Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, common femoral artery (profunda femoris, superficial femoral)
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 ruptured aneurysm, common femoral artery (profunda femoris, superficial femoral).
Summary
This procedure involves repairing or removing a part of an aneurysm or pseudoaneurysm (a bulge in a blood vessel) in the common femoral artery. A graft may also be inserted to replace the damaged section. It is typically performed to address a ruptured aneurysm which can cause serious bleeding and other complications.
Purpose
Medical condition or problem it addresses:
- Ruptured aneurysms or pseudoaneurysms in the common femoral artery.
Goals or expected outcomes:
- To repair the weakened or ruptured artery, halt internal bleeding, and restore normal blood flow.
Indications
Specific symptoms or conditions:
- Severe pain and swelling in the thigh or groin area.
- A palpable pulsatile mass along the artery.
- Signs of internal bleeding and shock.
Patient criteria:
- Presence of a ruptured aneurysm or pseudoaneurysm diagnosed through imaging studies.
- Failure of less invasive treatments to manage the aneurysm.
Preparation
Pre-procedure instructions:
- Fasting for a specified period before the procedure (typically 8-12 hours).
- Adjustments in medications as advised by the doctor, particularly blood thinners.
Diagnostic tests or assessments:
- Imaging tests such as ultrasound, CT scan, or MRI to visualize the aneurysm.
- Blood tests to assess overall health and readiness for surgery.
Procedure Description
Step-by-step explanation:
- The patient is placed under general anesthesia.
- An incision is made over the common femoral artery to expose the aneurysm.
- Clamps are applied to control blood flow.
- The aneurysm or pseudoaneurysm is repaired or excised.
- A graft, which may be synthetic or sourced from the patient's body, is inserted to replace the damaged part of the artery.
- In some cases, a patch graft is used to reinforce the artery.
- The incisions are closed, and blood flow is restored.
Tools and equipment:
- Vascular clamps, surgical instruments for dissection, graft materials.
Anesthesia:
- General anesthesia is typically used to ensure the patient is unconscious and pain-free during the procedure.
Duration
- The procedure generally takes between 2 to 4 hours, depending on the complexity of the aneurysm and the extent of the repair needed.
Setting
- This procedure is performed in a hospital surgical suite.
Personnel
- The surgical team typically includes a vascular surgeon, an anesthesiologist, surgical nurses, and possibly a surgical technologist.
Risks and Complications
Common risks:
- Infection at the incision site.
- Bleeding or hematoma formation.
- Blood clots.
Rare risks:
- Graft infection or rejection.
- Nerve damage.
- Long-term complications such as graft occlusion or stenosis.
Management of complications:
- Immediate medical intervention and additional treatments such as antibiotics or additional surgical procedures.
Benefits
Expected benefits:
- Immediate cessation of bleeding and stabilization of the patient.
- Restoration of normal blood flow to the affected limb.
Realization time:
- Benefits are typically immediate post-surgery, with significant improvement in symptoms as recovery progresses.
Recovery
Post-procedure care:
- Monitoring in the intensive care unit (ICU) initially.
- Pain management with prescribed medications.
- Instructions on wound care and signs of infection to watch for.
Expected recovery time:
- Full recovery can take several weeks to months, with follow-up appointments to monitor progress.
Restrictions and follow-up:
- Restricted physical activity, especially avoiding heavy lifting, until cleared by the surgeon.
- Regular follow-ups to ensure the graft is functioning properly.
Alternatives
Other treatment options:
- Endovascular repair using stents or coils.
- Conservative management with medications and lifestyle changes.
Pros and cons of alternatives:
- Endovascular repair: Less invasive, shorter recovery time, but may not be suitable for all aneurysm locations or sizes.
- Conservative management: Non-surgical, but may not adequately address large or ruptured aneurysms.
Patient Experience
During the procedure:
- The patient will be under general anesthesia and will not feel any discomfort during the surgery.
After the procedure:
- Post-operative pain managed with medications.
- Initial discomfort and limited mobility as healing progresses.
- Full recovery and return to normal activities may take time, with gradual improvement noted in follow-up visits.