CPT® Code 0078T

Deleted

1. Indications

The endovascular repair using prosthesis of abdominal aortic aneurysm, pseudoaneurysm, or dissection is indicated for the following conditions:

• Abdominal Aortic Aneurysm - A localized enlargement of the abdominal aorta that poses a risk of rupture.
• Pseudoaneurysm - An abnormal bulging in the arterial wall that can occur due to trauma or infection.
• Aortic Dissection - A serious condition where there is a tear in the inner layer of the aorta, leading to separation of the layers of the aortic wall.
• Involvement of Visceral Branches - Cases where the aneurysm or dissection extends into the visceral branches, specifically the superior mesenteric artery, celiac artery, and/or renal arteries.

2. Procedure

The procedure for endovascular repair involves several critical steps to ensure successful placement of the prosthesis:

• Step 1: Incision and Access - A small incision is made in the groin area over the femoral artery to gain access to the vascular system. This access point is crucial for the introduction of the necessary instruments.
• Step 2: Guide Wire Placement - A trocar is inserted into the femoral artery, and a guide wire is advanced through the external and common iliac arteries into the aorta. This guide wire serves as a pathway for subsequent instruments.
• Step 3: Navigating the Aneurysm - The guide wire is carefully advanced through the aneurysm to a point just above the renal arteries, ensuring that the prosthesis can be positioned correctly.
• Step 4: Introducer Sheath Advancement - An introducer sheath containing the compressed aorto-uni-iliac or aorto-unifemoral prosthesis is advanced over the guide wire and positioned in the aorta. The proximal edge of the prosthesis is placed below the visceral arteries but above the top of the aneurysm defect, while the distal edge is positioned below the bottom of the defect in either the iliac or femoral artery.
• Step 5: Deployment of the Prosthesis - The prosthesis is deployed under fluoroscopic guidance, beginning with the aortic portion. Once the aortic section is deployed and coverage of the aneurysm is confirmed, the iliac and femoral portions are deployed. Correct placement is verified using fluoroscopy.
• Step 6: Balloon Catheter Introduction - After the introducer sheath is removed, a balloon catheter is introduced and expanded to secure the proximal and distal ends of the prosthesis in place.
• Step 7: Angiography - A pigtail or sidehole catheter is introduced over the guide wire, and angiography is performed to evaluate the position of the endograft, patency of the renal and hypogastric arteries, and to check for any endoleaks. The patency of the lumbar and inferior mesenteric arteries is also assessed.
• Step 8: Closure - Finally, all catheters and guide wires are removed, and the incision in the groin is closed, completing the procedure.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications, such as bleeding or infection at the incision site. Patients may be observed for signs of endoleaks or other vascular complications through follow-up imaging studies. Recovery typically involves a shorter hospital stay compared to open surgical repair, with many patients able to resume normal activities within a few weeks. It is essential for patients to follow their physician's instructions regarding activity restrictions and follow-up appointments to ensure proper healing and monitoring of the prosthesis.