35122 Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, hepatic, celiac, renal, or mesenteric artery

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, hepatic, celiac, renal, or mesenteric artery.

Summary

This procedure involves repairing a ruptured aneurysm in a major abdominal artery (hepatic, celiac, renal, or mesenteric). It may include excising all or part of the aneurysm and replacing or patching the damaged artery with a graft.

Purpose

• Medical Condition: Ruptured aneurysm in the hepatic, celiac, renal, or mesenteric artery.
• Goals: To stop the bleeding, restore normal blood flow, and prevent further complications such as organ damage or death.

Indications

• Severe abdominal pain.
• Signs of internal bleeding (e.g., low blood pressure, rapid heart rate).
• Imaging studies revealing a ruptured aneurysm in the relevant artery.
• Patients without contraindications for surgery.

Preparation

• Pre-procedure Instructions: Fasting for several hours before the procedure, typically from midnight.
• Medication Adjustments: Instructions to stop certain medications like blood thinners.
• Assessments: Preoperative imaging studies (CT scan, MRI) and blood tests.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A surgical cut is made in the abdomen to access the affected artery.
3. Excision and Graft Insertion:
   • The aneurysm is isolated and partly or fully removed.
   • A synthetic graft is inserted in place of the damaged artery, or a patch graft is used to reinforce the arterial wall.
4. Closing Incision: The surgical site is closed with sutures or staples.
5. Monitoring: Post-operative monitoring in a recovery area.

• Tools/Technology: Scalpel, surgical clamps, synthetic graft materials, suturing equipment.

Duration

The procedure typically takes 3-6 hours, depending on complexity.

Setting

Performed in a hospital's surgical suite.

Personnel

• Surgeon: Vascular or general surgeon.
• Anesthesiologist: Manages anesthesia.
• Surgical Nurses and Technicians: Assist throughout the procedure.

Risks and Complications

• Common Risks: Infection, blood clots, and bleeding.
• Rare Complications: Graft failure, organ dysfunction, or stroke.
• Management: Close monitoring and prompt intervention for complications.

Benefits

• Expected Benefits: Immediate cessation of bleeding, restored blood flow, reduced risk of death, and improved long-term outcomes.
• Timeline: Lifesaving with immediate and long-term vascular health improvements.

Recovery

• Post-Procedure Care: Pain management, monitoring in an intensive care unit, and gradual reintroduction of fluid/food intake.
• Expected Recovery Time: 6-12 weeks, with possible restrictions on physical activities.
• Follow-Up: Regular appointments for imaging and assessment of graft function.

Alternatives

• Endovascular Aneurysm Repair (EVAR): Less invasive but not suitable for all aneurysm locations.
• Medical Management: Only for non-ruptured aneurysms or patients unfit for surgery.
• Pros and Cons: EVAR has a shorter recovery time but may not be as effective in all cases; medical management has limited efficacy for ruptured aneurysms.

Patient Experience

• During Procedure: Under general anesthesia; no awareness or discomfort.
• After Procedure: Pain and discomfort managed with medication, initial recovery in ICU, gradual improvement in mobility and normal activities.
• Pain Management: IV pain medications initially, transitioning to oral pain relievers as recovery progresses.