34848 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 Fenestrated Visceral Aortic Endograft and Concomitant Unibody or Modular Grafts

• Common Name: Endovascular aortic repair (EVAR)
• Technical Terms: Fenestrated aortic endograft, visceral aorta repair

Summary

Endovascular aortic repair (EVAR) is a minimally invasive procedure to fix issues in the visceral aorta and the infrarenal abdominal aorta. This repair involves using a specialized stent graft to reinforce weak or damaged sections of the aorta, often addressing conditions such as aneurysms or dissections.

Purpose

This procedure is designed to treat dangerous conditions affecting the aorta:

• Conditions Addressed: Aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, and traumatic disruptions.
• Goals: Stabilize the aorta, prevent rupture or further damage, and restore normal blood flow.

Indications

Patients may need this procedure if they exhibit the following symptoms or conditions:

• An aortic aneurysm or other serious defects visible on imaging.
• Pain in the abdomen, back, or chest (associated with aortic problems).
• Evidence of aortic rupture or imminent rupture.
• Patients with specific anatomical features suitable for endovascular repair.

Preparation

Before the procedure, patients must follow these steps:

• Fasting: Usually required for 6-8 hours before the surgery.
• Medication Adjustments: Blood thinners and other medications may need to be paused.
• Diagnostic Tests: Imaging studies like CT scans are critical to map the aorta's condition.

Procedure Description

The procedure involves several steps:

1. Anesthesia: Generally carried out under general anesthesia.
2. Access Points: Small incisions are made, typically in the groin, to access the blood vessels.
3. Guidewire and Catheter: A guidewire and catheter are inserted through the blood vessels toward the aorta.
4. Deployment of Endograft: Using imaging guidance, the fenestrated endograft is placed at the affected area of the aorta.
5. Unibody or Modular Grafts: Additional stents (if needed) are deployed to support the repair.
6. Sealing and Check: The grafts are expanded to seal off the damaged area, and final imaging checks ensure proper placement.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

This procedure is most commonly performed in a hospital, specifically in a surgical suite equipped with advanced imaging technologies.

Personnel

Healthcare professionals involved in the procedure include:

• Vascular Surgeons or Interventional Radiologists
• Anesthesiologists
• Surgical Nurses
• Radiology Technicians

Risks and Complications

While generally safe, potential risks include:

• Infection
• Bleeding
• Graft migration or leakage
• Blood clots
• Kidney damage (due to contrast dye)

Benefits

Expected benefits include:

• Stabilization of the aorta
• Reduced risk of aortic rupture
• Minimally invasive nature results in shorter recovery times. Benefits are often realized within a few weeks post-procedure.

Recovery

Post-procedure care involves:

• Hospital Stay: Typically 1-3 days.
• Activity Restrictions: Limited physical activity for several weeks.
• Follow-up: Regular imaging and check-ups to ensure the graft remains in place and functioning correctly.

Alternatives

Other treatment options might include:

• Open surgical repair (more invasive with longer recovery time)
• Medical management (ongoing monitoring without surgery)
• Pros and Cons: Open surgery is more durable but has higher risk and longer recovery; medical management is lower risk but less definitive.

Patient Experience

Patients can expect:

• During Procedure: Unconsciousness due to general anesthesia, no pain during the procedure.
• Post-Procedure: Some soreness at the incision sites, possible grogginess from anesthesia.
• Pain Management: Pain medication will be provided as needed to ensure comfort during recovery.