Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation
CPT4 code
Name of the Procedure:
Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm or Dissection, Radiological Supervision and Interpretation
Summary
Endovascular repair is a minimally invasive procedure to fix an aneurysm or tear in the lower part of the aorta, the large blood vessel that runs from your heart through your chest and abdomen. The procedure uses imaging guidance to place a stent-graft inside the affected section of the aorta, providing support and preventing rupture.
Purpose
This procedure is used to treat infrarenal abdominal aortic aneurysms or dissections, which are dangerous conditions where the wall of the aorta weakens or tears. The primary goal is to reinforce the aortic wall, prevent rupture, and improve blood flow.
Indications
- Presence of an infrarenal abdominal aortic aneurysm larger than 5.5 cm.
- Rapid expansion of the aneurysm.
- Aortic dissection resulting in compromised blood flow.
- Symptoms such as abdominal or back pain, pulsating feeling near the navel, or evidence of rupture.
Preparation
- Fasting for at least 6-8 hours before the procedure.
- Stop certain medications like blood thinners as directed by your doctor.
- Pre-procedure tests may include blood tests, imaging studies like CT scan or MRI, and cardiovascular assessments.
Procedure Description
- The patient is sedated or under general anesthesia.
- A small incision is made in the groin to access the femoral artery.
- Using fluoroscopic guidance, a catheter is inserted into the artery and directed to the affected section of the aorta.
- A stent-graft is deployed through the catheter and expanded at the site of the aneurysm or dissection.
- The stent-graft anchors to the healthy portions of the aorta to provide a new path for blood flow.
- The catheter is withdrawn, and the incision is closed.
Duration
The procedure typically takes 2 to 3 hours.
Setting
It is usually performed in a hospital surgical suite or specialized endovascular suite.
Personnel
- Vascular surgeons
- Interventional radiologists
- Anesthesiologists
- Surgical nurses
- Radiologic technologists
Risks and Complications
- Bleeding or infection at the incision site.
- Blood vessel injury or tear.
- Graft leakage or migration.
- Kidney damage due to the contrast dye.
- Allergic reaction to anesthesia or contrast material.
Benefits
- Minimally invasive with smaller incisions and quicker recovery.
- Reduced risk of aorta rupture.
- Improved blood flow and reduced symptoms.
- Most patients can anticipate significant improvement within a few weeks.
Recovery
- Monitor in a recovery room or intensive care unit for the first 24 hours.
- Gradual return to regular activities over 1-2 weeks.
- Follow-up appointments to ensure proper graft positioning and function.
- Avoid heavy lifting or strenuous activities for a few weeks.
Alternatives
Open surgical repair, which involves a larger incision and longer recovery.
- Pros: More durable, less chance of needing further procedures.
- Cons: Higher risk, longer hospital stay, and greater recovery time.
Medical management including blood pressure control.
- Pros: Non-invasive, avoids surgical risks.
- Cons: Does not repair the aneurysm or dissection, ongoing risk of rupture.
Patient Experience
During the procedure, the patient is sedated or under anesthesia, so they should not feel pain. Post-procedure, moderate discomfort at the incision site is common but manageable with pain medication. Most experience a significant improvement in symptoms and overall health within a few weeks.