CPT® Code 33884

Add-On Code

Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); each additional proximal extension (List separately in addition to code for primary procedure)

The CPT® Code 33884 refers to the placement of a proximal extension prosthesis specifically for the endovascular repair of the descending thoracic aorta. This procedure is indicated for various conditions affecting the aorta, including aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions. The endovascular approach involves accessing the aorta through a puncture in an artery, typically the femoral or iliac artery, allowing for the insertion of a flexible guidewire. This guidewire is navigated retrograde into the ascending aorta, often with the assistance of fluoroscopic guidance, which is a separate reportable service. In some cases, access through the brachial artery may also be necessary to facilitate the placement of the proximal extension components. Once access is established, a sheath is placed in the contralateral femoral or iliac artery, and a second guidewire is advanced into the ascending aorta. An aortogram is performed to evaluate the proximal aspect of the aneurysm, and an ultrasound probe is used to measure the proximal extension site. A stent-graft extension prosthesis is then selected based on these measurements. The procedure involves exchanging guidewires and sheaths to prepare for the deployment of the stent-graft extension prosthesis, which is carefully maneuvered into position. After verifying the correct placement with another aortogram, the prosthesis is deployed, and the overlapping segments are ballooned and sealed to ensure a secure fit. The final step includes obtaining another aortogram to confirm the complete exclusion of the defect in the thoracic aorta and to check for any potential leakage, ensuring the success of the procedure.