35331 Thromboendarterectomy, including patch graft, if performed; abdominal aorta

Name of the Procedure:

Thromboendarterectomy, including patch graft, if performed; abdominal aorta
(Commonly referred to as Aortoiliac Endarterectomy, Aortic Endarterectomy)

Summary

Thromboendarterectomy is a surgical procedure to remove atherosclerotic plaque from the abdominal aorta and possibly patch the surgical site to maintain blood flow. The procedure may include placing a patch graft for better arterial flow and prevention of future blockages.

Purpose

Medical Condition: Atherosclerosis, blockage of the abdominal aorta.
Goals:

• Restore normal blood flow through the abdominal aorta.
• Alleviate symptoms such as pain or gastrointestinal distress.
• Reduce risk of future cardiovascular events.

Indications

• Patients with significant blockage in the abdominal aorta.
• Symptoms such as claudication (leg pain), ischemic rest pain, or ulcers.
• Severe cases of abdominal aneurysm or other vascular diseases.

Preparation

• Preoperative fasting, typically starting the night before.
• Medication adjustments, especially blood thinners.
• Diagnostic tests: CT scan, MRI, or angiography to visualize the blockage.
• Baseline blood tests and EKG.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A surgical incision is made in the abdomen to access the aorta.
3. Plaque Removal: The aorta is clamped and incised, and the atherosclerotic plaque is carefully removed.
4. Patch Graft: If necessary, a patch graft (often made from synthetic material or vein) is sewn onto the aorta to widen it.
5. Closure: The aorta and the abdominal incision are closed with sutures.

Tools Used: Scalpel, retractors, aortic clamps, synthetic or vein graft.

Duration

Typically spans 2 to 4 hours.

Setting

Performed in a hospital operating room.

Personnel

• Vascular Surgeon
• Surgical Assistants
• Anesthesiologist
• Operating Room Nurses

Risks and Complications

• Infection at the surgical site.
• Bleeding or blood clots.
• Injury to surrounding organs or tissues.
• Adverse reactions to anesthesia.
• Potential for re-narrowing of the aorta.

Benefits

• Improved blood flow in the abdominal and lower extremity arteries.
• Relief from symptoms such as pain and gastrointestinal issues.
• Reduced risk of major cardiovascular events, like aortic aneurysm rupture.

Recovery

• Hospital stay: About 5 to 7 days.
• Post-procedure care: Pain management, monitoring for complications, gradual return to normal diet.
• Restrictions: Avoid heavy lifting and strenuous exercise for several weeks.
• Follow-up: Regular check-ups and imaging to monitor the surgical site.

Alternatives

• Medication management to control atherosclerosis and symptoms.
• Less invasive procedures like balloon angioplasty and stenting.
• Lifestyle changes, including diet and exercise adjustments.

Pros and Cons:

• Medication and Lifestyle Changes: Less invasive, but may be less effective for severe blockages.
• Angioplasty/Stenting: Minimally invasive with quicker recovery, but may require repeat procedures.

Patient Experience

• During the procedure: Unconscious or regionally numbed; no pain experienced.
• Post-operative sensations: Some pain and discomfort around the incision site, managed with medication.
• Long-term: Gradual increase in activity and improvement in symptoms over weeks to months.