CPT® Code 33886

The CPT® Code 33886 refers to the procedure involving the delayed placement of a distal extension prosthesis following an endovascular repair of the descending thoracic aorta. This procedure is typically indicated when complications arise from the initial repair, such as the presence of an endoleak, which is a condition where blood leaks back into the aneurysm sac, or when there is migration of the endovascular components that poses a risk of developing an endoleak. Additionally, it may be necessary when there is an extension of the aneurysm distally. The procedure begins with the puncture of an access artery, commonly the femoral or iliac artery, through which a flexible guidewire is introduced in a retrograde manner into the ascending aorta, utilizing fluoroscopic guidance that is reported separately. This is followed by puncturing the contralateral femoral or iliac artery, placing a sheath, and advancing a second guidewire into the ascending aorta. An aortogram is then performed to evaluate the aneurysm, and an ultrasound probe is used to measure the distal extension site. The selection of a properly sized stent-graft extension prosthesis is crucial for the success of the procedure. The flexible guidewire is exchanged for a stiffer one, and the sheath is replaced with an introducer sheath to facilitate the loading and positioning of the stent-graft extension prosthesis. After deploying the prosthesis, the overlapping segments are ballooned and sealed to ensure a secure fit, and additional segments may be added as necessary. The procedure concludes with another aortogram to confirm the complete exclusion of the defect in the descending thoracic aorta and to check for any potential leakage.