Name of the Procedure:

Placement of Proximal or Distal Extension Prosthesis for Endovascular Repair of Infrarenal Aortic or Iliac Artery Aneurysm, Pseudoaneurysm, or Dissection (EVAR with Extension Prosthesis)

Summary

This procedure involves placing a stent graft extension within the blood vessels of the abdomen or pelvis to reinforce weak areas in the aorta or iliac artery. It is done using minimally invasive techniques with radiological guidance to treat conditions such as aneurysms, pseudoaneurysms, or artery dissections.

Purpose

The procedure aims to prevent the rupture of aneurysms or pseudoaneurysms, restore proper blood flow, and repair artery dissections in the infrarenal aorta or iliac artery. By placing the extension prosthesis, the weakened sections of the artery are strengthened, reducing the risk of potentially life-threatening complications.

Indications

• Presence of an infrarenal aortic or iliac artery aneurysm or pseudoaneurysm.
• Dissection of the aorta or iliac artery.
• Enlargement or growth of a known aneurysm.
• Symptoms such as abdominal or back pain, or evidence of compromised blood flow.

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Medication adjustments may be necessary, particularly for blood thinners.
• Pre-procedure imaging tests such as CT scans or MRIs may be required to plan the intervention.

Procedure Description

1. The patient is given local or general anesthesia.
2. A small incision is made, usually in the groin area.
3. A catheter is inserted through the incision and guided to the affected area using fluoroscopy (live X-ray imaging).
4. The stent graft extension is delivered through the catheter to the site of the aneurysm or dissection.
5. The prosthesis is deployed, expanding to fit the arterial walls and creating a new pathway for blood flow.
6. Radiological imaging ensures proper placement and function of the graft.
7. The catheter is removed, and the incision is closed.

Tools and equipment include catheters, a stent graft extension, fluoroscopy machines, and contrast agents for imaging.

Duration

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

Setting

This procedure is usually performed in a hospital's interventional radiology suite or operating room.

Personnel

• Interventional radiologist or vascular surgeon
• Nurses specialized in interventional procedures
• Anesthesiologist or nurse anesthetist
• Radiologic technologist

Risks and Complications

• Infection at the entry site
• Bleeding or hematoma formation
• Damage to blood vessels
• Stent graft migration or misplacement
• Contrast-related kidney complications
• Blood clots

Benefits

• Minimally invasive with a quicker recovery time compared to open surgery.
• Effective in preventing aneurysm rupture and managing artery dissections.
• Improved blood flow and reduced symptoms shortly after the procedure.

Recovery

• Patients may need to stay in the hospital for 1-2 days for observation.
• Post-procedure instructions include wound care, activity restrictions, and medication management.
• Regular follow-up imaging to monitor the stent graft's position and function.
• Most patients can resume normal activities within a week, but heavy lifting and strenuous exercise should be avoided for several weeks.

Alternatives

• Open surgical repair of the aneurysm or dissection, which involves a larger incision and longer recovery.
• Medical management with regular monitoring and medication, suitable for patients not fit for surgery.
• Pros of alternatives include avoiding surgery and its immediate risks, but may have longer-term risk of aneurysm rupture.

Patient Experience

During the procedure, patients are either asleep or sedated, so discomfort is minimal. After the procedure, there may be mild discomfort or bruising at the incision site, managed with pain medication. Patients should expect some monitoring post-procedure, with regular follow-ups to ensure the stent graft remains in place and functions well.