34843 Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and inte

Name of the Procedure:

Endovascular Repair of Visceral Aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, traumatic disruption) by Deployment of a Fenestrated Visceral Aortic Endograft

Summary

Endovascular repair of the visceral aorta is a minimally invasive procedure used to treat various conditions, such as aneurysms, dissections, and ulcers, affecting the aorta—the large artery that supplies blood to the abdomen, pelvis, and legs. The procedure involves placing a fenestrated endograft within the aorta to reinforce the weakened area and restore normal blood flow.

Purpose

Medical Conditions:

• Aneurysms
• Pseudoaneurysms
• Aortic dissections
• Penetrating ulcers
• Intramural hematomas
• Traumatic disruptions

Goals:

• Prevent rupture of the aorta
• Stabilize the blood vessel wall
• Ensure uninterrupted blood flow to vital organs

Indications

• Significant aortic diameter enlargement
• Symptoms such as severe abdominal or back pain
• High risk of aortic rupture
• Unsuitability for open surgical repair due to medical conditions

Preparation

• Fasting for a specified period before the procedure
• Adjustment or temporary discontinuation of certain medications
• Pre-procedure imaging tests (CT scan, MRI) to assess the aorta’s condition
• Blood tests to evaluate overall health

Procedure Description

1. Anesthesia/Sedation: Administered to keep the patient comfortable, generally under general anesthesia.
2. Access: A small incision is made in the groin to access the femoral artery.
3. Catheter Insertion: A catheter (thin tube) is threaded through the artery to the affected area of the aorta.
4. Endograft Deployment: A fenestrated endograft (customized stent) is positioned at the site, ensuring proper alignment with branch arteries.
5. Imaging Guidance: Continuous radiological supervision helps guide the endograft into place.
6. Final Adjustments: The endograft is expanded to fit securely against the aortic wall, reinforcing the vessel.
7. Closure: The catheter is removed, and the incision is closed.

Duration

Typically takes 2 to 4 hours, depending on the complexity of the case.

Setting

Usually performed in a hospital’s vascular surgery suite or interventional radiology department.

Personnel

• Vascular surgeons
• Interventional radiologists
• Anesthesiologists
• Surgical nurses
• Radiologic technologists

Risks and Complications

• Infection
• Bleeding or hematoma at the incision site
• Endoleaks (persistent blood flow outside the graft)
• Blood vessel damage
• Kidney injury from contrast dye
• Stroke
• Temporary or permanent paralysis (rare)
• Graft migration or failure

Benefits

• Reduced risk of aortic rupture
• Minimally invasive with less recovery time compared to open surgery
• Decreased pain and scarring
• Improved survival rates for high-risk patients

Recovery

• Hospital stay of 1-2 days typically required
• Post-procedure imaging tests to ensure graft placement
• Avoid heavy lifting or strenuous activities for several weeks
• Follow-up appointments for monitoring aortic health

Alternatives

• Open surgical repair: More invasive with longer recovery time
• Medical management: Riskier for large or symptomatic aneurysms
• Watchful waiting: Suitable for small, asymptomatic aneurysms with regular monitoring

Patient Experience

• Mild discomfort during recovery
• Managing pain with prescribed medications
• Potential temporary limitations on physical activity
• Regular follow-up visits to monitor implant status and aortic health