Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving iliac vessels (common, hypogastric, exter
CPT4 code
Name of the Procedure:
Direct Repair of Aneurysm or Pseudoaneurysm and Graft Insertion for Abdominal Aorta Involving Iliac Vessels
Common Name: Abdominal Aortic Aneurysm Repair
Technical Term: Open Abdominal Aortic Aneurysm (AAA) Repair
Summary
This surgical procedure involves repairing a weakened or bulging section of the aorta, the body's main artery. The surgeon may use a graft to reinforce the damaged area, ensuring blood flows smoothly through the vessel.
Purpose
This procedure addresses aneurysms or pseudoaneurysms in the abdominal aorta that involve the iliac vessels (which supply blood to the lower limbs and pelvic organs). The goal is to prevent the aneurysm from rupturing, which can be life-threatening, and to restore normal blood flow.
Indications
- Presence of an abdominal aortic aneurysm or pseudoaneurysm.
- Associated occlusive disease affecting blood flow.
- Patients with significant symptoms such as pain, or evidence of aneurysm growth on imaging studies.
- Criteria: Typically recommended for aneurysms larger than 5.5 cm or those showing rapid growth.
Preparation
- Fasting for 8-12 hours before the procedure.
- Adjustment or cessation of certain medications, particularly blood thinners.
- Pre-operative diagnostic tests like blood work, CT scans, or ultrasounds to map the aneurysm.
- Pre-surgical consultations and assessments.
Procedure Description
- The surgery begins with the patient under general anesthesia.
- An incision is made in the abdomen to access the aorta.
- The aneurysmal section of the aorta is clamped to stop blood flow.
- The aneurysm is opened and a synthetic graft is sewn into place to reinforce or replace the damaged vessel.
- The graft is often sewn to extend into the iliac vessels if they are involved.
- Once the graft is securely in place, the clamps are removed to restore blood flow.
- The incision is closed in layers, and the patient is moved to recovery.
Duration
Typically lasts 2 to 4 hours.
Setting
Performed in a hospital operating room.
Personnel
- Vascular surgeons
- Nurses
- Anesthesiologists
- Surgical technologists
Risks and Complications
- Common risks: Infection, bleeding, blood clots, respiratory issues.
- Rare risks: Graft failure, stroke, heart attack, kidney failure.
- Complications may require further interventions or extended hospital stay.
Benefits
- Prevents life-threatening rupture of the aneurysm.
- Restores normal blood flow.
- Immediate reduction in mortality risk post-repair.
Recovery
- Initial recovery in an intensive care unit (ICU) for close monitoring.
- Hospital stay of 5-10 days.
- Restrictions on strenuous activity for several weeks.
- Follow-up appointments for monitoring graft and recovery progress.
- Gradual resumption of normal activities over the following months.
Alternatives
- Endovascular aneurysm repair (EVAR): A minimally invasive option with faster recovery but not suitable for all aneurysms.
- Watchful waiting with regular imaging: Suitable for smaller, asymptomatic aneurysms.
- Pros and cons depend on aneurysm size, location, and patient health.
Patient Experience
- During: Patient will be unconscious under general anesthesia.
- After: Some post-operative pain managed with medication, soreness at the incision site, gradual mobilization.
- Pain management with prescribed analgesics and comfort measures during recovery.