35131 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, iliac artery (common, hypogastric, external)

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, Iliac Artery (Common, Hypogastric, External)

Summary

This surgical procedure involves fixing a balloon-like bulge (aneurysm) or a false aneurysm (pseudoaneurysm) in the iliac artery. The procedure may include removal of part or all of the damaged artery, followed by the insertion of a graft to restore normal blood flow. It can address issues in the iliac artery, which is located in the pelvis and supplies blood to the lower limbs.

Purpose

The procedure is designed to correct or prevent the complications associated with aneurysms or pseudoaneurysms in the iliac artery, such as rupture or severe narrowing, which can lead to life-threatening bleeding or impaired blood flow to the legs.

Indications

• Diagnosis of an iliac artery aneurysm or pseudoaneurysm
• Symptoms of iliac artery occlusive disease, such as leg pain, claudication, or risk of embolism
• Imaging studies showing significant enlargement or risk of rupture
• Patients for whom conservative treatments have failed or are inappropriate

Preparation

• Fasting for at least 8 hours prior to surgery
• Adjustment or cessation of certain medications, particularly blood thinners
• Preoperative imaging studies (e.g., CT angiography, MRI)
• General health assessment and blood tests
• Anesthesia consultation

Procedure Description

1. Anesthesia: General anesthesia is commonly used.
2. Incision: A surgical incision is made to access the iliac artery.
3. Isolation: The affected artery is isolated.
4. Correction: The aneurysm or pseudoaneurysm is either repaired or excised.
5. Graft insertion: A synthetic or autologous graft is inserted to replace or reinforce the artery. A patch graft may also be used.
6. Closure: The incision is closed with sutures.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity of the condition.

Setting

Generally performed in a hospital-based operating room.

Personnel

• Vascular surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Bleeding
• Infection
• Graft failure or leakage
• Blood clot formation (thrombosis)
• Damage to surrounding tissues or organs
• Long-term complications such as graft stenosis or aneurysm recurrence

Benefits

• Stabilization and normalization of arterial blood flow
• Prevention of aneurysm rupture or embolic events
• Improved symptoms such as reduced leg pain and claudication
• Overall enhancement in quality of life

Recovery

• Hospital stay of 3-7 days
• Pain management with prescribed medications
• Instructions on wound care and activity restrictions
• Follow-up appointments for monitoring graft function and healing
• Gradual return to normal activities within a few weeks to months

Alternatives

• Endovascular aneurysm repair (EVAR)
• Conservative management with medication and monitoring
• Open bypass surgery for extensive occlusive disease
• Pros and cons: EVAR is less invasive but may not be suitable for all patients; open bypass is more invasive but can address extensive disease.

Patient Experience

• Use of general anesthesia ensures the patient is asleep and pain-free during the procedure.
• Postoperative pain and discomfort managed with medications.
• Initial mobility may be limited; gradual recovery and return to daily activities are expected.
• Close monitoring and follow-up are essential for optimal outcomes.