35092 Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving visceral vessels (mesenteric, celiac, renal)

Name of the Procedure:

Direct Repair of Aneurysm, Pseudoaneurysm, or Excision (Partial or Total) and Graft Insertion, with or without Patch Graft; for Ruptured Aneurysm, Abdominal Aorta Involving Visceral Vessels (Mesenteric, Celiac, Renal).

Summary

This procedure involves repairing or removing a rupture in the abdominal aorta and inserting a graft. It addresses issues in the blood vessels supplying the intestines, liver, stomach, and kidneys.

Purpose

This operation is performed to fix a ruptured aneurysm in the abdominal aorta to prevent life-threatening internal bleeding. The goals are to restore normal blood flow and prevent further damage to vital organs.

Indications

• Sudden, severe abdominal or back pain
• Symptoms of internal bleeding (e.g., dizziness, fainting, low blood pressure)
• Diagnosed ruptured aneurysm of the abdominal aorta
• Aneurysm involving the mesenteric, celiac, or renal vessels

Preparation

• Fasting for at least 8 hours before surgery
• Discontinuation or adjustment of certain medications (e.g., blood thinners)
• Preoperative imaging studies such as CT scans or ultrasounds
• Blood tests and cardiovascular assessment

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A large incision is made in the abdomen to access the aorta.
3. Aneurysm Control: The damaged section of the aorta is clamped to control bleeding.
4. Repair or Removal: The aneurysm or pseudoaneurysm is repaired or excised.
5. Graft Insertion: A synthetic graft or patch graft is inserted to replace or reinforce the blood vessel.
6. Closure: The incision is closed, and the patient is moved to recovery.

Duration

The procedure typically takes 3 to 6 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Vascular Surgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Kidney damage
• Respiratory complications
• Graft leakage or failure
• Heart attack

Benefits

• Stabilization of the aorta and prevention of further bleeding
• Restoration of normal blood flow
• Reduced risk of organ damage
• Improved survival rate

Recovery

• Hospital stay of 7 to 10 days
• Pain management with medications
• Gradual return to normal activities over 4 to 6 weeks
• Regular follow-up appointments for imaging and assessment

Alternatives

• Endovascular aneurysm repair (EVAR) - less invasive but not suitable for all patients
• Medication management (limited to unruptured aneurysms and used in conjunction with lifestyle changes)
• Regular monitoring and lifestyle changes for smaller, less risky aneurysms

Patient Experience

• The patient will be under general anesthesia during the operation and will not feel pain.
• Post-procedure, pain and discomfort will be managed with medications.
• There may be discomfort due to the abdominal incision, which will improve over time.
• Strict adherence to follow-up and restrictions to ensure proper healing and monitoring of the graft.