35111 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, splenic artery

Name of the Procedure:

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, Splenic Artery

Summary

This surgical procedure involves repairing or removing an aneurysm or pseudoaneurysm in the splenic artery and often involves inserting a graft to support the artery. The surgery may also address any occlusive (blocked) disease in the artery.

Purpose

The procedure is designed to:

• Remove or repair malfunctioning areas of the splenic artery.
• Prevent rupture of an aneurysm or pseudoaneurysm.
• Restore proper blood flow through the artery.
• Alleviate symptoms associated with the aneurysm (e.g., pain or nausea).

Indications

• Presence of a splenic artery aneurysm or pseudoaneurysm.
• Patients experiencing symptoms due to the aneurysm, such as abdominal pain.
• Evidence of occlusive disease that might obstruct blood flow through the splenic artery.
• Risk of rupture indicated by the size or growth rate of the aneurysm.

Preparation

• Pre-procedure consultation with a vascular surgeon.
• Fasting for a period specified by the doctor (usually from midnight on the night before the surgery).
• Medication adjustments as directed, including possibly stopping blood thinners.
• Diagnostic imaging (e.g., CT scan, MRI, or ultrasound) to assess the aneurysm or pseudoaneurysm.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A surgical incision is made in the abdomen to access the splenic artery.
3. Repair/Excision: The aneurysm or pseudoaneurysm is either repaired directly or excised partially or totally.
4. Graft Insertion: A graft, which may be a synthetic tube or a patch, is inserted to replace the damaged section of the artery or support the repair.
5. Occlusive Disease Management: Any occlusion in the artery is addressed to ensure proper blood flow.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes around 3 to 4 hours, but this can vary based on the complexity of the case.

Setting

The procedure is performed in a hospital’s surgical suite.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a surgical technician

Risks and Complications

• Infection at the incision site
• Bleeding complications
• Damage to surrounding organs or tissues
• Blood clots
• Graft failure or leakage
• Anesthesia-related risks

Benefits

• Reduced risk of aneurysm rupture
• Restoration of normal blood flow through the splenic artery
• Relief from associated symptoms
• Potential improvement in overall vascular health

Recovery

• Initial hospital stay of 3-5 days for monitoring.
• Pain management with prescribed medications.
• Gradual return to normal activities over 4-6 weeks.
• Follow-up appointments to monitor the success of the procedure and ensure proper healing.
• Possible lifestyle adjustments to improve vascular health.

Alternatives

• Endovascular repair: A minimally invasive option using catheters and stents.
• Medical management: Monitoring the aneurysm with imaging and managing risk factors with medication.
• Pros and cons: Endovascular repair usually involves a shorter recovery time but may not be suitable for all aneurysm types. Medical management avoids surgery but carries the risk of rupture over time.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-surgery, there may be discomfort or pain, managed with medications. Patients might feel fatigue and may need to limit physical activities while recovering. Regular follow-up care is critical to ensure a full recovery and monitor for any potential complications.