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, hepatic, celiac, renal, or mesenteric artery
CPT4 code
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 of Hepatic, Celiac, Renal, or Mesenteric Artery
Summary
This procedure involves the direct surgical repair of an aneurysm or pseudoaneurysm in major abdominal arteries, such as the hepatic, celiac, renal, or mesenteric arteries. It may include partial or total removal (excision) of the aneurysm and the insertion of a graft to maintain normal blood flow.
Purpose
The procedure addresses the medical condition of aneurysms or pseudoaneurysms in major arteries supplying blood to vital abdominal organs. The primary goal is to prevent rupture, improve blood flow, and alleviate symptoms related to arterial occlusion.
Indications
- Presence of an aneurysm or pseudoaneurysm in the hepatic, celiac, renal, or mesenteric artery.
- Symptoms such as abdominal pain, gastrointestinal issues, or hypertension related to the aneurysm.
- Imaging or diagnostic tests showing significant arterial occlusion or risk of rupture.
- Patients who meet criteria based on their overall health and stability for undergoing major surgery.
Preparation
- Patients may need to fast for a specified period before the procedure.
- Adjustments to current medications, including blood thinners, may be necessary.
- Pre-procedure assessments might include blood tests, imaging studies like CT scans or MRIs, and cardiovascular evaluations.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
- Incision: A surgical incision is made to access the affected artery.
- Aneurysm Repair: The aneurysm or pseudoaneurysm is carefully exposed. The surgeon may perform a direct repair by excising the aneurysm partially or totally, and then inserting a synthetic graft.
- Graft Insertion: The graft is sewn into place to replace the damaged section of the artery, ensuring proper blood flow.
- Closure: The incision is closed with sutures or staples, and the area is bandaged.
Duration
The procedure typically takes between 2 to 4 hours, depending on the complexity and location of the aneurysm.
Setting
The procedure is performed in a hospital operating room equipped for vascular surgeries.
Personnel
- Vascular Surgeon
- Anesthesiologist
- Surgical Nurses
- Surgical Technicians
Risks and Complications
- Common risks: Bleeding, infection, graft occlusion, or thrombosis.
- Rare risks: Damage to surrounding organs, renal failure, or complications from anesthesia.
- Management: Close post-operative monitoring and prompt intervention if complications arise.
Benefits
- Prevents aneurysm rupture and potential life-threatening hemorrhage.
- Restores normal blood flow, reducing symptoms and risk of organ damage.
- Patients typically see improvement in related symptoms soon after recovery.
Recovery
- Post-procedure care: Hospital stay of a few days for close monitoring.
- Instructions: Avoid heavy lifting and strenuous activity for several weeks.
- Follow-up appointments: Regular check-ups to monitor graft function and overall recovery.
- Full recovery typically occurs within 6 to 8 weeks, though individual experiences may vary.
Alternatives
- Endovascular aneurysm repair (EVAR) for select cases.
- Medication management for symptom control and blood pressure regulation.
- Regular monitoring with imaging studies for small or asymptomatic aneurysms.
- Each alternative has its own risks and benefits, and the choice depends on individual patient factors and the aneurysm's characteristics.
Patient Experience
- During the procedure: The patient will be under general anesthesia and unconscious.
- After the procedure: Initial pain and discomfort at the incision site managed with pain medications.
- Hospital stay: Patients might experience some post-operative fatigue and discomfort, gradually improving with time.
- Long-term: Regular follow-ups and imaging studies to ensure the graft remains functional and no new aneurysms develop.