though rare
• Potential for initial discomfort due to holding certain positions during imaging
• Delays due to complexity of individual anatomy
• Rarely, need for revision of the endograft design

Benefits

• A customized endograft tailored specifically for the patient’s anatomy
• Reduced risk of aneurysm rupture compared to traditional open surgery
• Minimally invasive procedure leading to quicker recovery

Recovery

• Usually no specific recovery required from the planning phase.
• Post-CT or MRI care includes hydrating to help flush out contrast dye.
• Scheduled follow-up to review the final plan.

Alternatives

• Open aortic surgery
  • Pros: Directly visualizes aneurysm repair
  • Cons: Longer recovery, higher risk of complications
• Standard endovascular aneurysm repair (without customization)
  • Pros: Less planning time, readily available
  • Cons: May not fit complex anatomies as well

Patient Experience

During imaging, the patient may feel discomfort from holding still. Post-imaging, there might be mild discomfort from the injection of the contrast dye. Once the plan is in place, patients typically feel reassured knowing a personalized and precise approach is being taken to manage their condition.