34846 Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modula

Name of the Procedure:

Endovascular Repair of Visceral Aorta and Infrarenal Abdominal Aorta with a Fenestrated Visceral Aortic Endograft (also known as F-EVAR).

Summary

Endovascular repair of the visceral and infrarenal abdominal aorta involves inserting a specially designed graft inside the damaged sections of the aorta using a minimally invasive approach. This procedure aims to reinforce the weak areas such as aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions, preventing rupture by using a fenestrated endograft tailored to accommodate branch vessels.

Purpose

The procedure addresses conditions like aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions of the aorta. The primary goal is to prevent fatal ruptures by reinforcing the damaged sections of the aorta and ensuring continuous blood flow to the vital organs located in the visceral area.

Indications

• Symptoms of aortic aneurysm such as abdominal or back pain
• Rapidly enlarging aortic aneurysms
• Symptomatic aortic dissection
• Patients with high surgical risk for open repair
• Presence of penetrating aortic ulcers
• Diagnosis of intramural hematomas or traumatic disruptions in the aorta

Preparation

• Fasting for 8 hours before the procedure.
• Pre-procedure imaging tests such as CT or MRI scans.
• Medication adjustments may include stopping blood thinners.
• Compliance with instructions regarding hydration and consumption of any preparatory medications.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the groin to access the femoral arteries.
3. A catheter is guided through the arteries to the diseased portion of the aorta.
4. The fenestrated endograft is carefully positioned to align with the branch arteries supplying the visceral organs.
5. The graft is deployed, expanding to conform to the aorta and anchoring in place.
6. The catheter is withdrawn, and the incision in the groin is closed.
7. Imaging guidance (like fluoroscopy) ensures accurate placement.

Duration

Typically, the procedure takes around 2 to 4 hours.

Setting

Performed in a hospital's vascular surgery or interventional radiology suite.

Personnel

• Vascular surgeon or interventional radiologist
• Anesthesiologist
• Surgical nurses
• Radiologic technologists

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma
• Graft migration or endoleak (leakage around the graft)
• Injury to adjacent organs or blood vessels
• Reaction to anesthesia
• Renal impairment, particularly in patients with existing kidney issues

Benefits

• Minimally invasive with quicker recovery time compared to open surgery.
• Reduced risk of aortic rupture.
• Preservation of blood flow to vital organs.
• Shorter hospital stay and quicker return to normal activities.

Recovery

• Post-procedure monitoring in a recovery unit.
• Pain management typically includes medications.
• Patients may go home within 1-3 days depending on their individual recovery.
• Restrictions on heavy lifting and strenuous activity for up to a month.
• Follow-up appointments including imaging to ensure graft stability and function.

Alternatives

• Open surgical repair (traditional approach but with a longer recovery).
• Medical management for small or asymptomatic aneurysms (involves regular monitoring).
• Each alternative comes with its own set of pros and cons based on invasiveness, risks, and recovery timelines.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Post-procedure, some discomfort or mild pain at the incision site is expected, managed by prescribed painkillers. Patients can expect to gradually return to normal activities with specific instructions and guidance provided by their healthcare team.