35216 Repair blood vessel, direct; intrathoracic, without bypass

Name of the Procedure:

Repair of Blood Vessel, Direct; Intrathoracic, Without Bypass

Summary

This procedure involves the direct repair of a blood vessel located within the chest cavity (thorax) without the use of a bypass. It typically addresses damage or abnormalities in major thoracic blood vessels.

Purpose

The procedure is performed to repair damage to large blood vessels within the chest that may be caused by trauma, aneurysms, or other vascular conditions. The primary goal is to restore normal blood flow and prevent life-threatening complications such as hemorrhage.

Indications

• Trauma to chest blood vessels resulting in bleeding or compromised blood flow
• Aneurysms or other vascular abnormalities in thoracic vessels
• Congenital vascular defects within the chest
• Patients with signs of vascular occlusion or stenosis causing symptoms like chest pain, respiratory distress, or signs of poor blood circulation

Preparation

• Patients may need to fast for at least 6-8 hours prior to surgery.
• Adjustment or discontinuation of certain medications, especially blood thinners.
• Pre-procedure diagnostic tests such as chest X-rays, CT scans, MRIs, and angiograms.
• Blood tests to evaluate blood clotting and overall health.

Procedure Description

1. The patient is placed under general anesthesia to ensure they are unconscious and pain-free.
2. A thoracotomy (incision into the chest wall) is performed to access the blood vessels.
3. The damaged vessel is carefully isolated and clamped to control bleeding.
4. The surgeon repairs the vessel directly, often using sutures or grafts.
5. Once the repair is complete, clamps are removed to restore blood flow.
6. The chest incision is closed using sutures or staples, and a drainage tube may be placed to remove excess fluid.

Duration

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

Setting

The procedure is performed in a hospital operating room equipped for thoracic surgery.

Personnel

• Thoracic or cardiovascular surgeon
• Anesthesiologist
• Surgical nurses and assistants
• Perfusionist (if intra-operative backup is needed)

Risks and Complications

• Infection at the incision site
• Bleeding or blood loss requiring transfusion
• Blood clots or embolism
• Damage to surrounding organs or structures
• Respiratory complications due to anesthesia or collapsed lung
• Risk of recurrent vascular issues

Benefits

• Restoration of normal blood flow
• Prevention of life-threatening complications like hemorrhage
• Relief of symptoms such as chest pain and respiratory distress
• Improved overall cardiovascular health

Recovery

• Hospital stay of 5-7 days is common for monitoring and recovery.
• Pain management with prescribed medications.
• Gradual return to normal activities, avoiding heavy lifting for 4-6 weeks.
• Follow-up appointments for imaging to assess the repair and ensure proper healing.
• Education on lifestyle modifications to improve cardiovascular health.

Alternatives

• Endovascular repair: less invasive but may not be suitable for all patients or vessel locations.
• Medical management: in cases where surgery poses high risk and can be managed with medications.
• Observation: monitoring condition without immediate intervention in cases with low-risk aneurysms.

Patient Experience

• Patients will be unconscious during the procedure due to general anesthesia.
• Post-procedure, patients may experience soreness, pain at the incision site, and fatigue.
• Pain management will be provided through medications.
• Patients may have a chest drainage tube temporarily post-surgery.
• Gradual improvement in symptoms as recovery progresses with proper care and follow-up.