CPT® Code 34703

Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the iliac bifurcation; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer)

The CPT® Code 34703 refers to the endovascular repair of the infrarenal aorta and/or iliac artery(ies) utilizing an aorto-uni-iliac endograft. This procedure is designed to address vascular conditions such as aneurysms, pseudoaneurysms, dissections, or penetrating ulcers, specifically when there is no rupture present. The endograft is a sophisticated medical device made from a non-permeable polyester material, which is reinforced by a self-expanding flexible metal frame. This design allows the endograft to taper gradually from the aortic attachment site down to the iliac artery attachment site, facilitating a secure fit within the vascular structure. During the procedure, a guidewire is introduced into the abdominal aorta, typically via the femoral artery or the distal external iliac artery. The endograft is then carefully positioned over the guidewire, with fluoroscopic guidance ensuring accurate placement. The deployment of the endograft involves a partial expansion, where the upper portion is positioned proximally to the non-aneurysmal aortic neck and distally to the iliac artery. A balloon catheter is subsequently used to expand the graft against the vessel wall, ensuring a tight seal from the proximal to the distal end. In cases where there is a rupture, rapid intervention is crucial to control hemorrhaging. If the endograft cannot be deployed quickly enough, a balloon occlusion device may be inflated in the aorta proximal to the rupture site to manage blood flow. Additionally, the placement of the aorto-uni-iliac endograft necessitates the occlusion of the contralateral common iliac artery using an endovascular device, along with the restoration of blood flow to the lower limb through a conventional femoral-femoral crossover bypass graft. This comprehensive approach aims to stabilize the vascular condition and prevent further complications.